Diabetes Care Process

Charter

At Select Health Alliance, our primary goal is to lessen the impact of diabetes in our population. For those patients diagnosed with diabetes, we encourage the early identification of risk factors, the pursuit of education, and increasedengagement with preventive measures.

Diabetes Facts

• Prevalence is 12% in ages 18 or older
• $245 billion: Total costs of diagnosed diabetes in the United States in 2012
• 85.2% of people with type 2 diabetes are overweight or obese
• A person with diagnosed diabetes at age 50 dies 6 years earlier than a counterpart without diabetes
• 37% of U.S. adults aged 20 years or older have prediabetes

Opportunity

• 1600 per 24,000 of members are known T2DM
  • Prevalence 6.6%
  • Benchmark prevalence 12.7%
• 1050 have T2DM without CAD
  • Total pmpm spend is $849.71 ($581.17 medical, $268.54 Rx)
    • Annual paid >$10,000,000
  • Benchmark pmpm spend is $306.77 ($265.50 medical, $50.27 Rx)
    • Benchmark paid $4,000,000
  • Savings opportunity $6,000,000

  Savings for managing patients with T2DM and CAD or other secondary diseases is not calculated, but improvement in care and expense is anticipated via SHA disease management and care coordination.

  Definition of Terms and Criteria

  AACE: American Academy of Clinical Endocrinology

  Obesity: BMI >34, plus 2 or more risk factors for diabetes and HgbA1C <5.7.

  Pre-diabetes: 2 or more risk factors for T2DM and HgbA1C 5.7-6.4.

  Diabetes: HgbA1C >6.5.

  Inpatient Hyperglycemia: Baptist One Care registry will capture these patients for coordination of care after discharge. Immediate DMMR identification during hospitalization facilitates patient engagement.