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Recent News:
Initiative Pledge Statements
Taking on Diabetes A Joint Initiative of the American Association of Health Plans and the American Diabetes Association Initiative Pledge Statements
AAHP and its member health plans are committed to providing the best health care with the best outcomes for people with diabetes. In adopting the pledge below, health plans express their resolve to reduce suffering and improve quality of life for people with diabetes. While realizing that these long term goals will require a long term commitment, health plans will hold themselves accountable to their pledge by evaluating their progress on a series of population-based goals and intermediate health care service objectives. To support its member plans as they seek to improve care for people with diabetes, AAHP will work to develop community coalitions of health plans, to educate the public, and to coordinate with professional and patient organizations.
1. Health plans pledge to reduce the incidence of irreversible vision loss through early detection and intervention for people with diabetes.
Baseline
By 30 years of duration of diabetes, 30% of patients have visual acuity worse than 20/40 in their best eye, and 10% are legally blind. Much of this is because of the development of proliferative retinopathy (which has a prevalence of 50% after 20 years of diabetes) which is missed, or treated too late (Diabetes Workgroup). Currently 46% of people with diabetes are screened annually for retinopathy (NCQA).
2. Health plans pledge to reduce the development of End Stage Renal Disease (ESRD) for their members with diabetes.
Baseline
The prevalence of proteinuria (macro albuminuria) is 30% after 30 years duration in type 1 diabetes, and 15 years duration in type 2 diabetes. Of those with proteinuria, 50% will develop End Stage Renal Disease (ESRD) requiring dialysis and/or transplantation within 10 years. For people with ESRD, the 2 year mortality is 60% and the 10 year mortality is 90%. Much of this could be avoided by screening for early nephropathy, reducing smoking, and better management of blood pressure (Diabetes Workgroup). Currently the range of nephropathy screening is wide, from a low score of six percent to as high as 44% (NCQA).
3. Health plans pledge to reduce the loss or partial loss of lower extremities from the loss of blood circulation and foot ulcers for persons with diabetes.
Baseline
The incidence of new foot ulcers among diabetic patients is 6% over a three year period (Diabetes Workgroup). The vast majority of these are preventable if we could identify which patients are at high risk, and then give those patients closer surveillance and prophylactic foot care education (Diabetes Workgroup). Currently 44% have foot examinations for foot ulcers (NCQA).
4. Health plans pledge to reduce the risk of cardiovascular disease associated with diabetes.
Baseline
People with diabetes are at two to four times the average risk for developing cardiovascular disease. In this population, heart disease disproportionately affects women. Heart disease for people with diabetes has a higher mortality rate than for the overall population. Tobacco use, elevated blood pressure, and high cholesterol accelerate the onset of cardiovascular complications for people with diabetes (Diabetes in America, 2nd edition, NIH).
Service and Access Objectives
For people with diabetes, health plans are committed to the following measurable targets:
- Increase the number of diabetic patients screened and treated for visual problems by 50% over 3 years;
- Reduce the number of diabetic patients placed on dialysis by 30% over 3 years;
- Reduce the number of new foot ulcers in diabetic patients by 50% over 3 years;
- Increase hemoglobin A1c testing rates for people with diabetes.
- In the first year of the initiative, AAHP and the participating plans will establish a baseline for this objective and set an improvement target;
- Increase hemoglobin A1c control for people with diabetes. In the first year of the initiative, AAHP and the participating plans will establish a baseline for this objective and set an improvement target;
- To increase control of cholesterol levels at levels below 200mg for people with diabetes. In the first year of the initiative, AAHP and the participating plans will establish a baseline for this objective and set an improvement target;
- Increase smoking cessation counseling for people with diabetes by 20% over 3 years.
Long Term Population-Based Goals
For people with diabetes, health plans are committed to the following long-term measurable population goals for people with diabetes:
- Reduce the incidence of blindness from 2.2 (USDHHS) to 1.4/1000
- Reduce the incidence of ESRD from 1.5 (USDHHS) to 1.4/1000
- Reduce the incidence of lower limb amputation from 8.2 (USDHHS) to 4.9/1000
References
Diabetes Workgroup - estimates developed based on health plan data provided by members of the AAHP Diabetes Workgroup.
NCQA - Proceedings from meeting of the Committee on Performance Measurement, 3/2-3/98.
USDHHS - United States Department of Health and Human Services, Healthy People 2000, National Health Promotion and Disease Prevention Objectives, 1990.
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