Case study demonstrates positive impact of diabetes management program

A case study published in the current issue of the American Journal of Health-System Pharmacists, demonstrates the positive impact of a diabetes management program designed to educate and motivate members to engage in their health care.  The program was implemented by CVS Caremark (NYSE: CVS) and Polk County, Florida, a self-insured government employer client.  After one year, the Polk County Contract for Care program resulted in improvements in key clinical measurements for enrolled members – decreased glycosylated hemoglobin (HbA(1c), a critical measurement of blood sugar levels) and lowered blood pressure levels – while also reducing emergency room visits and in-patient hospital admissions.

"Enabling members with diabetes to achieve optimal management of their underlying disease, as well as other related conditions such as high blood pressure, is critical to improving their health outcomes," said Troyen Brennan, M.D., M.P.H., Executive Vice President and Chief Medical Officer, CVS Caremark.  "As the prevalence of diabetes continues to rise, it is critical that these patients are educated about the impact of their disease and presented with tools and programs to help actively engage them in their health care."

Polk County implemented the Contract for Care program in February of 2005.  The program is designed to engage members as active participants in managing their health and requires members to be accountable for components of their care.  Enrolled Polk County employees agree to work with the CVS Caremark clinical pharmacist, located on-site at the County's employee health clinic, to develop individualized care plans and coordinate regular follow-up.  Enrolled members receive co-pay waivers on disease-related medications (generic and preferred brands) as well as related supplies and non-prescription products.

"We wanted to implement a program that would incentivize our employees living with chronic diseases such as diabetes to take an active role in their health care in order to improve their overall health," said Michael Kushner, Director, Risk Management, Polk County Government.  "Through our partnership with CVS Caremark we have seen positive results that reflect both improved health outcomes for our employees as well as cost savings for both enrolled employees and the overall plan."

At the end of the first year of the program 477 members were enrolled and were included in the analysis. The study's primary outcome was the change in clinical values for HbA(1c).  Secondary outcomes included changes in utilization metrics such as all-cause hospitalization, ER visits and blood pressure values. After one year the reduction in HbA(1c) values was especially high among members in the critical risk group, with nearly 78 percent of these members achieving a significant HbA(1c) reduction.  In addition mean systolic blood pressure decreased six points (from 134 Hg to 128 Hg) and mean diastolic blood pressure decreased four points (from 81 Hg to 77 Hg).  Medical claims data also revealed a 30 percent decrease in all-cause hospitalizations and a 24 percent decrease in ER visits for enrolled members.

"These positive results provide compelling evidence about how the efforts of a motivated employer like Polk County combined with strategies to engage and educate members can make a difference in managing a chronic disease such as diabetes," said Dr. Brennan.  "The success of this type of program is particularly important when you realize that only about 28 percent of people with diabetes currently achieve optimal management of their disease, which includes adherence to anti-diabetic medications as well as to other recommended therapies to treat co-morbid conditions such as high blood pressure."



The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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