Diabetes Care: 15% In 2007 the population for the Diabetes QI Glucose meters were offered to members identified with a diagnosis of diabetes free of charge …

2007 DIABETES QI FUND PROJECT
The purpose of the HMO Diabetes QI Fund Project is to improve the quality of diabetes care by increasing the percentage of physicians who provide recommended diabetes services and track diabetes care using diabetes flow sheets or electronic medical records The 2007 goals for the diabetes indicators were: HbA1c Control 70: Establish baseline Eye Exam: 50 LDL-C Control 100 mg/dL: 50 Blood Pressure control 140/90: Establish baseline Blood Pressure control 130/80: Establish baseline Screening for Depression: 55 Medical Attention for Nephropathy: 65 Overall Diabetes Care: 15 In 2007 the population for the Diabetes QI Fund Project increased by more than 10,000 members, resulting in a 50 increase by incorporating IPA encounter data This additional data source identified newly diagnosed members, members who may have been diet controlled, and those members who only had episodic visits to PCP The 2003-2007 Network results are outlined in the following table Diabetes Indicator HbA1c Testing HbA1c Control 90 HbA1c Control 70 Eye Exam LDL-Cholesterol 130 mg/dL LDL-Cholesterol 100 mg/dL Blood Pressure Control 140/90 Blood Pressure Control 130/80 Screening
for Depression Medical Attention for Nephropathy 2004-2006 Overall Diabetes Care: HbA1c 90 Eye exam LDL 130 mg/dL Medical Attention for Nephropathy 2007 Overall Diabetes Care HbA1c 70 LDL 100 mg/dL Medical Attention for Nephropathy 2003 73 14,084/19,272 N/A N/A 44 8,404/19,272 60 11,467/19,272 37 7,140/19,271 N/A N/A N/A N/A N/A 2004 78 15,335/19,664 65 12,738/19,664 N/A 50 9,790/19,664 68 13,328/19,664 44 8,591/19,661 N/A N/A 29 5,386/18,580 N/A N/A 2005 81 15,381/18,895 68 12,905/18,895 N/A 52 9,858/18,895 74 14,020/18,895 51 9,609/18,895 N/A N/A 49 8,543/18,895 66 12,476/18,895 30 5,729/18,895 2006 86 16,201/18,862 71 13,454/18,862 N/A 58 10,923/18,862 76 14,301/18,862 51 9,615/18,862 N/A N/A 58 10,222/17,647 75 14,182/18,862 36 6,762/18,862 2007 N/A N/A 39 11,369/29,036 56 16,147/29,036 N/A 46 13,454/29,036 62 18,125/29,036 32 9,169/29,036 57 15,630/27,252 74 21,443/29,036 N/A

N/A

20 5,850/29,036

Identified Barriers to Diabetes Care: Members: May not be aware of importance of diabetes management in reducing the risks of complications May not be aware of national recommendations for diabetes care May not be aware that diabetes services ie, eye exam,
glucose meter supplies, etc are a covered benefit May be non-compliant with PCP recommendations May not seek routine care Physicians: May lack systems to promote recommended diabetic care for members May not provide care in accordance with BCBSIL Diabetes guideline May find it challenging to cover all the diabetes care services when members are coming in only for acute care IPAs:

May find it difficult to motivate physicians to utilize flowsheets or track services in electronic medical records EMR May find it difficult to get practitioners to routinely screen members with diabetes for depression

Interventions Implemented to Address Identified Barriers: Members: Provided online resources, including Personal Health Manager and Ask a Nurse Educational materials were distributed to members identified with a diagnosis of diabetes through quarterly reminder cards The topics covered in 2007 and the number of members who received the information are summarized in the following table 2007 Healthy lifestyle Diabetes and Kidney Disease Hypertension Glucose monitoring and meter offer with diabetes program description High Strata mailing: Preventive Care Kidney Disease Number of
Members 29,954 34,511 31,032 29,692 4,722

Glucose Meter Program: Glucose meters were offered to members identified with a diagnosis of diabetes free of charge through a special mailing The numb er of meters distributed in 2007 is summarized below 2007 Number of Members Total Number of Glucose Meters Distributed 2,149 Physicians/IPAs: A Diabetes Blue Star was awarded to IPAs meeting at least four of seven payment thresholds A QI Fund payment was made to IPAs with project results that met or exceeded established thresholds The BCBSIL Guidelines for the Prevention and Early Detection of Complications of Diabetes Mellitus were made available to all network physicians A sample flowsheet for tracking diabetes care is available on the Provider section of wwwbcbsilcom Quality Improvement staff conducted educational trainings for IPAs as requested The Diabetes QI Project was completed with the QI Fund paid Feedback provided to the IPAs included IPA results, patient specific reports and network results The IPA HMO QI Fund Training was conducted in March 2007 The Quality Improvement staff hosted quarterly QI Forums
2

The criteria for three indicators from the 2007 Diabetes QI Fund
Project became more stringent and results are not trendable There was one new indicator, Blood Pressure Control; these results are baseline data Goals were met for seven of the eight indicators LDL-C 100 mg/dL was slightly below the goal of 50 at 46 2007 HEDIS results 2006 reporting year

Diabetes Program
Condition Management

Diabetes Program Objective:
Promote improvements in diabetic care by encouraging physicians to track and trend diabetes care on a flowsheet, which can help members manage their condition

Screenings increased

Decrease
of poor control rate is desired

Improvement

18
28

2000 - 2006 HbA1c Screening Rate

2000 - 2006 HbA1c Poor Control Rate

Screenings increased

44
81

Screenings increased

13
85

Improvement

12
44

000 - 2006 Nephropathy Screening Rate
March 19, 2008

2000 - 2006 LDL Screening Rate
Experience Wellness Everywhere

2003 - 2006 LDL-C Control Rate 100 mg/dl
Source: HEDIS data

In 2007, a sub-analysis was done for a cohort of diabetic members who had diabetes claims each year from 2002 to 2006 and who were included in the diabetes project each year from 2003 through 2006 There were significant improvements in each
of the diabetes quality indicators from 2003 to 2006 for this cohort of members The Diabetes QI Fund Project has stimulated improvements in quality that are associated with lower utilization and improved the quality of care for members with diabetes The current analysis has shown that the cohort of diabetic members with most consistently managed diabetes in terms of: HbA1c control 9 in all 4 years 2003 2006, LDL control 130 mg/dL in all 4 years 2003 2006 and Overall Diabetes Care in 2 years 2005 2006 have a 27 to 47 lower likelihood of an ER visit and a 22 to 28 lower likelihood of a hospital admission, compared to those who were not controlled in any of the four years The following slide depicts the 5-Year Outcomes from this sub-analysis

Diabetes Program
Outcomes

Outcomes:
For the 9,993 diabetic patients enrolled each year from 2002-2006, those whose diabetes was more consistently controlled achieved better health outcomes

20 15 10 5 0

17 14 11 10

Percentage of Diabetic members with One or More ER Visit in 2006

0 Years

1 Year

2 Years

3 Years

4 Years

of Years Controlled

Relationship Between Frequency of HbA1c Control and Diabetes Inpatient
Admissions
Rate per 1,000 Asthmatics
175 165 155 145 135 125 115 105 95

167 146 145 110 101
2002 2003 2004 2005 2006

0 Years 1 Years 2 Years 3 Years 4 Years