ADA and AAHP join hands to combat complications
Aggressive 10-year plan targets doctors, patients
Common causes makes strange bedfellows. Now the driving mission to contain the devastatingly destructive — and costly — complications of diabetes has brought together organizations that are often adversaries: the American Diabetes Association (ADA) and the American Association of Health Plans (AAHP), a huge combination representing more than 1,000 managed care companies with nearly 150 million Americans enrolled.
The early stages of the initiative promote screening, early intervention, and state-of-the-art treatment for those populations served by managed care companies.
Because many diabetes advocates see managed care as the bogeyman, "It is an unusual alliance," admits Peter Fitzgerald, MSc, AAHP’s director of outcomes research in Washington, DC. "We think it’s historic in that we are partnering with a consumer organization to address a chronic illness. It’s unprecedented for us."
Gerald Bernstein, MD, president of the ADA, notes, "The ADA is not an advocate for anybody except people with diabetes. "Sometimes on the professional level, it becomes a little confusing," he adds, "but here is an opportunity to work with a group that delivers care to the population as a whole. If we can get care delivered to the diabetic population in the right way, then it’s the right thing."
At the launch of the initiative in late October, Bernstein said the alliance was an unprecedented effort in terms of its scope and potential to fight the disease and improve the quality of life for people with diabetes. "To steal a basketball analogy," he said, "it amounts to a full-court press against diabetes and its consequences."
AAHP officials hope the power of the managed care plans and the expertise and community presence of the ADA will change the face of diabetes management in terms of "quality of care and quality of life for people with diabetes throughout the country."
The 10-year "Taking on Diabetes" initiative calls for:
1. reducing the incidence of irreversible vision loss by 40% through early detection and intervention;
2. reducing the development of end stage renal disease by 30%;
3. reducing the incidence of new foot ulcers by 50%;
4. reducing the number of foot amputations by 40%;
5. reducing the risk of cardiovascular disease associated with diabetes.
To date, approximately one-fourth of AAHP’s member plans representing more than 75 million people (four million diabetics) have signed on to participate in the largely unstructured drive that targets what Fitzgerald calls "real benefits in terms that would be meaningful for people with diabetes."
"We didn’t talk about HbA1c levels, the control of which is a means to avoid complications," he explains. "We talked about the complications themselves. Our end results are very much what we want for people with diabetes to experience: a higher quality of life than they might otherwise have. We want them to retain their vision. We want them to retain their limbs. We want them to avoid end stage renal disease and not to experience cardiovascular disease. Our end results are very much aimed at consumers."
There is no prescribed formula for AAHP’s managed care companies to follow other than ADA guidelines. Fitzgerald says each company implements its diabetes management plan as it sees fit, with guidance from AAHP. "We are looking at identifying best practices. We are looking at what kind of programs have actually worked to move the delivery of care and to move patients in the right directions so they can avoid these complications."
In addition, he says, AAHP plans to form a communitywide network of plans and subscribers "so we won’t have patients floating in and out of networks that provide the kind of care they need, so we’ll be able to provide consistency of care" and bring education programs to the workplace to target undiagnosed diabetics.
Experts are beginning to perceive a sea change in the attitude of managed care toward diabetics as study after study shows the long- and short-term benefits not only of glycemic control, but of diligence toward screening. "They know they’ll save money through prevention," Bernstein says. "They are beginning to see the short-term savings just by keeping people out of the hospital."
For its part, AAHP is soft peddling the concept of saving money through prevention, declining to estimate how much money can be saved by early diagnosis and prevention of complications. "We haven’t approached it in that way," Fitzgerald says. "We know there are complications associated with diabetes that can be reduced, and we aim to reduce them."
For further information, contact: the ADA at (703) 549-1500 or the AAHP at (202) 778-3200.
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