Diabetes program cuts ED visits 67% in first 6 months

NetCare yields cost savings of 26%

Early outcomes for Diabetes NetCare, a comprehensive diabetes program devel-oped by the Nashville, TN-based Diabetes Treatment Centers of America (DTCA), may come closer to exploding the notion that diabetes management can’t yield significant short-term cost savings.

A recently concluded pilot study of 115 NetCare patients yielded an 83% drop in inpatient admissions within six months of implementation. Over that same time period, direct health care costs fell by 25.8%, a decrease of $140.89 per member per month — from $546.66 to $405.77. Other results include the following:

• Percentage of patients receiving a retinal eye exam rose from 28% to 80% (43% higher than the national average).

• Percentage of patients receiving an annual foot exam rose from 3% to 99%.

• Percentage of patients receiving a serum creatinine test to assess kidney function increased from 55% to 90%.

• Days of inpatient utilization fell by 85%.

• Emergency department utilization fell by 67%.

• Glycosylated hemoglobin percentages decreased by about 10% for Type I and Type II patients.

"Our basic tenet is that if you’re going to have an impact on a chronic disease population, you have to be interacting directly with the population and their physicians, regardless of how health care is organized or paid for in this country," says Robert Stone, executive vice president of DTCA. "Our approach is to do a significant part of that in market, on site, face to face. And while that’s clearly a more expensive alternative in terms of cost than using some of the technology solutions being offered out there, it’s a reflection of where we’re prepared to bet our money on achieving the outcomes."

NetCare, whose customer set includes 10 HMOs, is offered on a carve-in basis to payers. Services are provided using the plans’ existing network of physicians, and DTCA shares the risk, Stone says. Included in the program are diabetes educators, nurse case managers, and dietitians who interact with patients and physicians "across the entire spectrum of the patient’s health care needs," he says. "And all of that’s tied together by a proprietary electronic medical record, which we developed and which our staff uses. Data are the critical element here. You need to know what’s happening with the patient all the time, and you need to respond proactively to variations in either desired behavior or desired outcomes."

Stone admits that the results of the pilot study must be regarded with some caution — given the relatively small number of patients in the study and because the patients were derived from a self-funded insurer’s population. "Demographically, there are some differences between the profile of the patients and the profile that we see with our commercial HMO customers. But [a 26% cost reduction] is about three times what our first year model projections were. So even with the potential limitations, we’re comfortable that we’re going to be able to deliver on the value proposition that we’ve offered our customers."

Stone believes the study also can serve as an indication to payers that diabetes management can be financially viable even in the very short term. "Our ability to demonstrate first-year savings at least equal to the cost of the program addition is a critical factor," he says. "The computer models out of NIH’s [the Bethesda, MD-based National Institutes of Health] diabetes division say you can’t provide this kind of service for net fewer dollars. And for three years without any proof, we’ve said, ‘Yes, you can.’ Now we’re starting to come forward with the data that supports the position that we bet our stockholders’ money on."

Stone notes that NetCare’s initial savings come almost exclusively from the reduction of emergency department utilization. With the program, physician costs actually rise slightly. Laboratory costs also increase as patients become more compliant.

"The whole system is designed to educate physicians and patients in terms of management behaviors, which are going to lead to better control in whatever setting they’re in," Stone says. "And then support to sustain those desired behaviors over time. It’s the support delivered in a consistent, continual, and frequently face-to-face fashion that makes the whole thing work."

[For more information about NetCare, contact Robert Stone, Executive Vice President, Diabetes Treatment Centers of America, Nashville, TN. Telephone: (615) 665-1133.]