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New York Business Group on Health: Getting the Best in Diabetes Treatment for Your Employees NYSHealth Diabetes Campaign Provider Quality Incentives for Diabetes. July 28, 2010 New York, NY. Diabetes Epidemic is Growing. 1.1 million New Yorkers diagnosed with diabetes

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july 28 2010 new york ny

New York Business Group on Health: Getting the Best in Diabetes Treatment for Your Employees NYSHealth Diabetes CampaignProvider QualityIncentives for Diabetes

July 28, 2010

New York, NY

slide2

Diabetes Epidemic is Growing

  • 1.1 million New Yorkers diagnosed with diabetes
  • 760,000 have it and don’t know it
  • Up to 4.2 million adults with pre-diabetes
slide3

Diabetes Epidemic is Costly

  • People with diagnosed diabetes incur average medical expenditures of $11,744 per year with $6,649 attributed to diabetes. People without diabetes incur average medical expenditures of $5,095 per year.*
  • The total cost for New Yorkers with diabetes was almost $12.9 billion in 2006.
    • This includes excess medical costs of approximately $8.7 billion
    • Lost productivity valued at $4.2 billion.**

* American Diabetes Association. Economic Cost of Diabetes in the U.S. in 2007. Diabetes Care. 2008; 31:1-20

** American Diabetes Association: Diabetes Cost Calculator. Available at http://www.diabetesarchive.net/advocacy-and-legalresources/cost-of-diabetes-results.jsp?state=New+York&district=0&DistName=New+York+%28Entire+State%29. Accessed 7/7/2010

slide4

NYSHealth Diabetes Campaign

  • $35 million, five year campaign to reverse the diabetes epidemic in New York
slide5

NYSHealth Diabetes Campaign

  • Improving Clinical Care
    • Spreading clinical best practices at community health centers, hospital OPDs, and private physicians
      • 3000 primary care providers recognized under NCQA or BTE’s diabetes programs
  • Mobilizing Communities
    • Supporting community-based diabetes prevention, screening, and management strategies
  • Promoting Policy
    • Conducting analyses and advocacy to support payment policies that sustain comprehensive, coordinated care for diabetes patients
    • Supporting community-based policy strategies
      • e.g., increasing availability of nutritious foods and recreation spaces
slide6
Encourage health plans to offer and align financial incentives that motivate physicians and practices to improve outcomes for patients with diabetes

Many health plans do not currently have financial incentive programs

Existing incentives program design varies greatly – different measures, different reporting, different rewards = confusing and burdensome to providers

Provider Quality Incentives

slide7
Our strategy: Diabetes Incentive Program Endorsement

Public recognition from NYSHealth of effective incentive programs

Based on a set of principles

Based on evidence from the field

Includes a minimum core set of diabetes outcome measures that are tightly linked to patient risk reduction

Using the endorsement as a lever to get plans to offer incentives and align incentive programs across plans

Endorsed plans get public recognition, technical assistance to create and improve incentive programs, and eligibility to apply for an upcoming RFP

slide8
Use minimum core outcome measures that are tightly linked to patient risk reduction

Use nationally endorsed measures

Reward quality regardless of “efficiency”

Reward improvement in performance as well as achievement of certain quality goals

Endorsement Principles

slide9

Endorsement Principles

  • Make incentives meaningful to physicians
    • Pay “enough”
    • Pay incentives across all product lines
  • Recognize that more effort demands greater incentives
  • Leverage existing initiatives to reduce physician reporting burden
  • Engage plan members in better self-management and adherence
core diabetes measures
Core Diabetes Measures

Poor Control Measures

HbA1c > 9.0

Blood Pressure ≥ 140/90

LDL ≥ 130mg/dl

Superior Control Measures

HbA1c < 7.0 & < 8.0

Blood Pressure < 130/80

LDL < 100mg/dl

payer response to date
Payer Response To Date

Four plans endorsed

Empire BCBS – new program!

Monroe Health Plan for Medical Care – new program!

Hudson Health Plan

CDPHP

Two have agreed to establish programs and are getting assistance in designing them for a 2010 launch

Health Plus

Health First