Week 9 – R X S T E W A R D S H I P

Moving Toward STRATEGIC RX STEWARDSHIP^™

During last week’s “R is for Results” post, we made the case that while simple metrics are a good starting point for measuring outcomes, it is important to try to move toward a longer-term goal of measuring impact. We also teased this week’s installment of our Rx Stewardship blog series and our exploration of the positive financial and clinical outcomes achieved as the result of implementing a Northwind diabetes clinical blueprint.

BACKGROUND

It would be hard to overstate the impact diabetes has had on patient lives or overall healthcare trends. As seen in the graphic below, the prevalence of diabetes continues to increase at a disturbing rate. Perhaps even more concerning is data that indicates a significant driver of this increase is the incidence of diabetes in adolescents.

    Source:  CDC. National Diabetes Statistics Report; 2020.

The cost of treating a patient with diabetes is ~ 2.3 times the cost of treating a patient without the disease. According to the most recent data available, $327 billion is spent annually to provide diabetes-related care throughout the United States. This accounts for 1 out of every 4 dollars spent on healthcare! And yet for all the resources devoted to this effort, diabetes remains a leading cause of blindness, chronic kidney disease, non-traumatic amputations and cardiovascular mortality. As prevalence increases, addressing this disease may require new or additional resources and planning.

CLINICAL BLUEPRINTS

As employers grapple with the impact of diabetes, they have become ever more interested in seeking solutions that mitigate the human and financial resource toll this disease imparts. This need was a major driver in the development Northwind’s chronic disease clinical blueprints – a road map that patients, employers and health services providers can follow to achieve more efficient medical and pharmacy resource utilization and better outcomes.  

All thirteen of Northwind’s clinical blueprints, including diabetes, provide a mechanism for removing the medical, pharmaceutical, educational and financial challenges patients face in managing a chronic disease. One important feature of the clinical blueprints is that for employers who offer a health center for their employees – the programs are designed to further incent patients to utilize the health center offering by making it a true nexus of care. In this way there is maximization of the value of the investment already being made by an employer.

Northwind has partnered with a variety of health center providers and employers to implement our clinical blueprint for diabetes. While the size of the employer, the geographic location of the employees and the work they do is highly varied, the need to support the healthcare journey for those with diabetes is very consistent.  Northwind is proud to work with our employer and health center partners in supplying subject matter expertise and additional resources to supplement their efforts. We are inspired by their commitment to better health and their willingness to try innovative approaches to care management.

RESULTS

One of the most common metrics for measuring diabetes control is Hemoglobin A1c (A1c). Not only does this lab test measure longer-term blood glucose control, it is also an indicator of the level of risk for future complications including stroke and heart attack. From the pre-program baseline through the first six months of program participation, we are seeing an average 1% reduction (12% relative reduction) in A1c. Patients who had good control of their disease have stayed in control, while those who had struggled are now experiencing remarkable results. As an example, we have seen patients lower A1c values as much as 4 percent. One longer term program patient lowered their A1c from 14.3% to 7.4%. As a point of reference – a decrease of 0.5% is typically considered clinically relevant.

The program has resulted in increases in compliance with routine foot exams and annual eye exams. Improvements in blood pressure and cholesterol control have also been noted. Emergency Department visits and inpatient hospital admissions for a diabetes-related condition are dropping.  Pharmacy and medical benefit costs have been reduced.

While this success has been tremendous, perhaps the most important outcome has been the impact on the lives of the participants. Multiple program enrollees have come forward to thank their employers for providing this level of support. They have relayed how the program has provided benefit not only to them but to their family members. As witnessed by the quote below, that impact has been substantial.

“This removed a big worry. I am able to stay healthy and pay rent.” 

VP, Compensation and Benefits describing the reaction of an employee enrolled in their Diabetes Management Program

Are you ready to take the next step to drive results for your organization and your employees? Are you interested in learning more about Northwind’s clinical blueprints?  If so, let’s have a conversation!