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December 3, 2009 Volume VI, No. 28

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Diabetes cases are expected to double in the next 25 years. In this issue of the DM Update, you will learn about CVS Caremark's medication adherence program for diabetics, trends in diabetes cases and costs for the next 20-some years, and a new pilot program from BCBSA to help reduce the rates and cases of childhood obesity and diabetes.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Diabetes Medication Adherence
  2. Diabetes Cases to Double
  3. Reducing Avoidable Hospital Readmissions
  4. Patient Education Materials for Diabetics
  5. Healthcare Trends: Medication Adherence Interventions
  6. Tackling Diabetes With Innovative Physician Toolkit
  7. Healthcare Case Management

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CVS Caremark Programs Help Diabetics Maintain Optimal Adherence to Therapy

CVS Caremark's comprehensive adherence program for people with diabetes positively impacts medication adherence for both new and continuing patients, according to a review of data tracking the program. The review found that 75.6 percent of patients continuing on a diabetes therapy who participated in the adherence program maintained optimal adherence to their prescribed therapy vs. 61.2 percent in the control group. The study also found that patients newly prescribed a diabetes medication who participated in the adherence program achieved a first fill persistency rate of 80 percent, 8 percent higher than the control group.

The CVS Caremark adherence programs are some of the most comprehensive in the industry. All members enrolled in these programs, whether they utilize the mail pharmacy or fill their prescriptions at any of the 64,000 retail pharmacies within the CVS Caremark retail network, receive timely messaging and interventions designed to help keep them adherent to medications for chronic conditions. These interventions include Interactive Voice Response (IVR) and Web refill reminders, renewals and pick-up prompts, and letters about the importance of staying on a prescribed therapy sent to patients who have stopped filling a maintenance prescription and their healthcare provider.

According to Troyen A. Brennan, M.D., M.P.H., executive vice president and chief medical officer for CVS Caremark, "our data illustrates that direct, focused interventions to help patients with a chronic disease such as diabetes stay on their medications work. CVS Caremark's comprehensive adherence program is designed to engage all enrolled plan participants in their care by providing disease and therapy education and outreach to help them improve medication adherence, resulting in improved outcomes and reduced overall costs."

To learn more about this research, please visit:

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Diabetes Cases to Double and Costs to Triple by 2034

In the next 25 years, the number of Americans living with diabetes will nearly double, increasing from 23.7 million in 2009 to 44.1 million in 2034. Over the same period, spending on diabetes will almost triple, rising from $113 billion to $336 billion, even with no increase in the prevalence of obesity, researchers based at the University of Chicago report in the December issue of Diabetes Care. The number of those with diabetes covered by Medicare will rise from 8.2 million to 14.6 million, the researchers predict. Medicare spending on diabetes will jump from $45 billion to $171 billion.

The new estimates are far more rigorous, and more troubling, than previous predictions. For instance, a 1991 study stated that the number of Americans with diabetes would double, from 6.5 million in 1987 to 11.6 million by 2030, which, as it turns out, is less than half the number of cases in 2009. "These projections stress the importance of prevention and education," the authors declare. "The requisite change in lifestyle, exercise or nutrition habits will be more difficult than if a drug is developed for treatment."

The 2009 Diabetes Care study places increased emphasis on changes in demographics, advances in treatment, and the natural history of this disease, including the timing and frequency of its costly complications. Much of the increase in cases and in costs will be driven by aging baby boomers — the 77 million Americans born between 1946 and 1957 who are approaching the age of retirement, diabetes complications and federal health insurance.

To learn more about this research, please visit:

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Aligning Reimbursement To Reduce Avoidable Hospital Readmissions

Maryland's Hospital Preventable Readmissions program rewards efforts that reduce hospital readmissions while improving care quality and decreasing cost. Dianne Feeney, associate director of quality initiatives for the Maryland Health Services Cost Review Commission (HSCRC), describes HSCRC's response to hospitals that claim they can't afford the empty beds that result from programs like these, as well as processes to help ensure that higher-risk patients are not refused admittance to hospitals. She also explains how partnerships with "siloed settings" — nursing homes and home health providers — can reduce common errors that occur during patient handoffs.

To listen to this complimentary HIN podcast, please visit:

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Patient Education Materials for Diabetics

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Roberta Burgess, R.N., nurse case manager for Community Care Plan of Eastern Carolina with Heritage Hospital in Tarboro, North Carolina.

Question: What types of patient education materials for diabetics did you develop? Were there any challenges with communicating this information to the Medicaid patients?

Response: The most important tool that we developed was one of the diabetic action plans. The information brochure form has information for the client at a level that they can understand — all the things that they need to know when they go to an office visit for their diabetes care. And it explains to them from the beginning what their hemoglobin A1C level is; they have their exact numbers on that date. We break it down for them so that they understand when they go in that they must know their numbers. They know what their guide is, they know what to expect from the doctor visit. That’s one of the most important processes that we developed for our clients. The biggest challenge was making sure that they understand what we wanted them to do with that tool which was to take it with them when they go to the doctor. That helps facilitate communication instead of having patients sit there and not really know what to do and what to ask.

Many of them did remember to do that. Not everybody, but a lot of them did. The providers have commented that they know we’re out there — the patients are bringing in all these forms and it keeps them on their toes.

For more information on diabetes medical home pilots, please visit:

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Anticipatory Care Management — Medication Adherence Interventions

The story is in the statistics: 65 percent of all prescriptions show non-compliance; 33 percent of all prescriptions are not even filled; medication-related hospital admissions cost $100 billion every year. Yet, studies show that education interventions can be effective in improving adherence. Learn how medication adherence interventions can improve outcomes while lowering costs.

To download this complimentary white paper, please visit:

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BCBSA Tackles Childhood Obesity and Diabetes with Innovative Physician Toolkit

The Blue Cross and Blue Shield Association (BCBSA) has launched a new pediatric obesity and diabetes prevention pilot program in five states in an effort to help reduce childhood obesity and prevent future cases of diabetes.

The pilot program consists of an easy-to-use obesity and diabetes prevention toolkit designed for physicians that has convenient physician reference materials, as well as educational and behavior changing tools to share with patients and parents. The toolkit, developed in consultation with the American Diabetes Association and the American Academy of Pediatrics (AAP), encourages healthy choices and behaviors and will be piloted in collaboration with five BCBS companies.

The toolkit materials display healthy messages from The Good Health Club, a group of animal characters, encouraging kids to eat five servings of fruits and vegetables every day, limit screen time to two hours or less, get at least one hour of physical activity and limit sweetened drinks to zero.

HHS reports that overweight adolescents have a 70 percent chance of becoming overweight or obese adults. Obese children or teens are at risk for health problems like heart disease and diabetes — the two leading causes of death in the United States. The prevalence of obesity among children ages 6 to 11 has more than doubled in the past 20 years from 6.5 percent in 1980 to 17 percent in 2006.

To learn more about this research, please visit:

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Healthcare Case Management

Case managers are playing a larger role in the coordination of all phases of patient care, from management of the chronically ill in primary care offices to monitoring hospitalized patients from admission through discharge to overseeing care of residents of long-term care facilities. Complete HIN's Survey of the Month on Healthcare Case Management by December 31 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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