20 Nov 2024
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Diabetes Awareness Month: MVC Highlights MCT2D Collaborations to Improve Diabetes Care

Diabetes Awareness Month: MVC Highlights MCT2D Collaborations to Improve Diabetes Care

November 20, 2024 | 0 Comments | , , ,

November is Diabetes Awareness Month, a time to bring attention to the growing prevalence and impact of diabetes as well as the importance of early diagnosis, effective management, and prevention. According to the CDC, diabetes is a leading cause of morbidity and mortality in the United States, affecting vital organs such as the nervous system, kidneys, heart, and eyes. In 2021, it was estimated that 38.4 million people of all ages had diabetes—more than 1 in 9 adults in Michigan alone—a number that continues to rise globally. Additionally, recent studies show that 98 million American adults have prediabetes, putting them at high risk for developing Type 2 diabetes (T2D). The need for increased awareness and proactive care has never been more urgent.

Despite being one of the most prevalent chronic conditions worldwide, T2D is largely preventable. Given its chronic nature, it is essential to advocate for widespread access to patient resources, leverage data analytics to pinpoint areas for improvement, and ensure that all individuals across Michigan have the opportunity to access care that can prevent the disease from progressing.

MVC Offerings for T2D Care

MVC is committed to using claims-based data to improve the health of Michigan through sustainable, high-value healthcare. Recently, MVC expanded its focus to address T2D and its complications. In March 2024, MVC incorporated two high-volume emergency department (ED) conditions into its new ED-based episodes: diabetes with long-term complications (e.g., renal, eye, neurological, and circulatory issues) and short-term complications (e.g., ketoacidosis, hyperosmolarity, or coma). These ED-based episodes were developed in partnership with MEDIC and can be used to generate custom analytics for any MVC hospital or physician organization member.

MVC also has ongoing collaborations with the Michigan Collaborative for Type 2 Diabetes (MCT2D) to identify opportunities to improve care for T2D patients and evaluate the impact of CQI initiatives. Currently, both teams are partnering on a value exercise to assess whether practices participating in MCT2D reduced the use of certain diabetes medications compared to non-participating sites. This work will provide valuable insights into medication utilization.

More recently, MVC’s collaboration with MCT2D led to the creation of a new report on T2D in Michigan. It provided demographics and analyses for patients with T2D in Michigan insured by Blue Cross Blue Shield of Michigan (BCBSM), Blue Care Network (BCN), Medicare Fee-for-Service (FFS), and Michigan Medicaid between 2017 and 2023. The report also integrated pharmacy prescription claims. The report showcased several key trends, including:

  • A notable decrease in ED utilization and hospitalizations for T2D care from 2017-2023 (Figure 1).
  • An increase in visits with primary care providers (PCPs) and specialists, such as endocrinologists and nephrologists (Figure 2).
  • A shift in prescription utilization, with increased use of newer medications like GLP-1 receptor agonists and SGLT2 inhibitors, while the use of older therapies such as insulin and sulfonylureas declined (Figure 3).

Figure 1. Yearly Rates of ED Utilization Among T2D Beneficiaries, 2017-2023

Figure 2. Yearly Rates of Provider Visit Utilization Among T2D Beneficiaries by Provider Type

Figure 3. T2D Medication Utilization Among Beneficiaries with T2D, 2017-2023

The report also highlighted important demographic trends, including that T2D patients in Michigan are, on average, older, more likely to be male, and more likely to be Black, with a higher prevalence of non-commercial insurance coverage. These insights are helping MVC and MCT2D to focus their future efforts.

Looking Towards the Future

Although the prevalence of diabetes is a significant challenge, the innovative efforts of groups such as MCT2D and the American Diabetes Association provide hope for the future. MVC is excited to complete and share its value exercise with MCT2D in 2025, as well as continue to build on its offerings to MVC member hospitals and physician organizations for diabetes-related improvement projects.

Diabetes Awareness Month offers an opportunity to reflect on the challenges faced by millions living with diabetes, while also recognizing the significant progress being made in the fight against the disease. With the continued support of healthcare professionals, organizations, and communities, MVC is committed to improving care, prevention, and education. Together, we can raise awareness, improve outcomes, and provide support for those affected by diabetes.

24 Sep 2024
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MVC, MCT2D Introduce New State-of-the-State Report on Type 2 Diabetes in Michigan

MVC, MCT2D Introduce New State-of-the-State Report on Type 2 Diabetes in Michigan

September 24, 2024 | 0 Comments | , , , , ,

Chronic disease management was a key driver of healthcare utilization over the last decade and has been cited as the most expensive chronic disease in the U.S. In response, MVC recently partnered with the Michigan Collaborative for Type 2 Diabetes (MCT2D) to develop a statewide report on Type 2 Diabetes (T2D), a chronic illness that impacts over 1 million adults in Michigan. This new report was recently shared by both MVC and MCT2D at the Michigan Obesity Summit and will be distributed to MVC member hospitals later this week.

The report summarized demographics, healthcare utilization, and prescription patterns among those patients with T2D in Michigan insured by Blue Cross Blue Shield of Michigan (BCBSM), Blue Care Network (BCN), Medicare Fee-for-Service (FFS), and Michigan Medicaid between 2017 and 2023. To create this report, MVC first used its claims data to identify beneficiaries aged 18 and older with a qualifying T2D diagnosis in the past year. After identifying annual cohorts of beneficiaries with T2D for each year, 2017-2023, MVC assessed annual utilization of T2D prescription medications, emergency department (ED) visits, inpatient hospitalizations, and provider visits.

MVC assessed filled prescriptions among T2D beneficiaries with corresponding prescription coverage using its pharmacy claims. This was the first time MVC included prescription claims data in a member push report and the first time that prescription claims from all MVC payer sources were utilized in a single MVC analysis. Medicare beneficiaries were excluded from 2022 and 2023 prescription utilization rates because Medicare pharmacy claims were only available through 12/31/2021. Diabetes-related drug classes were identified in pharmacy claims based on National Drug Code (NDC) as well as standardized prescription names and classes.

Newer medications such as GLP-1 receptor agonists and SGLT2 inhibitors are frequently prescribed to improve glucose control, reduce mortality, slow kidney disease progression, and aid in weight loss. The American Diabetes Association now recommends the use of these medications for patients with cardiovascular disease, kidney disease, and obesity. In keeping with these guidelines, MVC’s analyses indicated a large increase in utilization of GLP-1 receptor agonists (3.1% to 18.6%) and SGLT2 inhibitors (2.3% to 14.2%) between 2017 and 2023 (Figure 1). In the same period, prescriptions decreased from 2017 to 2023 for insulins (20.9% to 16.5%) and sulfonylureas (17% to 10.9%).

Figure 1.

Demographic characteristics including age, sex, race (Figure 2), and insurance provider (payer) were described within the report for all beneficiaries with T2D across all payers 2017-2023 and compared to the characteristics of all beneficiaries reflected in MVC data during those years. Compared to all beneficiaries, those with T2D were older, with an average age of 66 years versus the average of 43 years among all beneficiaries. T2D beneficiaries were also more likely to be male (50% vs 43%), Black (20% vs 15%), and more often covered by non-commercial insurance plans (45% vs 28%).

Figure 2.

From 2017 to 2023, rates of diabetes-related ED visits and hospital admissions remained relatively infrequent among T2D beneficiaries. Around two percent of T2D beneficiaries visited an ED for a reason related to diabetes each year, and one percent were hospitalized in relation to diabetes. ED utilization unrelated to diabetes decreased from 37.4% in 2017 to 33.1% in 2023 among T2D beneficiaries (Figure 3). Hospital admissions unrelated to diabetes decreased from 21.3% to 16.4% (Figure 4).

Figure 3.

Figure 4.

In contrast, T2D beneficiaries saw primary care physicians, nephrologists, and endocrinologists more frequently between 2017 and 2023, with observed increases for all three provider types (Figure 5). Most notably, visit utilization with primary care providers increased from 18.3% to 32.9%. Nephrologist visit utilization increased from 1.2% to 2.2%, and endocrinologist visit utilization increased from 1.9% to 3.6%.

Figure 5.

This new report created in partnership with MCT2D provided a high-level overview of healthcare utilization among T2D beneficiaries within Michigan. Since the analyses utilized data derived from medical insurance claims, one key limitation was the exclusion of uninsured individuals as well as key indicators of T2D outcomes that are not accurately captured in claims data, such as HbA1C levels, blood pressure, continuous glucose monitor utilization, and retinopathy screening. Despite these gaps, the data revealed promising trends in diabetes care, including increased primary care visits, greater use of guideline-directed medications proven to show significant benefit, and reduced emergency department visits. MVC’s analyses also underscored areas for improvement, such as the need to address health equity gaps and continued promotion of guideline-directed medical therapy.

MVC will share copies of the completed report directly with members later this week, and a copy is also available on the MVC website [PDF]. If you are interested in pursuing a custom analysis for any of these measures or a different tailored custom analysis, please reach out to MVC.

02 Mar 2023
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MVC, MBSC Estimate Significant Diabetes Medication Savings Following Bariatric Surgery

MVC, MBSC Estimate Significant Diabetes Medication Savings Following Bariatric Surgery

March 2, 2023 | 0 Comments | , , ,

Diabetes is commonly cited as the most expensive chronic disease in the U.S., accounting for over $37 billion in 2017. As many as 1 in 10 Americans have been diagnosed, 90-95% of whom have Type 2 diabetes. Management of Type 2 diabetes involves healthy eating, physical activity, and often taking medication prescribed by a doctor, such as insulin, other injectable medications, or oral diabetes medicines to help manage blood sugar. It is both clinically and economically significant, then, that the Michigan Value Collaborative (MVC) was recently part of an analysis that estimated over $76.5 million in insurance savings on prescription diabetes medications after patients underwent metabolic surgery.

MVC identified these savings in partnership with the Michigan Bariatric Surgery Collaborative (MBSC) last year and published their findings in a co-authored research letter in JAMA Surgery. This work was featured recently by the medical news site Medpage Today.

The partner project was initiated by MBSC in 2022 to help assess the impact of bariatric surgery on prescription fills for diabetes medications across the state of Michigan, driven largely by existing evidence in the literature that bariatric surgery resolved or improved Type 2 diabetes symptoms in a large proportion of patients (Varban et al., 2022). MBSC is a regional group of hospitals and surgeons that aim to innovate the science and practice of metabolic and bariatric surgery through comprehensive, lifelong, patient-centered obesity care.

Using its rich administrative claims data sources, the MVC team first analyzed pre-surgery and post-surgery receipt of diabetes medications, which was then used to estimate a high-level snapshot of the overall impact across Michigan. MVC's analysis included estimated cost savings to health insurance providers that could be attributed to a decrease in post-surgery diabetes medication prescription fills.

The analysis used bariatric surgery episodes for Roux-en-Y Gastric Bypass (RYGB) and sleeve gastrectomy hospitalizations. It was limited to bariatric surgery patients with a diagnosis of Type 2 diabetes who filled an outpatient diabetes medication prescription prior to their discharge. The analysis focused on episodes with index admissions between 2015 and 2021 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial and BCBSM Medicare Advantage plans for individuals who were continuously enrolled in a prescription sub-plan. This amounted to 760 patients with Type 2 diabetes undergoing gastric bypass (22%) or sleeve gastrectomy (78%) between 2015 to 2021.

In the 120 days prior to surgery, MVC found that 88% of patients filled an outpatient oral diabetes medication prescription, 30% filled an insulin prescription, and 21% filled a GLP-1 receptor agonist prescription. From the 120 days pre-surgery to the 120 days post-surgery, there was a significant decrease in fills for any diabetes medication (p<.001). The most frequent change in medications between pre- and post-surgery was from oral diabetes medication to no diabetes medication. In the 1 to 120 days following surgery, half (50%) of patients filled no diabetes medication prescriptions, and in the 121 to 240 days following surgery, most patients (63%) filled no diabetes medication prescriptions (see Figure 1).

Figure 1.

This amounted to an average decrease in diabetes prescription payments made by the insurance provider of approximately $4,133 per patient in the first year following surgery. Given that 34% of bariatric surgery patients have diabetes and 54,454 bariatric surgeries were performed in Michigan between 2015 and 2021, MVC estimated that insurance providers in Michigan saved $76.5 million on diabetes medications in the 360 days following bariatric surgeries in 2015-2021. In addition, data suggest that savings would continue to increase in future years due to long-term diabetes remission and cost benefits from optimized diabetes management. These results provide evidence of significant statewide clinical outcome improvement and cost savings for Type 2 diabetes following bariatric surgery.

These findings and their implications were also highlighted recently during an MVC workgroup featuring Dr. Oliver Varban of MBSC as the guest speaker. See below for a complete recording of his insightful presentation about bariatric surgery, its impact on chronic disease management, and more.

MVC’s expertise and data frequently result in partner projects like this; MVC completed three other CQI impact assessments last year (Figure 2). These projects are an example of MVC’s interest in CQI collaboration, which is also demonstrated through new condition and report development, data analysis and metric consultation, and data matching exercises that pair clinical and claims-based data.

Figure 2.

To request a copy of any of MVC’s completed impact assessments from 2022 or prior, please contact the MVC Coordinating Center.

24 Jun 2021
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Continuous Glucose Monitoring Has Potential in Inpatient Setting

June 24, 2021 | 0 Comments | , ,

One of the most prevalent comorbidities in the United States is diabetes; as many as 1 in 10 Americans are diagnosed with this condition, and 90-95% having potentially preventable Type 2 diabetes. It is well documented that unstable blood glucose levels can contribute to increases in morbidity, mortality, and healthcare costs.

In the inpatient setting, the current standard of care for monitoring and testing blood glucose levels in diabetic patients is point-of-care (POC) testing, which combines a specific testing schedule and approved devices to measure blood glucose levels. A recent study involving 110 adults with Type 2 diabetes looked at implementing real-time continuous glucose monitoring (RT-CGM) in order to better manage inpatient glycemic levels. The patients were on a non-intensive care unit (ICU) floor, and received either the standard of care or the RT-CGM with Dexcom G6 monitoring—where a tiny sensor wire is inserted just beneath a person’s skin using an automatic applicator. Data was transmitted from the bedside wirelessly, and monitored by hospital telemetry. The bedside nurses were notified of any abnormal glucose levels or trends and the patients were treated accordingly. The results indicated that patients in the RT-CGM group demonstrated lower mean glucose levels and less time in hyperglycemia.

Another study that evaluated the efficacy of RT-CGM discussed the effect that uncontrolled glycemic levels can have on clinical outcomes and healthcare costs. Currently, hospitals use POC glucose testing in order to monitor and treat hypoglycemia, and it is recommended that POC testing occur four to six times per day. However, this leaves many hours throughout the day where hypoglycemia can go undetected. RT-CGM using a glucose telemetry system (GTS) offers an alternative method to monitor these glucose values. A total of 82 patients participated in this study. Patients in the RT-CGM group experienced 60.4% fewer hypoglycemic events compared to the POC group. Figure 1 below illustrates the number of hypoglycemic events per patient for both the CGM/GTS and the POC.

Figure 1.

RT-CGM has yet to be implemented in inpatient settings for several reasons. The primary reason is the lack of U.S. Food and Drug Administration (FDA) approval. Additionally, institutional challenges may act as a significant barrier. For instance, staff need to be prepared for increased workload and educated on appropriate protocols and procedures. Technological support is required to ensure hardware compatibility and maintain a robust internet network with minimal interference in transmission of results and alerts. Additional factors within the hospital setting include certain medications, procedures, nutrition, acute illness, and any other condition that may affect glucose control. All of these challenges have the potential to impact CGM and its associated workload because of the effect they may have on the patients’ blood glucose levels. Although challenges remain to the implementation of RT-CGM in the inpatient setting, the benefits may outweigh the risks; thus, it is worth considering, especially given the successes in the outpatient arena.

The Michigan Value Collaborative hosts diabetes workgroups where topics such as continuous glucose monitoring are discussed by Collaborative members. If you are interested in attending the next MVC diabetes workgroup, please connect with the MVC Coordinating Center at: michiganvaluecollaborative@gmail.com.