Measuring disparities. Huge disparities (differences) exist in our world.
Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo...
-
Upload
eric-carter -
Category
Documents
-
view
216 -
download
2
Transcript of Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo...
![Page 1: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/1.jpg)
Diabetes, Disparities, Demographics:Making a Difference
BCBSA Congressional Briefing
Eduardo Sanchez, MD, MPH, FAAFPVice President and Chief Medical Officer
Blue Cross and Blue Shield of Texas
October 12, 2011
![Page 2: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/2.jpg)
Place Matters
Determinant of Diabetes?
• People living in low-income communities are 80% more likely to be hospitalized for diabetes or related complications, compared with those living in affluent areas.
Source: AHRQ
![Page 3: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/3.jpg)
Relationship Between Social Determinants and Mortality in 2000
0 50 100 150 200 250 300
Area level poverty
Income inequality
Individual poverty
Low social support
Racial segregation
Low education level
Deaths (1000s)
Source: AJPHSource: AJPH
![Page 4: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/4.jpg)
Personal Choice or Healthy Food Accessibility?
• Low income areas have 1/3 fewer grocery stores than higher income neighborhoods.
• Corner stores and gas stations typically charge 1½ times the price of similar items in grocery stores.
• Not having automobile or adequate public transportation can reduce access to affordable, healthy food.
• Less expensive foods are often high in calories and fat.
• Limited time and knowledge of food preparation can increase demand and consumption of prepackaged or processed foods.
Community Health and Food Access: The Local Government Role; http://icma.org/activelivingCommunity Health and Food Access: The Local Government Role; http://icma.org/activeliving
![Page 5: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/5.jpg)
Diabetes Prevalence by Race/Ethnicity, Texas, 2008
State of Texas 9.7% 1,205,993
Race/Ethnicity Prevalence Estimated # of People
White, Non-Hispanic 8.3% 736,987
Black, Non-Hispanic 13.0% 251,543
Hispanic 11.1% 680,351
Other 7.5% 59,389
Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2008
Note: All reported rates (%) are weighted for Texas demographics and the probability of selection and thus are not derived from the simple division of numerator and denominator cases.Note: All reported rates (%) are weighted for Texas demographics and the probability of selection and thus are not derived from the simple division of numerator and denominator cases.
![Page 6: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/6.jpg)
Texas Projected Diabetes Cases 2000 - 2040
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
2000 2010 2020 2030 2040
Nu
mb
er
of
Dia
be
tes
Ca
se
s
Hispanic (Prevalence = 12.3%) Black, non-Hispanic (Prevalence = 12.9%)
White, non-Hispanic (Prevalence = 8.5%) TOTAL (Prevalence = 10.3%)
Source: Texas Diabetes Council; uses 2007 diabetes prevalence by race/ethnicity from BRFSS and population data from the Texas State Data Center - Office of the State Demographer, Institute for Demographic and Socioeconomic Research. Uses 0.5 migration scenario.
Source: Texas Diabetes Council; uses 2007 diabetes prevalence by race/ethnicity from BRFSS and population data from the Texas State Data Center - Office of the State Demographer, Institute for Demographic and Socioeconomic Research. Uses 0.5 migration scenario.
![Page 7: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/7.jpg)
New England Journal of Medicine 2010;363:1196-1199/23/2010
• There is a gap between the existing evidence that supports proven interventions and the translation of this knowledge into policy and practice.
• Diabetes care, simultaneous control of glucose levels, blood pressure, and lipid levels is achieved in less than 10% of people with diabetes.
• There is a consensus that effective and comprehensive strategies necessitate:
– a mix of evidence-based environmental, regulatory, and behavioral interventions at the population and individual levels;
– a shifting of health care systems from curative models suited to acute illnesses to more integrated primary care systems with considerable patient empowerment; and
– appropriate restructuring of financial and insurance systems.
![Page 8: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/8.jpg)
National Strategy for Quality Improvement in Health Care
• Better CareImprove the overall quality, by making health care more patient-centered, reliable, accessible, and safe.
• Healthy People/Healthy CommunitiesImprove the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.
• Affordable CareReduce the cost of quality health care for individuals, families, employers, and government.
![Page 9: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/9.jpg)
The Community Guide – Diabetes
• Health care system-level interventions
Case management interventions to improve glycemic control R
Disease management programs R
• Self-management education
– In the community gathering places (adults; type 2) R
– In the home (children, adolescents; type 1) R
– In the home (type 2) I
– In recreational camps I
– In worksites I
– In school settings I
Source: AHRQ
![Page 10: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/10.jpg)
BCBSTX Diabetes Control Strategy
• Community Health
• Member Education – Web Site
• Member Wellness
• Metabolic Syndrome Program
• Condition Management
• Bridges To Excellence
• Patient-Centered Medical Home
• Accountable Care Organizations
![Page 11: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/11.jpg)
Marathon Kids®
Kids walk or run 26.2 miles!
• Children participating in Marathon Kids exercised more, ate more fruits and vegetables, and had a better self-image than non-participants.
Promote Health/Prevent Childhood Obesity
• Free community and school-based program for K-5th grade
• Targets children most vulnerable to sedentary lives, obesity and Type 2 diabetes
• Challenges kids to run or walk 26.2 miles over six-month period
• Funded by corporations, foundations and private donations
• Offered in nine cities across the country, including Dallas, Houston, Austin, and El Paso
This program really works...
![Page 12: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/12.jpg)
About Bridges To Excellence
• Bridges to Excellence programs are offered nationally by the Health Care Incentives
Improvement Institute (HCI3)
• Organization awards recognition to clinicians who demonstrate that they provide quality
care that meets or exceeds established guidelines
• Recognizes clinicians in all 50 states with “formal” programs in more than 22 states,
including BCBSNM, BCBSOK and BCBSTX
• Has the potential to significantly improve the quality of care experienced by patients with
diabetes and to reduce the financial and human burden of unnecessary hospital visits
and complications
![Page 13: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/13.jpg)
Bridges to Excellence Results
Several studies have shown that BTE participation leads to:
![Page 14: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/14.jpg)
Recognized providers are more cost-effective in treating patients with diabetes
Source: Bridges to Excellence “Five Years On: Bridges Built, Bridges to Build,” 2003 - 2008
Promoting Quality Diabetes Care:Bridges to Excellence
Number of Diabetics with At Least One Episode
Year RecognizedNon-
Recognized
2003 271 294
2004 260 351
2005 290 368
Diabetes Costs per Patient by Type of Provider
![Page 15: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/15.jpg)
The BCBSTX BTE Program Experience
• Financial rewards program ($100 per BCBSTX patient per year) for physicians who have achieved BTE recognition in Diabetes Care and/or Cardiac Care
• Diabetes program initiated in June 2009 and Cardiac program started in June 2010
• In Texas, there are 356 Diabetes Care recognized physicians treating more than 14,500 members with diabetes
• Cardiac program has 168 Cardiac Care recognized physicians treating more than 1,300 members with cardiac disease
• BTE Program has paid out more than $975,000 in incentives since inception
• In 20 Texas counties, will give a bonus of $500 to any physician that is either currently recognized or achieves BTE Diabetes Care recognition by 12/31/2011 to cover data submission fees and offset administrative expenses for data collection and submission
![Page 16: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/16.jpg)
Salud por Vida/Health for Life
• Focus on Five Texas Counties
• SPV/HFL Initiative Goals
– Improve medical management of diabetes
– Ensure patients receive all recommended services
– Enhance the availability and provision of diabetes self-management education
![Page 17: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/17.jpg)
Energy Intake Energy Expenditure
Energy Balance
Individual Factors
Behavioral Settings
Social Norms and Values
Communities
Worksites
Health Care
Schools and Child Care
Home
Demographic Factors (e.g., age, sex, SES, race/ethnicity)
Psychosocial Factors
Gene-Environment Interactions
Other Factors
Government
Public Health
Health Care
Agriculture
Education
Media
Land Use and Transportation
Communities
Foundations
IndustryFoodBeverageRetailLeisure and
RecreationEntertainment
Physical Activity
Sectors of Influence
Food & Beverage Intake
A socio-ecological approach for preventing and a managing diabetes
Adapted from: Institute of Medicine, Progress in Preventing Childhood
Obesity, 2007, pg 20
![Page 18: Diabetes, Disparities, Demographics: Making a Difference BCBSA Congressional Briefing Eduardo Sanchez, MD, MPH, FAAFP Vice President and Chief Medical.](https://reader035.fdocuments.net/reader035/viewer/2022062717/56649e5f5503460f94b58c9d/html5/thumbnails/18.jpg)
results
Management vs. Prevention
Managing disease… Preventing disease…
…Great. …Better!