community–clinical linkages to prevent type 2 diabetes€¦ · christopher holliday, phd, mph...

Christopher Holliday, PhD, MPH

Director, Population Health

Community–Clinical Linkages to

Prevent Type 2 Diabetes

Michigan Diabetes Prevention Network

July 28, 2016

© 2016 American Medical Association. All rights reserved.

Objectives

• Describe the clinical practice burden and trends in type 2 diabetes

• Describe how the AMA is making the clinical-community connection for

diabetes prevention

• Describe the components of the AMA-CDC Prevent Diabetes STAT

toolkit for healthcare professionals and other tools

• Discuss strategies to increase participation in diabetes prevention

programs by AMA investing to increase visibility of work within the

Michigan market

2


AMA strategic focus to improve health outcomes

3

The AMA has promoted scientific advancement, improved public health, and

invested in the doctor and patient relationship through three strategic focus

areas:

• Helping physician practices

thrive

• Creating the medical school of

the future

• Improving patient health

Vision

Improved

health of the

nation

preventing

chronic disease

Mission

All primary care

physicians

screening and

referring

• Strategic partnerships

• Remove barriers

• Increase awareness

and demand

Key Activities


Key strategy for improving health outcomes

4

Research & evaluate

Devise interventions

Implement & test

Reassess & adjust

Scale for impactCreate, validate and

spread evidence-

based, value-added

tools and resources

for physicians, care

teams, residents

and students


AMA is helping to create solutions that…

• Summarize the evidence and best practices

• Improve assessment and measurement

• Connect practices with community-based resources

• Promote a culture of teamwork and reliability

• Can be used by busy physicians and care teams

5

National Snapshot:

Epidemiology &

Clinical Burden of

Prediabetes6


Chronic Disease Impact on Clinical Practice

7

are for chronic disease

managementis due to chronic

conditions

50% of visits to

primary care~75% of health care

spending

50% 75%


Financial and Health Impact of Diabetes

• In 2012, the economic cost of type 2 diabetes was $245 billion

– Diabetes costs approximately $2,700 per individual with newly

diagnosed diabetes in the first year of treatment

• Compared to people without type 2 diabetes, adults with diabetes are:

– 2 times likely to develop hypertension

– 1.8 times more likely to be hospitalized for heart attack

– 1.5 times more likely to be hospitalized for stroke

– 1.7 times more likely to die from heart disease or stroke

8

CDC: National Diabetes Statistics Report, 2014.


Increasing Impact on Clinical Practice

9

Over the next 5 years, a typical large clinical practice could experience a

32% increase in the number of patients with diabetes

23,57721,896

20,19818,483

16,75015,000

2015 2016 2017 2018 2019 2020

Based on a panel size of approximately 100,000 patients

Slide courtesy of Ronald T. Ackermann, MD, MPH, Northwestern University Feinberg School of Medicine


Widespread Burden to Clinical Practice

10

Menke et al. JAMA. 2015;314(10):1021-1029.

Number of Patients

Representative of

U.S. Population

High Proportion of

Racial/Ethnic

Minorities

Type 2 Diabetes 14,000 Up to 24,000

Prediabetes 36,500 Up to 40,000

Example: a large clinical practice with 100,000 patients

Clinical-community

Linkages: Making the

connection for

Diabetes Prevention

11


Primary Care

12

Etz et al. Am J Prev Med 2008;35(Suppl. 5):S390-S397.

Bridging the Gap

Primary Care

• Capacity for risk

assessment

• Ability for brief counseling

• Capacity and ability to

refer

• Awareness of community

resources

Community Resource

• Availability of resource

• Affordability of resource

• Accessibility of resource

• Perceived as value added

• Perceived as value added

Connecting

Strategies


Opportunities/Game changers

Opportunities

• Health care payment models are moving away from fee for service

• Health care delivery is moving towards a patient-centered model

• Primary care physicians need to focus on managing increasing numbers of patients with more than one chronic disease

• Majority of chronic diseases are associated with lifestyle behaviors

• Physicians are not generally trained in lifestyle counseling and don’t have the time to provide intensive lifestyle counseling

Game Changers

• USPSTF screening recommendation, obese, 40-70, HgA1c of FPG / CPSTF recommendation

• Medicare coverage of the DPP (rulemaking process)

• PCMH alignment

• Diabetes screening quality measure – to be done

13


USPSTF screening recommendations

P14

Population Adults aged 40 to 70 years who are overweight or obese

Recommendation

Grade: B

Screen for abnormal blood glucose. Offer or refer patients with abnormal glucose

to intensive behavioral counseling interventions to promote a healthful diet and

physical activity.

Risk Assessment Risk factors include overweight and obesity or a high percentage of abdominal fat,

physical inactivity and smoking.

Screening Tests Hemoglobin A1c or fasting plasma glucose or an oral glucose tolerance test.


CPSTF recommendations

P15

Combined Diet and Physical Activity Promotion Programs for

Prevention of Diabetes: Community Preventive Services Task Force

Recommendation Statement Nicolaas P. Pronk, PhD; Patrick L. Remington, MD, MPH, on behalf of the Community Preventive Services Task Force*

The Task Force recommends:

• Use of combined diet and physical activity promotion programs by health

care systems, communities, and other implementers to provide counseling

and support to clients identified as being at increased risk for type 2

diabetes.

• Economic evidence indicates that these programs are cost-effective.

Ann Intern Med. 2015;163(6):465-468. doi:10.7326/M15-1029

http://annals.org/article.aspx?articleid=2395731#n1-10


"This program has been shown to reduce health care costs and help prevent diabetes, and is one that Medicare, employers and private insurers can use to help 86 million Americans live healthier.”

- HHS Secretary Sylvia M. Burwell

Building a case for prevention – CMS expansion of

Medicare benefits to include DPP

16

• CMS agrees that the National

Diabetes Prevention Program is a

worthwhile investment!

• $2,650 medical cost savings in 15

months (Medicare)^

• $2,700 medical cost savings in 1

year (commercial)^^ per prevented

case

^ Office of the Actuary, Centers for Medicare and Medicaid Services. “Certification of Medicare Diabetes Prevention Program”. March 23, 2016.

^^ American Medical Association. 2009-2012 individual level data from the Truven Health MarketScan® Lab Database - a 4.4 million subsample of the Truven Health MarketScan® Treatment Pathways.

MarketScan is a registered trademark of Truven Health Analytics Inc.

First ever preventive service model eligible for expansion

under Medicare holds promise for employers, private insurers

and patients


Alignment with PCMH standards

17

• The Practice Team

• Population Health Management

– Must-Pass: Use data for population management

– Critical-Factor: Implement evidence-based decision support

• Care Management and Support

– Critical-Factor: Identify patients for care management

– Support self-care and shared decision making

• Performance Measurement and Quality Improvement

– Measure clinical quality performance

AMA-CDC

Prevent Diabetes

STAT Toolkit

18


www.preventdiabetesstat.orgP19


5 Steps to Preventing Diabetes

20

1. Create awareness

2. Identify patients with prediabetes

3. Educate at-risk patients

4. Refer patients with prediabetes

to an evidence-based diabetes

prevention program

5. And, follow up on patient

progress


Step One – Create Awareness

21


Step Two – Identify Patients

22


Step Three – Educate at Risk Patients

23

Key Messages

• Your blood sugar is higher

than normal but not at the

level of diabetes. This

condition is prediabetes.

• Prediabetes is a serious

condition: It raises your risk of

heart attack and stroke and

poses a very high risk of

eventually progressing to full-

blown diabetes.

• Prediabetes is treatable and

reversible

• The goal is 5-7% weight loss


Step Four – Refer

24


Step Five – Follow-up

25


Other tools in development and planned

26

• Diabetes prevention cost savings calculator for

employers and payers – expansion of tool to include

Medicaid and case studies for purchasers

• Interactive digital health solutions

• Prediabetes algorithm for use in EHRs and registries

to support population health management

• Support STR – patient portals, referral orders,

telehealth, HIEs to close referral loop

© 2016 American Medical Association. All rights reserved. 27

Working with the AMA to prevent diabetes in a busy practice

Park Nicollet Clinic collaboration with diabetes prevention program

https://www.youtube.com/watch?v=qvbTQoIkZYw&feature=youtu.be

AMA investing to

increase visibility in

the Michigan market

28


Communications & Marketing Plan overview

• Goal: Increase promotion of AMA’s national campaign to prevent type 2

diabetes in partnership with the CDC, ADA and Ad Council within the

Michigan market as a key driver to inform the public to talk with their doctors

about prediabetes

– Priming the market has already proven to boost engagement among physicians

and patients

– Link communications efforts with strong AMA grassroots efforts in partnership

with MSMS including key influencer meetings, highly-visible sponsorship ops,

and strong engagement with business/payer leaders to help foster holistic

change to chronic disease prevention across the care continuum

29


Situation overview: two-pronged approach

30

Phase 1: Prime the market with broad-reaching marketing and communications efforts across Michigan

Phase 2: Supplement and support grassroots efforts once health systems and key decision makers are engaged to mobilize implementation


Key marketing/communications objectives

31

Primary: Increase awareness and usage of STAT tools by primary care physicians and health systems & DoIHavePrediabetes.org by consumers

Secondary: Increase referrals to Diabetes Prevention Programs within the MI market

*Includes baseline study

Marketing and

Communications

Strategies and

Approaches in MI

32


Marketing/communications strategies

33

Educate primary care physicians about the risk, impact and prevalence of prediabetes among patients in Michigan

• Communicate the need for physicians to take an active role in helping patients to stop the progression to type 2 diabetes

• Leverage key Michigan statistics to build the case for prevention and sense of urgency

• Leverage Michigan State Medical Society’s channels to increase credibility and deepen reach

Encourage Michigan’s involvement by framing this as an opportunity to serve as a leading example that will be touted nationally

• Michigan’s progress will be scaled nationally in the coming years

• Offer STAT tools as a solution to help move the needle on screening, testing and referring within Michigan


Multi-Pronged Approach

34

Earned

mediaAMA

Wire

Social

media

SEO

Native

content

Geo-

targeted

ads

Custom

content

Email

series

Event

takeover

PCPs in

Michigan


Earned media to continue the drumbeat

• Issue joint press release with MSMS and other MI-based partners (e.g. MI

Department of Health and Human Services on State Action Plan to Prevent Diabetes)

• Pitch Michigan-based media in partnership with MSMS and other key collaborating

organizations

– Trade media (i.e. county medical society, health systems, hospital and medical school

publications)

– Local radio shows (i.e. NPR affiliates) for AMA and MSMS spokespeople

– Develop MI-based media list from top five media markets: Detroit, Grand Rapids/Kalamazoo,

Flint, Lansing, Traverse City

• Develop joint op-ed strategy with MSMS or physician champions to highlight efforts

and mark key milestones

– Tailor to each media market

– Pitch bylines to local trade publications (IHO to assist with identifying partners)

35


Potential media targets


Social media to extend reach

• Leverage social media to amplify relevant media coverage and Wire

stories on Twitter, Facebook and LinkedIn

– Geo-target when possible

37

In 2016, 78 percent of U.S. Americans had a social network profile, representing a five

percent growth compared to the previous year. www.statista.com/.../percentage-of-us-population-with-a-social-network-profile/


Custom content: LinkedIn InMail

• Target PCPs and care teams in Michigan using sponsored LinkedIn

InMail to target messaging and visuals

– HCPs will receive InMails when they log in to LinkedIn

– Consider key leader from Michigan to serve as “sender” of content

– Personalized experience will include link to STAT tools

– Credible experience through trusted third-party source

38


Custom marketing: Modern Healthcare

• Place a geo-targeted banner on Modern Healthcare’s website

(Michigan)

– Average is 11,790 website impressions per month

• Feature white paper or case study on Modern Healthcare’s website to

showcase AMA’s expertise and experience in prediabetes

– Featured content appears nationally for one month (timing should coincide

with national STAT partners announcement to leverage national push)

39


Custom content: AMA email series

• Supplement communications efforts

with email series targeted to Michigan

physicians

• Plot out email timing to coincide with

external communications and status of

health system engagement

40


Integrate into existing partner events and assets*

• Disseminate awareness messaging through MSMS and health

department channels and efforts (determine feasibility with partners)

– Webinars

– Newsletters and websites

– Email campaigns

• IHO to tap other Michigan partners to determine opportunities for

alignment

– Ad Council campaign social media and out-of-home advertising are currently

being pursued in Michigan

41


Best practices for enabling physicians/care teams/consumers to

assure clinical-community linkages to prevent type 2 diabetes

• Identify champions through local medical societies and health systems

• Frame as a process or quality improvement initiative (QI strategy)

• With physician support, “automate” screening and referrals – tech solution

– Retrospective query to identify those at risk

– Criteria to identify those most at risk/likely to act/likely to be successful

– Referral through EMR / integrated into existing referral systems

• Build feedback loops so that physicians can discuss progress with their patients

• Provide on-the-ground support in the practices

• Raising awareness among physicians, care teams and patients through marketing campaigns, grand rounds, webinars and CME – a comprehensive comms strategy

• Diabetes prevention is a team sport

42


Christopher Holliday, PhD, MPH

Director, Population Health

[email protected]

community–clinical linkages to prevent type 2 diabetes€¦ · christopher holliday, phd, mph...

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