In Massachusetts, there are currently 320,000 people diagnosed with diabetes, with an estimated additional 100,000-140,000 undiagnosed in the state. The Milken Institute estimates the total impact of chronic illness on Massachusetts, including both treatment expenditures and lost productivity, at $34 billion. This costly health problem has demanded close attention and swift action in the state.
The Disease Management and Wellness Task Force, with input from a broad coalition of stakeholders, is working to accomplish three primary goals:
- Develop an action-oriented framework for managing and treating chronic disease in Massachusetts, initially focusing on diabetes, which will include identifying key policy and programmatic steps that can be taken to reduce complications associated with diabetes. This advancement will expand screening and ensure appropriate care of diabetes, with the intention of seeing measurable changes within a relatively short period of time.
- Contribute to a broader statewide blueprint for chronic disease prevention and management that can be used to guide work on heart disease, asthma and other chronic conditions. This task is a joint project of HealthyMass and the Massachusetts Health Care and Quality Cost Council (HCQCC), which was established as a component of our state's Health Care Reform endeavors. Learn more about the HCQCC.
- Contribute to an obesity action plan to focus on primary prevention of chronic conditions.
The Disease Management and Wellness Task Force offers the potential for a major, coordinated, public-private initiative to integrate public and medical care, promote early detection and better chronic disease management using a chronic care model, thereby reducing hospitalizations, readmissions and complications, improving outcomes among those with chronic illnesses while decreasing costs.
The Disease Management and Wellness Task Force has analyzed recommended indicators, identified data sets for tracking changes, and highlighted the limitations of each category. The three recommended indicators, which are available through the Behavioral Risk Factor Surveillance System (BRFSS), are:
- the number of new cases of diabetes;
- the number of new cases of pre-diabetes (identified by blood glucose levels that are higher than normal but not in the range associated with diabetes); and
- the percentage of individuals with diabetes receiving recommended care (i.e. annual foot exam, annual eye exam, HbA1c at least two times in the last year and annual flu exam).
The first two indicators will improve and expand the diagnosis of individuals living with - but unaware of - pre-diabetes or diabetes. The third indicator aligns with the goals of improving access to appropriate care for individuals with pre-diabetes and diabetes, and maintaining good health among those individuals.
The Task Force has also developed a survey to distribute to Managed Care Organizations in Massachusetts to ascertain the optimal practices and policies for managing patients with diabetes. These steps include identifying practices for inclusion in their diabetes programs; determining the percentage of those with diabetes who are currently enrolled in diabetes management programs; establishing components of diabetes programs; generating estimates of the costs and savings of the programs; and formulating plans for program improvements.
Third, the Task Force successfully identified the drivers behind diabetes trends to define the workgroups that will be formed. These workgroups will seek to generate action plans for each targeted area. Driving factors include:
- limited access to services;
- uncoordinated care;
- primary care quality;
- lack of awareness of Certified Diabetes Educators; and
- inability to pay (for co-pays, treatment, etc).
The Task Force has also determined the categories of drivers behind diabetes trends to generate action plans for each targeted area. Categories include:
- workforce factors;
- practitioner factors;
- patient factors; and
- insurer factors.
Workgroups are currently developing strategies and recommendations across these four categories.
In June 2009, the Disease Management and Wellness Taskforce issued its final report, which features an overview of diabetes data in Massachusetts and offers recommendations for policymakers, providers, insurers, advocates and consumers to prevent and manage diabetes in the Commonwealth; maximize health outcomes and quality of care; and control health care costs.
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