Blue Cross Blue Shield of North Dakota-Changing Incentives to Promote Better Care

Patient Centered Medical Home: Diabetes Management

Improved Compliance, Lower Costs & Fewer ER Visits and Hospitalizations

Blue Cross Blue Shield of North Dakota partnered with providers to implement an innovative, patient-centered, diabetes management pilot based on performance measures recommended by the American Diabetes Association (ADA) that rewards physicians for delivering coordinated care in order to improve health outcomes.  Disease management nurses are assigned to diabetic patients through a medical practice which serves as the member's "medical home."

Diabetes affects approximately 6 percent of the U.S. population and a similar percentage in North Dakota.  Medical expenses for this population are two and a half times greater than non-diabetics -- costing the nation an estimated $92 billion in 2002.

In 2006, the second year of this pilot, BCBS of ND was able to save its members an average of $1,200 per patient, primarily from reduced emergency room visits and hospitalizations.  This pilot is demonstrating how the patient-centered medical home can improve quality and outcomes while reducing overall costs, which in turn, can help make health care more affordable.

Program Design and Goals

The effective management of diabetes requires patients to have regular screenings to monitor their disease and prevent harmful complications. National studies have shown that preventive screenings have a direct impact on health care utilization, such as reduced hospital admissions and shorter hospital lengths of stay, saving as much as $600,000 per 1,000 members in the first year.¹

Designed to improve the quality and management of care and make care more affordable, the North Dakota diabetes program focuses on:

• Review of patient history by the care team;
• Development of a care plan;
• Tracking of care needs;
• Educating patients on self-management techniques; and
• Ongoing communication with the Disease Management Nurse (DMN) to ensure medication adherence, preventive testing and better self management.

Through adherence to the key components of the disease management program outlined above, BCBS of ND aimed to:

• Reduce inpatient admissions;
• Reduce emergency department visits;
• Increase patient compliance with diabetes guidelines;
• Improve patient self-management skills; and
• Reduce future health care costs.

Results

BCBS of ND compared member data from before and after the pilot to determine the results.  Program success was recorded according to a number of preventive ambulatory measures, including:

• Percentage of members with A1C blood sugar levels below 7.0;
• Percentage of members with LDL levels below 100 mg/dl;
• Percentage of members with blood pressure below 130/80mmHg;
• Percentage of members who were tobacco-free;
• Percentage of members, aged 40-75, on aspirin therapy.

The following chart illustrates the diabetes management program is improving care and lowering costs. 

1. Rubin, R.J.; Dietrich, K.A.; Hawk, A.D. (1998). Clinical and Economic Impact of Implementing a Comprehensive Diabetes Management Program in Managed Care. Journal of Endocrinology & Metabolism, 83(8), 2635-2642.