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For ADA, 'new era' of health care offers opportunities for population impact
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ORLANDO, Fla. — The health care costs of diabetes and the continued disparities in diabetes treatment related to race and socioeconomic status underscore the key challenges health care transformation seeks to address, and several new American Diabetes Association initiatives are designed to meet these population health needs, according to a speaker here.
Diabetes is ranked No. 1 among all health conditions in costs to health care and public health systems, with $1 of every $4 in health care-related spending going to care for people with diabetes, Felicia Hill-Briggs, PhD, ABPP, president of health care and education for the ADA and a professor of medicine, health, behavior and society and acute and chronic care at Johns Hopkins University School of Medicine, said during a special lecture at the ADA Scientific Sessions. Despite spending on diabetes care and treatments, diabetes outcome metrics have not improved significantly at the population level, Hill-Briggs said.
“Diabetes risk prevalence, morbidity and mortality continue to differ by race and ethnicity and by socioeconomic status, and measurable disparities in care persist, with racial and ethnic minorities and lower income individuals receiving lower quality of diabetes care,” Hill-Briggs said. “Hence, diabetes underscores the challenges health care transformation seeks to address.”
Hill-Briggs spoke of her own struggles to gain access to basic care. Diagnosed with type 1 diabetes in 1975 at age 9 years, Hill-Briggs was treated at a segregated hospital on the west side of Baltimore, where she was the first case of type 1 diabetes providers in her practice had seen, she said. Without a knowledgeable care team, proper information or a community of peer support, Hill-Briggs said she relied on the ADA’s Diabetes Forecast magazine as her only source of information about her diagnosis.
“Everything was a big black box,” she said. “The only person I knew with diabetes was Mary Tyler Moore. She became my role model.”
Due to Hill-Briggs’ preexisting condition, she struggled to find health insurance, and diabetes supplies were often unaffordable, she said. As she went on to train as a clinician and researcher and the impact of diabetes in the United States intensified, she set out to focus on meeting the needs of underserved and underrepresented populations who struggle with the disease.
Health care transformation
The components of health care transformation are multifaceted and include the health of populations, health equity and intervening on the social determinants of health, providing the right care in the right place at the right time and an emphasis on the use of data to identify populations, monitor outcomes and ensure initiatives have impact, Hill-Briggs said.
“Collectively, this is population health, and this has implications for ADA,” Hill-Briggs said.
The settings of population health are many, and people with diabetes need the right care at the right time with the right work force, Hill-Briggs said. Care often takes place in hospitals, but far more opportunities exist in local communities, homes and even faith-based organizations, she said. To create an attainable population health impact, ADA is engaging health systems and aligning stakeholders to meet population health objectives with several programs:
National Diabetes Prevention Program dissemination and implementation — In 2017, the ADA, CDC and American Medical Association and the Ad Council launched a new prediabetes risk-assessment campaign that encouraged people to take a 1-minute prediabetes risk test to learn how they can reduce their risk for type 2 diabetes. Those identified as high risk were advised appropriate diagnosis and enrollment in the CDC’s National Diabetes Prevention Program (DPP), whereas those at low risk were given appropriate information and guidance.
“Goals are to reach 20 million people to take the risk test, with the result being 2.5 million people referred to a national DPP,” Hill-Briggs said. “To ignite this movement, we will engage you, our members, our supporters, our partners, our stakeholders.”
The next ADA initiative is scaling DPP dissemination to key underserved populations, she said.
Diabetes INSIDE — The program name, which stands for inspiring system improvement with data-driven excellence, is designed to fill exactly that need, Hill-Briggs said. The program integrates the ADA’s Standards of Care and professional education initiatives with national health care systems to improve population outcomes for people with diabetes. It applies the population health data science and analytics to tailor interventions to the needs, goals, resources and demographics of health care partners and populations. Since 2012, Diabetes INSIDE has been used in eight health care systems and has now expanded to regional collaboratives bringing group of health care systems together, Hill-Briggs said.
Mental health provider education directory — The ADA and the American Psychological Association partnered to create the first-ever, diabetes-focused, continuing education program for licensed mental health providers, Hill-Briggs said. The mental health provider directory is now available online through the ADA website. “I encourage all professionals to help direct mental health practitioners toward this phenomenal program to increase the work force available to all patients with diabetes,” Hill-Briggs said.
Addressing the gaps
Despite the best efforts of the ADA, some groups of the population remain “left behind,” Hill-Briggs said. However, efforts are underway to address these gaps in underserved communities.
“People with diabetes in the community where I was born fare no better today than was the case in the era when I was diagnosed,” Hill-Briggs said. “The social determinants of health scientific review committee will conduct a rigorous review and synthesis of the literature on social determinants in diabetes outcomes specifically, and the impact of social determinants intervention approaches on outcomes. This will serve as an authoritative, up-to-date resource on social determinants and diabetes to inform our clinical and community practice and identify research gaps.”
International population health initiatives are also underway, Hill-Briggs said, adding that she looks forward to the uptake of the ADA’s population health directions around the globe, to achieve true diabetes population health improvement.
“I hope you are as energized as I am about health care and education at the American Diabetes Association,” Hill-Briggs said. “This is a new era with new opportunities for population impact, and through initiatives and collaborations underway, such as the risk test campaign, the National Diabetes Prevention Program dissemination program, Diabetes INSIDE, the mental health provider training and referral directory, and our social determinants of health review, the ADA’s relevance in this era is palpable and measurable.” – by Regina Schaffer
Reference:
Hill-Briggs F. The American Diabetes Association in the era of health care transformation. Presented at: American Diabetes Association 78th Scientific Sessions; June 22-26, 2018; Orlando, Fla.
Disclosure: Hill-Briggs is president of health care and education for the ADA.