Medical claim cost impact of improved diabetes control for medicare and commercially insured patients with type 2 diabetes

Journal of Managed Care Pharmacy

Volumn 19, Issue 8, 2013, Pages 609-620

  Fitch, Kathryn ^a   Pyenson, Bruce S ^a   Iwasaki, Kosuke ^a  

^a MILLIMAN INC   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

HEMOGLOBIN A1C; HIGH DENSITY LIPOPROTEIN;

ADULT; AMPUTATION; ARTICLE; BLINDNESS; BLOOD PRESSURE MEASUREMENT; CEREBROVASCULAR ACCIDENT; CONGESTIVE HEART FAILURE; COST CONTROL; COST EFFECTIVENESS ANALYSIS; DIABETES CONTROL; DIABETIC PATIENT; DIASTOLIC BLOOD PRESSURE; FEMALE; HEART INFARCTION; HEMOGLOBIN BLOOD LEVEL; HUMAN; ISCHEMIC HEART DISEASE; KIDNEY FAILURE; MAJOR CLINICAL STUDY; MALE; MANAGED CARE ORGANIZATION; MEDICARE; NON INSULIN DEPENDENT DIABETES MELLITUS; PRACTICE GUIDELINE; RISK FACTOR; SYSTOLIC BLOOD PRESSURE;

AGED; DIABETES COMPLICATIONS; DIABETES MELLITUS, TYPE 2; DISEASE MANAGEMENT; FEMALE; HUMANS; INSURANCE CLAIM REVIEW; MALE; MANAGED CARE PROGRAMS; MEDICARE; MIDDLE AGED; PROSPECTIVE STUDIES; UNITED STATES;

EID: 84885401674     PISSN: 10834087     EISSN: None     Source Type: Journal    
DOI: 10.18553/jmcp.2013.19.8.609     Document Type: Article

References (52)

1. Cheung BM, Ong KL, Cherny SS, Sham PC, Tso AW, Lam KS. Diabetes prevalence and therapeutic target achievement in the United States, 1999 to 2006. Am J Med. 2009;122(5):443-53.
2. Huang ES, Basu A, O'Grady M, Capretta JC. Projecting the future diabetes population size and related costs for the U.S. Diabetes Care. 2009;32(12):2225-29. Available at: http://care.diabetesjournals.org/content/ 32/12/2225.full.pdf+html. Accessed June 22, 2013.
3. Centers for Disease Control and Prevention. 2011 national diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States. Atlanta, GA: U.S. Department of Health and Human Services; 2011. Available at: http://www.cdc.gov/diabetes/pubs/factsheet11. htm. Accessed July 9, 2013.
4. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405-12. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27454/pdf/405.pdf. Accessed June 22, 2013.
5. Anonymous. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837-53.
6. Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. 2004;141(6):421-31.
7. National Heart Lung and Blood Institute. Questions and answers: action to control cardiovascular risk in diabetes (ACCORD) study. March 15, 2010. Available at: http://www.nhlbi.nih.gov/health/prof/heart/other/accord/q_a. htm. Accessed June 22, 2013.
8. Fitch K, Iwasaki K, Pyenson B. Improved management can help reduce the economic burden of type 2 diabetes: a 20-year actuarial projection. Milliman Client Report. April 28, 2010. Available at: http://publications.milliman. com/publications/health-published/pdfs/improved-management-canhelp. pdf. Accessed June 22, 2013.
9. Shetty S, Secnik K, Oglesby AK. Relationship of glycemic control to total diabetes-related costs for managed care health plan members with type 2 diabetes. J Manag Care Pharm. 2005;11(7):559-64. Available at: http://www. amcp.org/data/jmcp/Original%20Research_559_564.pdf.
10. Gilmer TP, O'Connor PJ, Manning WG, Rush WA. The cost to health plans of poor glycemic control. Diabetes. 1997;20(12):1847-53.
11. Aagren M, Luo W. Association between glycemic control and shortterm healthcare costs among commercially insured diabetes patients in the United States. J Med Econ. 2011;14(1):108-14.
12. The CDC Diabetes Cost-Effectiveness Group. Cost-effectiveness of intensive glycemic control, intensified hypertension control, and serum cholesterol level reduction for type 2 diabetes. JAMA. 2002;287(19);2542-51. Available at: http://jama.ama-assn.org/content/287/19/2542.full.pdf+html. Accessed June 22, 2013.
13. Menzin J, Langley-Hawthorne C, Friedman M, Boulanger L, Cavanaugh R. Potential short-term economic benefits of improved glycemic control: a managed care perspective. Diabetes Care. 2001;24(1):51-55. Available at: http://care.diabetesjournals.org/content/24/1/51.full.pdf+html. Accessed June 22, 2013.
14. Menzin J, Korn JR, Cohen J, et al. Relationship between glycemic control and diabetes-related hospital costs in patients with type 1 or type 2 diabetes mellitus. J Manag Care Pharm. 2010;16(4):264-75. Available at: http://www. amcp.org/data/jmcp/264-275.pdf.
15. Stephens JM, Botteman MF, Hay JW. Economic impact of antidiabetic medications and glycemic control on managed care organizations: a review of the literature. J Manag Care Pharm. 2006;12(2):130-42. Available at: http:// amcp.org/data/jmcp/subj_review_130-142.pdf.
16. Koopman RJ, Mainous AG 3rd, Diaz VA, Geesey ME. Changes in age at diagnosis of type 2 diabetes mellitus in the United States, 1988 to 2000. Ann Fam Med. 2005;3(1):60-63.
17. Stevens RJ, Kothari V, Adler AI, Stratton IM; United Kingdom Prospective Diabetes Study (UKPDS) Group. The UKPDS risk engine: a model for the risk of coronary heart disease in type II diabetes (UKPDS 56). Clin Sci (Lond). 2001;101(6):671-79. Available at: http://www.clinsci.org/ cs/101/0671/1010671.pdf. Accessed June 22, 2013.
18. Mayne L, Girod C, Weltz S. 2012 Milliman Medical Index. Milliman, Inc. May 15, 2012. Available at: http://insight.milliman.com/article. php?cntid=8078&utm_source=milliman&utm_medium=web&utm_ content=MMI-mktg&utm_campaign=Healthcare&utm_ terms=Milliman+Medical+Index. Accessed June 22, 2013.
19. Fitch K, Iwasaki K, Kalin D, Pyenson B. Cost trends for chroniccondition cohorts with Medicare benefits. Milliman, Inc. May 1, 2008. Available at: http://insight.milliman.com/article.php?cntid=7170&utm_ source=search&utm_medium=web&utm_content=7170&utm_ campaign=Search. Accessed June 22, 2013.
20. American Diabetes Association. Standards of medical care in diabetes-2011. Diabetes Care. 2011;34(Suppl 1):S11-S61. Available at: http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC3006050/pdf/zdcS11.pdf. Accessed June 22, 2013.
21. Fischer MA, Stedman MR, Lii J, et al. Primary medication nonadherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010;25(4):284-90. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2842539/pdf/11606_2010_Article_1253.pdf. Accessed June 22, 2012.
22. Heisler M, Choi H, Rosen AB, et al. Hospitalizations and deaths among adults with cardiovascular disease who underuse medications because of cost: a longitudinal analysis. Med Care. 2010;48(2):87-94. Available at: http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC3034735/pdf/nihms262571.pdf. Accessed June 22, 2012.
23. Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27(5):1218-24. Available at: http://care.diabetesjournals. org/content/27/5/1218.full.pdf+html. Accessed June 22, 2013.
24. Ho PM, Rumsfeld JS, Masoudi FA, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med. 2006;166(17):1836-41.
25. Lau DT, Nau DP. Oral antihyperglycemic medication nonadherence and subsequent hospitalization among individuals with type 2 diabetes. Diabetes Care. 2004;27(9):2149-53. Available at: http://care.diabetesjournals.org/content/ 27/9/2149.full.pdf+html. Accessed June 22, 2013.
26. Nichols G, Koo Y, Shah S. Delay of insulin addition to oral combination therapy despite inadequate glycemic control. J Gen Intern Med. 2007;22(4):453-58. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC1829438/pdf/11606_2007_Article_139.pdf. Accessed June 22, 2013.
27. Grant RW, Cagliero E, Dubey AK, et al. Clinical inertia in the management of type 2 diabetes metabolic risk factors. Diabet Med. 2004;21(2):150-55.
28. Ulcickas MT, Lafata JE, Koro C. et al. Time to pharmacotherapy change in response to elevated HbA1c test results. Curr Med Res Opin. 2006;22:1567-74.
29. Shah BR, Hux JE, Laupacis A, Zinman B, van Walraven C. Clinical inertia in response to inadequate glycemic control: do specialists differ from primary care physicians? Diabetes Care. 2005;28(3):600-06. Available at: http://care.diabetesjournals.org/content/28/3/600.full.pdf+html. Accessed June 22, 2013.
30. Peyrot M, Rubin RR, Lauritzen T, et al. Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. Diabetes Care. 2005;28(11):2673-79. Available at: http://care.diabetesjournals.org/content/ 28/11/2673.full.pdf+html. Accessed June 22, 2013.
31. Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA. 1999;281(21):2005-12. Available at: http://jama.ama-assn.org/content/281/21/2005.full.pdf+html. Accessed June 22, 2013.
32. Chen JY, Kang N, Juarez DT, Hodges KA, Chung RS, Legorreta AP. Impact of a pay-for-performance program on low performing physicians. J Healthc Qual. 2010;32(1):13-21.
33. Coleman K, Reiter KL, Fulwiler D. The impact of pay-for-performance on diabetes care in a large network of community health centers. J Health Care Poor Underserved. 2007;18(4):966-83.
34. Curtin K, Beckman H, Pankow G, Milillo Y, Green RA. Return on investment in pay for performance: a diabetes case study. J Healthc Manag. 2006;51(6):365-374.
35. Bojadzievski T, Gabbay RA. Patient-centered medical home and diabetes. Diabetes Care. 2011;34(4):1047-53. Available at: http://www.ncbi.nlm.nih. gov/pmc/articles/PMC3064021/pdf/1047.pdf. Accessed June 22, 2013.
36. Bott DM, Kapp MC, Johnson LB, Magno LM. Disease management for chronically ill beneficiaries in traditional Medicare. Health Aff (Millwood). 2009;28(1):86-98. Available at: http://content.healthaffairs.org/content/ 28/1/86.full.pdf+html. Accessed June 22, 2013.
37. Villagra VG, Ahmed T. Effectiveness of a disease management program for patients with diabetes. Health Aff (Millwood). 2004;23(4):255-66. Available at: http://content.healthaffairs.org/content/23/4/255.full.pdf+html. Accessed June 22, 2013.
38. Walker EA, Schmukler C, Ullman R, Blanco E, Scollan-Koliopoulus M, Cohen HW. Results of a successful telephonic intervention to improve diabetes control in urban adults: a randomized trial. Diabetes Care. 2011;34(1):2-7. Available at: http://care.diabetesjournals.org/content/34/1/2.full.pdf+html. Accessed June 22, 2013.
39. Norris SL, Nichols PJ, Caspersen CJ, et al. The effectiveness of disease and case management for people with diabetes. A systematic review. Am J Prev Med. 2002;22(4 Suppl):S15-S38.
40. Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002;25(7):1159-71. Available at: http://care.diabetesjournals. org/content/25/7/1159.full.pdf+html. Accessed June 22, 2013.
41. Sidorov J, Shull R, Tomcavage J, Girolami S, Lawton N, Harris R. Does diabetes disease management save money and improve outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization-sponsored disease management program among patients fulfilling health employer data and information set criteria. Diabetes Care. 2002;25(4):684-89. Available at: http://care.diabetesjournals. org/content/25/4/684.full.pdf+html. Accessed June 22, 2013.
42. McCall N, Cromwell J. Results of the Medicare Health Support diseasemanagement pilot program. N Engl J Med. 2011;365(18):1704-12.
43. Duncan I, Birkmeyer C, Coughlin S, Li QE, Sherr D, Boren S. Assessing the value of diabetes education. Diabetes Educ. 2009;35(5):752-60.
44. Rickheim PL, Weaver TW, Flader JL, Kendall DM. Assessment of group versus individual diabetes education: a randomized study. Diabetes Care. 2002;25(2):269-74. Available at: http://care.diabetesjournals.org/content/ 25/2/269.full.pdf+html. Accessed June 22, 2013.
45. Rashed SM. Cost outcomes of diabetes education in a specialized community pharmacy. Am J Pharm Benefits. 2010;2(7):421-28.
46. Garrett DG, Bluml BM. Patient self-management program for diabetes: first-year clinical, humanistic, and economic outcomes. J Am Pharm Assoc (2003). 2005;45(2):130-37.
47. Welch G, Zagarins SE, Feinberg RG, Garb JL. Motivational interviewing delivered by diabetes educators: does it improve blood glucose control among poorly controlled type 2 diabetes patients? Diabetes Res Clin Pract. 2011;91(1):54-60. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3011053/pdf/nihms253171.pdf. Accessed June 22, 2013.
48. Zeng F, An JJ, Scully R, Barrington C, Patel BV, Nichol MB. The impact of value-based benefit design on adherence to diabetes medications: a propensity score-weighted difference in difference evaluation. Value Health. 2010;13(6):846-52.
49. Quinn CC, Shardell MD, Terrin ML, Barr EA, Ballew SH, Gruber-Baldini AL. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011;34(9):1934-42.
50. American Diabetes Association. Economic costs of diabetes in the U.S. in 2007. Diabetes Care. 2008;31(3):596-615. Available at: http://care.diabetesjournals. org/content/31/3/596.full.pdf+html. Accessed June 22, 2013.
51. ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560-72.
52. Milliman 2011 health cost guidelines. Milliman, Inc. Available at: http:// www.milliman.com/expertise/healthcare/products-tools/health-cost-guidelines/. Accessed July 9, 2013.