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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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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%
© 2016 American Medical Association. All rights reserved.
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.
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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.
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
"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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
www.preventdiabetesstat.orgP19
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
Step One – Create Awareness
21
© 2016 American Medical Association. All rights reserved.
Step Two – Identify Patients
22
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
Step Four – Refer
24
© 2016 American Medical Association. All rights reserved.
Step Five – Follow-up
25
© 2016 American Medical Association. All rights reserved.
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
AMA investing to
increase visibility in
the Michigan market
28
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
Multi-Pronged Approach
34
Earned
mediaAMA
Wire
Social
media
SEO
Native
content
Geo-
targeted
ads
Custom
content
series
Event
takeover
PCPs in
Michigan
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved. 36
Potential media targets
© 2016 American Medical Association. All rights reserved.
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/
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved.
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
© 2016 American Medical Association. All rights reserved. 43
Christopher Holliday, PhD, MPH
Director, Population Health