NBCH's annual report: How America's health plans are doing to improve care and control costs for diabetes

Today the National Business Coalition on Health (NBCH) issued its annual report on how America's health plans are doing to improve care and control costs for diabetes. The analysis is based on health plan survey data from NBCH's eValue8™ program, the nation's leading Request for Information (RFI) tool used by employers, coalitions and their purchaser members to set expectations and measure health plan performance.

"eValue8 is an excellent example of employers and coalitions working with health plans in their community to move the health care reform agenda forward," said Andrew Webber, president and CEO of NBCH. "By focusing on the management of chronic conditions such as diabetes, we are working to move the health delivery system away from demand management and cost-shifting, to one that promotes health, prevents illness, coordinates care delivery, and ultimately addresses the factors driving up costs."

The publicly available report, "2009 Health Plan Diabetes Performance," outlines important treatment goals for diabetes and the approaches plans are using to prevent the disease and improve its care. With health care reform on the horizon and the inexorable movement towards electronic health information systems, coalitions and employers hope to see an acceleration of activities that stem the tide of new diabetes cases and prevent the devastation and increasing costs of improperly managed disease.

eValue8 report findings

The findings indicate that health plans are moving forward on diabetes quality efforts, but there have been no major transformations in approaches or outcomes.

• Overall diabetes quality indicators continue to improve slowly. Health plans report that 80% of diabetics have at least an annual hemoglobin A1C test, an important indicator, and an annual cholesterol screening. Still, one-third of patients have uncontrolled blood sugar. eValue8 sets a standard that plans should leverage their information about gaps in care (e.g. informing doctors which of their patients failed to take a necessary test), but more fundamental changes need to take place in order to motivate physicians and consumers if we want outcomes like lab results to improve.
• Virtually all health plans offer a personal health assessment (PHA) to identify people with or at risk for diabetes, and some proactively search for members with diabetes using claims and other data sources. However, PHA use and uptake is far from universal by members of employers; only 3% of members respond to the PHA, and not all employers offer it through their plan. Plans do offer to administer incentives for PHA completion, but the onus is more on the employer to improve completion rates.
• Plans continue to work with physicians to help them overcome shortcomings in physician information management systems and identify gaps in care: 95% of health plans indicate they report back to physicians on gaps in care, 70% of plans can now show physicians how they compare with their peers, and 35% of plans offer financial rewards or incentives to physicians to adopt electronic health systems.
• Plans are also making progress in helping members identify and select the better quality physicians, but this capability is still low. Less than 20% offer a lower copay, deductible or premium to members who choose a high quality primary care doctor and less than half have any financial rewards to patients for selecting higher quality specialty physicians, where the health stakes are even higher. For most plans, performance differentiation at the physician practice level demands inter-plan collaboration to reach the level of information necessary to adequately portray all practices in a community.
• Value-based benefit design continues to gain traction as a means to encourage members to use essential medications and treatments for chronic disease. In 2008 48% of plans had capability to waive copays for first time prescriptions and equipment for diabetes. For maintenance medications in 2009 57% of plans could alter the copay as an incentive. 73% of plans have capability to reward members for using the PHA to identify and control risk factors.

Health plans from across the U.S. submit performance data around clinical quality and administrative efficiency. In 2009 the information was used by 13 employer purchasing coalitions as well as large, national employers and other purchasers to negotiate pricing, determine employee premiums and launch programs to improve treatment of costly chronic health conditions such as diabetes, asthma and cardiovascular disease. Over 96 million Americans, or about two-thirds of those insured by employers, are members of the more than 70 health plans that responded to the eValue8 survey. The report was developed with support from sanofi-aventis.