Heinz Nagel, MD
German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich Heine University of Duesseldorf, Germany
Thomas Baehring, PhD
German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich Heine University of Duesseldorf, Germany
Werner A. Scherbaum, MD, PhD
German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich Heine University of Duesseldorf, Germany
PDF version: 

Objectives: The objective of this study is to examine the acceptance of disease management programs (DMPs) for type 2 diabetes among patients as well as physicians in Germany.

Background: DMPs began in the United States in the 1990s. The German government developed interest in DMPs for specific conditions and implemented them nationwide in 2003 for patients with diagnosed type 2 diabetes. The goal was to improve the quality and efficiency of diabetes care nationwide. Participation in the program is voluntary for both patients and physicians.

Methods: Data were systematically collected from the publicly accessible Web sites of the Federal Insurance Agency (Bundesversicherungsamt) and the State Associations of Ambulatory Care Physicians (Kassenaerztliche Vereinigungen). In addition, these agencies were contacted directly by phone to verify the completeness and accuracy of the data.

Results: Since the national implementation of DMPs in Germany, the most dramatic growth in patient enrollment occurred during the first year with a doubling every three months until the 1 million mark was reached in July 2004. Since then the enrollment has shown a slower but steady growth rate, with 1.76 million patients with type 2 diabetes currently enrolled.

About 75 percent of primary care physicians have enrolled in a DMP. However, there are significant regional differences in enrollment rates from state to state.

Conclusions: About one third of all patients with type 2 diabetes and three quarters of all primary care physicians are currently enrolled in a DMP. This implies a high rate of acceptance by both patients and physicians. One of the main reasons for the success of the programs with regard to enrollment has been the passage of risk adjustment legislation, which created an incentive for health insurance companies to enroll patients with chronic conditions, rather than creating disincentives to enrollment. This finding may be of interest to other countries that already have DMPs in place or that are considering the introduction of DMPs into their health care system.

Early reports show an average improvement of glycemic control in enrolled patients, but further studies need to be done to examine whether this leads to an overall improvement in patient outcomes.

Author correspondence:
Heinz Nagel, MD, MHS
German Diabetes Center at the Heinrich-Heine-University of Duesseldorf WHO Collaborating Center in Diabetes
Auf'm Hennekamp 65
40225 Duesseldorf
Germany

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.