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Facing the Coming Diabetes Care Tsunami: Information Technology as a Key Enabler of Change

April 10, 2016
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Two recent managed care articles point to the gaps around diabetes self-management and care management

Information technology long has been touted as a facilitator of outcomes improvement in healthcare. How that proposition might play out in the next decade is likely to be strenuously tested when it comes to helping patients/healthcare consumers manage their diabetes and prediabetes, as two recent articles in the American Journal of Managed Care online indicate.

As Mary Caffrey wrote in an AJMC article entitled “How Technology Can Bring Diabetes Prevention, Care to the Masses,” and published online on April 9, “Diabetes, by the numbers, is staggering: 29 million Americans have it; most have type 2 disease. Another 86 million have prediabetes, which means they are at risk of progressing to diabetes. Between the shortage of endocrinologists and primary care physicians swamped with newly insured patients, just seeing everyone is challenge,” McCaffrey noted. Furthermore, she noted, “That’s assuming all who need to be treated for diabetes can travel to a doctor regularly, because many cannot. So, how can the healthcare system meet this need? Technology can, and should, offer solutions for both prevention and treatment of diabetes, according to a speaker and panelists who appeared Friday at Patient-Centered Diabetes Care, presented by The American Journal of Managed Care,” she reported.

Referencing the announcement three weeks ago on the part of the federal Centers for Medicare & Medicaid Services (CMS) that it would offer the National Diabetes Prevention Program (NDPP) through Medicare, McCaffrey described a presentation at that event that was made by Mike Payne, chief commercial officer and head of medical affairs at Omada Health. Payne had expressed great enthusiasm over the CMS announcement, noting that, to date, only 1 percent of those who could benefit from the NDPP have gone through the program.

The key point here is that one-on-one behavioral counseling for diabetic and pre-diabetic patients needs to be encouraged via reimbursement incentives. What’s more, McCaffrey noted in her report, Payne had indicated that the Omada program, as successful as it had been in its “intensive counseling” focus,” would be difficult to scale up, on the kind of scale that will be needed going forward.

In a similar vein, AJMC online offered another article, “Dr. Lonny Reisman Discusses Big Data and Diabetes Care.” That article showed a short video interview with Dr. Reisman, a specialist physician and the CEO of HealthReveal, a New York City-based company that specializes in “leveraging advanced analytics and biomonitoring for early detection and diagnostic and treatment guidance to preempt the advance of disease.”

As HealthReveal’s website notes, Dr. Reisman “is Founder and Chief Executive Officer of HealthReveal. Previously, Lonny served as Aetna's chief medical officer for six years. During his tenure at Aetna he was responsible for the company's clinical strategy to improve the health of Aetna's members and helped build a better healthcare system supported by evidence-based accountability by every participant. He led healthcare system change through Aetna's clinical thought leadership, Innovation Labs, clinical policy and integrated system design.”

Responding to questions from AJMC around the topic of how diabetes care might benefit from the use of big data, Reisman said that “I think diabetes care is complex in many ways. There’s clearly an emphasis on glycemic control and, to the extent that there are risks to hypoglycemia, we’re learning, for example—there’s collaboration between Medtronic and IBM Watson—we’re learning how to predict hypoglycemia in patients at risk. There are certainly issues with poor glycemic control, severe hyperglycemia, and control of [hemoglobin] A1C. So again,” he said, “understanding what combinations of drugs work, patient preferences, where the evidence is compelling regarding other benefits of certain drugs; Jardiance is an example where we’ve seen cardiovascular outcomes improved in well-conducted trials. So there’s just so much that we can do regarding what’s effective, learning what patients are willing to do or need to do in order to improve adherence and behavior.”

Both of these articles, coming from different conceptual places, point to key elements that need to be considered going forward. As a society, the United States (along with many other societies moving in the same direction) is facing a tsunami of diabetes, with the percentage of Americans who will eventually be diagnosed with diabetes or pre-diabetes eventually becoming overwhelming. Think about it: potentially 120 million Americans needing to be care-managed and health-monitored with regard to one chronic illness? And that doesn’t even take into account the other main chronic illnesses that make up the oft-referenced “big five” of chronic diseases: congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD), and asthma.