Background and objectives: Diabetes mellitus is a growing medical and economic burden that requires ongoing vigilant screening and effective management to prevent the development of serious and costly complications. In 2002, the Genesys Physician-Health Organization (PHO) implemented a quality initiative called the Clinical Excellence Program (CEP) with the purpose of increasing and documenting the quality of care provided to patients with particular health issues, including diabetes. This 5-year analysis (2002-6) of CEP findings was conducted to assess physician compliance with mandated screening/testing guidelines, evaluate the clinical impact for members with diabetes, and identify any potential economic effects.
Methods: Internal goals are set annually for specific diabetes care-related metrics (measurement of glycosylated hemoglobin [HbA1c], low-density lipoprotein-cholesterol [LDL-C] levels and blood pressure; retinal exams and foot exams; nephropathy screening) and communicated to Genesys PHO primary care physicians, who are then audited twice yearly for compliance with these measures. Physicians are given credit for any documentation showing that a given screening/test/referral was carried out or facilitated in good faith. CEP scores are compared against the 'index year' (2002) as an internal standard, and various national and regional benchmark datasets as external standards. Audit results are communicated to the physicians, and those scoring below preset deviation limits for compliance are subject to more frequent review.
Results: Physician compliance with diabetes screening parameters generally showed consistent annual improvement. Rates of HbA1c and LDL-C level testing were already favorable in the index year, but steadily improved over the 5-year period. The most dramatic increase was observed in the nephropathy screening rate, which nearly doubled from 43% in 2002 to 81% in 2003. Overall costs for medical and pharmacy claims, as well as emergency department visit costs and hospitalization rates, all demonstrated downward trends from 2003 through 2006, possibly reflecting the improvements in care and screening.
Conclusion: This analysis of the first 5 years of the Genesys CEP suggests that the program is meeting its primary goal of providing high-quality care, while realizing some degree of cost savings.
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