Aetna Pilot Helps Physicians Improve Care For Diabetics

Main Category: Diabetes
Article Date: 09 Jul 2009 - 7:00 PDT

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Aetna (NYSE: AET) and Total Therapeutic Management (TTM) announced the results of a pilot program in Southeastern Pennsylvania and South Florida that improved patient care and increased the number of physicians recognized by the National Committee for Quality Assurance (NCQA) Diabetes Physician Recognition Program. Funded by Amylin Pharmaceuticals, Inc., the program included outreach to physicians, chart reviews, and face-to-face meetings to discuss appropriate screening tests and gauge how patient care was being managed. Of the 40 physicians who participated in the 2008 pilot, 17 were recognized by the NCQA for providing high-quality care to patients with diabetes. Findings from the program were presented at the ISPOR international meeting held in Orlando, Florida.

"I am proud to be part of a distinguished group of physicians recognized by NCQA for providing high-quality diabetes care," said Joseph Chiaramonte, M.D., a physician in Brandon, Florida. "The process to achieve the designation requires significant investment to submit performance data on several dimensions of diabetes care, including eye exams, blood pressure tests, glucose levels and lipid control. We know that patients who receive care according to the NCQA and American Diabetes Association guidelines are less likely to suffer complications such as heart attacks, stroke, blindness, kidney disease and amputations. The Aetna program really provided the resources I needed to review charts and submit data, which ultimately leads to even better quality of life for my patients."

"As the debate about health care reform heats up, everyone can agree that helping people with chronic conditions manage their disease can advance health care quality and reduce costs," said Aetna Chief Medical Officer Lonny Reisman, M.D. "Diabetes is a chronic disease that affects 24 million Americans and costs the U.S. more than $174 billion a year. By working with organizations like NCQA to improve the quality of care for people living with this disease, we can help Aetna members understand their disease and achieve their optimal health."

NCQA, in partnership with the American Diabetes Association, developed the Diabetes Physician Recognition Program to provide physicians with tools to support the delivery and recognition of consistent high-quality care. This voluntary program recognizes physicians who use evidence-based measures and provide excellent care to their patients with diabetes. The program has 10 measures that cover areas such as HbA1c control, which relates to blood sugar levels, blood pressure control, LDL cholesterol control, eye examinations, kidney damage assessments and advice about smoking cessation.

"For a person with diabetes, the right physician can make the difference between living with diabetes as opposed to suffering from diabetes," said Margaret O'Kane, president of NCQA. "Physicians who earn recognition through the Diabetes Physician Recognition Program have an established track record of providing excellent diabetes care. This recognition is not easily achieved, so the physicians in Southeastern Pennsylvania and South Florida are to be commended for this designation."

Pilot Program Design

In two markets, Southeastern Pennsylvania and South Florida, Aetna identified participating physicians with 25 or more Aetna members who were over the age of 18, were diagnosed with diabetes and under the physician's care in 2007. Forty practitioners were recruited into the program, 20 from each market. Aetna partnered with TTM, a research organization, to recruit the qualifying practitioners and conduct in-office chart reviews to look for patients receiving care in accordance with diabetes treatment guidelines. TTM reached out to discuss physicians' status in achieving recognition and share pharmacy compliance reports. In addition, TTM provided Aetna-developed tools such as chart stickers, eye exam report forms, and a three-year diabetes checklist to promote quality improvement in tracking and managing members with diabetes.

Pilot Program Results

In order to achieve diabetes recognition, practitioners needed a cumulative score of 75 points or more from 10 measures related to diabetes care. Of the 40 practitioners that participated in the program, 4 had the potential points necessary to meet the recognition in the initial evaluation. Six months after the initial review, 18 practitioners continued in the program and participated in the second evaluation utilizing NCQA sample methodology. Of the 18 physicians who were evaluated, 17 met the criteria for recognition.

Source
Aetna