Diabetes Disease Mgmt: Getting Started

1. Diabetes Disease Mgmt:Getting Started! CDR Padden Special Thanks to: CAPT Jackson Ms Marullo CAPT Williams

2. How many of you have previously been involved with unsuccessful disease management efforts? Why were these efforts unsuccessful? Begin the session with a query of the audience and their experience with DM programs. Acknowledge that folks may know of some good efforts, and we want them to share their ideas throughout�but, if we were all doing such a great job�we wouldn�t need to be here�right?Begin the session with a query of the audience and their experience with DM programs. Acknowledge that folks may know of some good efforts, and we want them to share their ideas throughout�but, if we were all doing such a great job�we wouldn�t need to be here�right?

3. Objectives Consider the roles/training of the multidisciplinary members of your team Differentiate carved-in and carved out models of disease management Examine the importance of patient self-management and the PCM relationship Our three major objectives are to: Consider how important it is for the team to consist of multiple disciplines, and not just providers. They must learn how to work together to efficiently deliver high quality care�the right person delivering the right care. Characterize the difference between carved in and carved out models of disease management�focusing on that neither is necessarily better than the other, but which is chosen should reflect the needs of the providers, the patients and the MTF resources. Review the principles of self management and why it is so crucial to success in disease management. Drive home the importance of a continuing relationship with a PCM and how that can improve outcomes and potentially decrease costs.Our three major objectives are to: Consider how important it is for the team to consist of multiple disciplines, and not just providers. They must learn how to work together to efficiently deliver high quality care�the right person delivering the right care. Characterize the difference between carved in and carved out models of disease management�focusing on that neither is necessarily better than the other, but which is chosen should reflect the needs of the providers, the patients and the MTF resources. Review the principles of self management and why it is so crucial to success in disease management. Drive home the importance of a continuing relationship with a PCM and how that can improve outcomes and potentially decrease costs.

4. New Age for Navy Medicine: BUMED Business Planning? Reorganization Comparison across MTFs Are they AWARE a business plan exists? Have any of them been involved in the planning? What is their understanding of the business plan and the part that disease management plays in the business plan.Are they AWARE a business plan exists? Have any of them been involved in the planning? What is their understanding of the business plan and the part that disease management plays in the business plan.

5. Setting the Stage BUMED Business Plan mandates implementation of disease management Diabetes performance metrics identified Modest expectations in beginning MTF C.O. Report cards Population Health Navigator (PHN) the accepted information source Diabetes Action Team (DAT): Accepted the DOD VHA Diabetes CPG & Toolkit Drive home that BUMED requires each MTF to develop a business plan that has uniform elements such as 1) Improved access 2) Budget neutral (Manage your capitated budget well!) 3) High quality care 4) Internal and external customer satisfaction 5) Highly productive (RVU�s, Value of care, Operating margin) Dec 2004 BUMED Note 6310: Commands must establish disease management programs for diabetes, asthma and breast health care. Must have a champion, identify populations. Goals are to be aware of diabetics with HbA1C > 9.0% and when our patients go to the ER. Note can be found at: https://dataquality.med.navy.mil/community/default.aspx Drive home that BUMED requires each MTF to develop a business plan that has uniform elements such as 1) Improved access 2) Budget neutral (Manage your capitated budget well!) 3) High quality care 4) Internal and external customer satisfaction 5) Highly productive (RVU�s, Value of care, Operating margin) Dec 2004 BUMED Note 6310: Commands must establish disease management programs for diabetes, asthma and breast health care. Must have a champion, identify populations. Goals are to be aware of diabetics with HbA1C > 9.0% and when our patients go to the ER. Note can be found at: https://dataquality.med.navy.mil/community/default.aspx

6. BUMED Note 6310 Outlines system-wide expectations and guidelines for diabetes management Clinical and Administrative Champions Population Health Navigator (PHN) Clinical information system for identifying cohorts Disease Management Re-engineering Identify, aggressively treat A1C > 9.0% Notification of PCM if DM patient seen in ER 24 hour access for DM patients

7. HEDIS Measures Mandatory HbA1c: Percent of patients with HbA1c values less than or equal to 9.0 % during the past year LDL-Cholesterol: Percent of patients with LDL-Cholesterol test values < 100 mg/dl * Recommended Initial Assessment Foot Exams Retinopathy screen Patient education Periodic follow up *note that current recommendations are LDL < 70 mg/dl