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All-or-none diabetes system could reduce costs of care


After initial investment, approach could help reduce outpatient and professional costs while maintaining or improving outcomes, new study says.

An all-or-none diabetes care system that helps to automate the treatment of patients with type 2 diabetes may reduce long-term cost of care and improve health outcomes, according to the results of a study conducted by the Geisinger Health System published in the American Journal of Managed Care (AJMC).

Despite the availability of evidence-based guidelines for the care of patients with type 2 diabetes, variation in care remains within the healthcare system. Daniel D. Maeng, PhD, of Geisinger Center for Health Research, and colleagues recently conducted a study of Geisinger’s newly developed all-or-none diabetes system of care (DSC) to determine if exposure to the system resulted in a reduction in costs.

According to the study, the Geisinger system was redesigned to allow physicians to focus more on physician-related tasks like complex decision making and patient relationships. As part of this redesign, in 2006, it developed a DSC that included a nine-component all-or-none bundle made up of quantifiable measures of care based on commonly accepted clinical elements of diabetes care and intermediate outcome targets (ex, having HbA1c measured every 6 months and achieving an HbA1c of <7%).

The all-or-none bundle measures the proportion of patients who achieve all of the recommended measures, instead of the average or composite of the individual measures. Incentive payments are made to the primary care team based on the number of patients who achieve all of the process and intermediate outcome measures.

“In short, the all-or-none bundle system differs from typical diabetes care in that the system does not rely on diligence of individual primary care physicians (PCPs) to meet all the clinical guidelines,” Maeng told Medical Economics. “It is truly a ‘system of care’ that enables PCPs to provide the right care for every eligible patient. Moreover, it's a more advanced form of PCP performance measure, because physicians get credit for meeting all of the bundle elements.”


In this study, Maeng and colleagues used claims data to identify 1,875 members exposed to the DSC and compared them against a propensity score matched non-DSC cohort.

Looking at data from January 2006 to December 2013, they found that the total medical cost savings associated with DSC exposure was about 6.9% (P<.05) or $47 per member per month.  Savings was mostly a result of inpatient facility cost, which had a savings of 28.7% during the study period (P<.01).

The researchers did acknowledge though that during the first year of DSC exposure, there was an increase in costs, including a $20 per member per month (13%) increase in outpatient costs and a $15 per member per month (9.7%) increase in professional costs.

According to Maeng, these results were not surprising given the findings from a 2014 study also published in the AJMC that showed the DSC was associated with significant improvements in patient outcomes.

“The main contribution of the current study is that it dispels the notion that higher quality of care necessarily mean higher cost of care,” Maeng said. “In fact, it's the opposite-higher quality care can lead to savings in cost of care.”

In addition, Maeng said this system can be applied widely and is scalable. However, the DSC does require significant investment in terms of changing the workflows within a typical PCP office setting, developing and implementing the appropriate health IT infrastructure, and data mining/reporting capabilities. 

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