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- MHealthy: Focus on Diabetes
- Diabetes:
Background Information
- Questions & Answers
- Diabetes Resources
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Focus on Diabetes Honored by National Health Care Leaders
The MHealthy: Focus on Diabetes Program received a Driving Value in Health Care Award sponsored by a coalition of health care leadership organizations including the National Business Coalition on Health, The Leapfrog Group and Bridges to Excellence. The award was presented at the May 16 Advancing Value Driven Health Care Incentives and Rewards Symposium. Principle program investigator Allison Rosen, M.D., Sc.D., an assistant professor of internal medicine and health management and policy at U-M, commented on the award by saying: “We implemented this program to improve both the quality and value of care for our workforce with diabetes. In turn, it is our hope that a rigorous evaluation of the impact of these targeted value-based co-pay reductions may help inform the efforts of other employers and insurers trying to improve the value of their health care spending.”
Click here to read the May 21, 2007 University Record article about the award.
MHealthy: Focus on Diabetes is part of the Michigan
Healthy Community Initiative, a major initiative announced
in 2004 by President Mary Sue Coleman to:
- Promote the health and well-being of the U-M community
- Advance public discussion and social commitment to change in this area by developing, testing, and studying efforts to improve community wellness
- Develop more cost-effective delivery of health care as a model for other institutions
MHealthy: Focus on Diabetes is a ground-breaking
program that will eliminate or reduce the cost of selected
medications for U-M employees and dependents who have diabetes.
The two-year pilot program begins on July 1 and
will encourage the proper and sustained use of specific drugs
that affect blood sugar, blood pressure, cholesterol
and depression and help prevent or reduce the long-term complications
of diabetes.
Who receives the co-pay reductions?
All U-M employees and their dependents will be
enrolled in the program automatically if they previously filled
a prescription through the U-M Prescription Drug Plan for a
blood sugar-controlling medication or insulin. Program participants
will be charged no co-pay for generic drugs that control blood
sugar and no co-pay for certain other generic drugs used to
treat common complications of diabetes like high blood pressure,
heart and kidney disease and depression. A reduced co-payment
will be charged for brand-name drugs.
No action is needed to participate in the program
since the U-M pharmacy plan will recognize the co-pay reductions
for eligible drugs at the time a prescription is filled. There
is no submission or review of personal medical records.
Those employees who filled a prescription for a qualifying
drug will receive a mailing to their homes with details by
the end of June.
Filling prescriptions for blood-sugar controlling
medications or insulin qualifies individuals
for the program. Once qualified, those individuals will also
receive reduced or eliminated co-pays for certain other drugs
(beta-blockers, calcium channel blockers, antihypertensives,
diuretics, antihyperlipidemics, and antidepressants) where
evidence shows that those with diabetes who are on these medications
have decreased complications from their disease.
Research at the University of Michigan Center for Value Based Insurance Design has demonstrated that specific, targeted co-pay relief could improve quality of care and help contain costs. This program ties employer decisions about co-pay amounts to the long-term health benefit of specific drugs among people with diabetes.
Why is the University doing
this?
We believe this program is good for
the health of U-M employees and their dependents. And we hope
that by preventing or slowing the complications of diabetes,
such as heart attacks and kidney damage, we can help contain
the amount and cost of the care that participants will need
in the future. We will evaluate the program’s costs and any
cost-savings that are realized over the long term as an employer.
Objective evaluation is crucial to determining outcomes and
helping other organizations adopt strategies
that encourage good health while helping to contain health
care costs.
Controlling long-term treatment costs through
prevention can help curb the rate of increase for overall
health care costs in our society. MHealthy: Focus on Diabetes
will test a direct investment in individual health for a specific
disease where there is great potential value to improve community
health and reduce public health costs.
This project is in conjunction with a much broader
MHealthy health-improvement effort that is now under way throughout
the three campuses of our University. The other components
of the Michigan Healthy Community Initiative address health
issues that are important for all, including regular exercise
and safe working environments and habits.
WHY DIABETES?
Diabetes was chosen for several important reasons:
- There is a large U.S. population of individuals with diabetes
Diabetes facts:
- 20.8 million Americans, or 7 percent of the population, have diabetes.
- Diabetes costs America $132 billion each year in medical costs, disability, work loss and premature death.
- Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2002
- Medication adherence is just 50% among individuals with diabetes nationally and within the U-M community
- Because many people with diabetes take multiple medications, as many as 10 to 12, their out-of-pocket co-pay and other expenses can add up. The U-M benefit design includes a single prescription drug plan for most employees and dependents, making it feasible to assess whether lowering outpatient drug co-pays increases adherence and benefits people’s lives.
- Medications are the cornerstone to preventing or slowing the progression of complications of diabetes, including heart attacks, strokes, nerve damage, eye damage, and kidney damage.
- Poor adherence to medication can result in significantly
faster progression of diabetes complications, which lead
to avoidable hospitalizations, and can contribute to premature
disability or death (adherence to medication reduces mortality
by up to 50%).
The goal is to increase compliance with drug therapy by:
- Understanding and reducing barriers
- Addressing a combination of factors including patient drug co-pays, patient education, case management, and patient beliefs to target those diabetes patients who are most likely to begin using, or stick to, the drugs that can help them the most.
- Using proven preventive interventions in areas where services are now underutilized and greater utilization has been shown to be of great value to health improvement and long-term cost control.
Other diseases, such as heart disease, will be considered for future evidence-based programs using the same consistent criteria, i.e. services or medications are underutilized and high rates of utilization are proven to be of great medical value for health improvement as well as long-term cost reduction by prevention of complications, avoidable hospitalizations, and disease progression.
HOW WILL THE PROGRAM WORK?
Beginning July 1, 2006, all employee members of the U-M Prescription Drug Plan and their dependents will be charged no co-pay or a reduced co-pay when filling prescriptions for specific classes of drugs that control blood sugar.
The program utilizes the existing tiered co-pays in the U-M drug plan. There is no co-pay for generic drugs and co-pays are reduced 50 or 25 percent when a patient is prescribed a brand name drug in tiers two or three respectively.
Participants receive educational materials on health improvement and the importance of consistent use of medications for reduction of diabetic complications.
All faculty and staff and their dependents with U-M prescription drug coverage (regardless of the medical insurance plan they have chosen) are eligible. Those who filled a prescription for blood-sugar controlling drug or insulin by May 1, 2006 will automatically be charged no co-pay or a reduced co-pay when filling a prescription for a designated drug. Those who did not fill a blood-sugar controlling prescription by May 1, but who have diabetes and want to enroll, may do so. Approximately 2,100 employees currently fill prescriptions for blood-sugar regulating medications. No registration is required and there is no review of personal medical records.
Drug classes included in the program are antidiabetics
and insulin. Those who fill prescriptions for these medications
will also be eligible for eliminated or reduced co-pays on
the following classes of drugs: Beta-blockers, calcium channel
blockers, antihypertensives, diuretics, antihyperlipidemics,
and antidepressants. The program is also designed to encourage
individuals who need medication for diabetes, but who are not
taking it, to speak with their physicians about whether they
might benefit from taking any of the eligible medications regularly.
An additional feature will be available to employees and dependents covered by M-CARE medical insurance. They will receive free annual eye exams for early detection of diabetes-related retinopathy in addition to the free and reduced-cost drugs.
The effects of the pilot program will be evaluated to determine whether reducing the cost barrier for drug products increased adherence to medication regimens and reduces overall health expenditures. The results of the evaluation will help determine whether the program continues.
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