How does this proactive approach improve outcomes?
The new initiative went into effect in the last quarter of 2007. We focused on people with very high blood sugar levels. In medical terminology, that is defined as people who have a Hemoglobin A1c level greater than 9 — that means their blood sugar level is very much out of the desired range.
We measure year to year what percent of the diabetic population has an A1c greater than 9. In 2007, 24 percent of our diabetic members had an A1c level higher than 9. In 2008 and 2009, that number was reduced to just about 15 percent — more than a 30 percent improvement. Lower is better in this measurement; it shows more people have better control of their blood sugar.
Because diabetes is more than just blood sugar, we have to carefully control blood pressure and cholesterol as well. From 2006 to 2008, there were also significant improvements that occurred in the degree to which blood pressure and cholesterol were brought under control in our diabetic membership.
Why should employers care about PCM?
One more outcome to this activity, besides the improvements in blood sugar, blood pressure and cholesterol, is that we’ve also seen a reduction in the number of hospitalizations that have occurred from diabetic complications from 2007 to the present.
That is of interest for employers, because it keeps employees out of the hospital and functioning at a more healthy level, which results in greater productivity and less absenteeism.
If we can keep diabetics out of the hospital for complications, we can reduce health care costs. It’s a win-win for employers. It’s been well demonstrated in scientific medical research that if a health care system can improve blood sugar, blood pressure and cholesterol control, many of the cardiac complications of diabetes, which are the most feared, can be prevented. That is really what this program is about — trying to prevent complications of diabetes.
How can PCM keep your employees healthy and productive at work?
One important PCM function is that it occurs outside of the setting of a traditional doctor’s office visit. For example, a patient may be so busy at work and with family life that they don’t have time to come in and see the doctor, even if they have a chronic condition like diabetes. The PCM function we’ve described identifies those members even though they haven’t come in for a doctor’s visit in some time, and allows us to proactively reach out to them to remind them that they are in need of certain treatments to stay healthy.
Dr. Mark A. Roth is a physician adviser for the population care department of Kaiser Permanente. Reach him at (440) 786-8296 or [email protected].
