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    All-or-none diabetes system could reduce costs of care

    An all-or-none diabetes care system that helps to automate the treatment of patients with type 2 diabetes may reduce long-term cost of care and improve health outcomes, according to the results of a study conducted by the Geisinger Health System published in the American Journal of Managed Care (AJMC).

    Despite the availability of evidence-based guidelines for the care of patients with type 2 diabetes, variation in care remains within the healthcare system. Daniel D. Maeng, PhD, of Geisinger Center for Health Research, and colleagues recently conducted a study of Geisinger’s newly developed all-or-none diabetes system of care (DSC) to determine if exposure to the system resulted in a reduction in costs.

    According to the study, the Geisinger system was redesigned to allow physicians to focus more on physician-related tasks like complex decision making and patient relationships. As part of this redesign, in 2006, it developed a DSC that included a nine-component all-or-none bundle made up of quantifiable measures of care based on commonly accepted clinical elements of diabetes care and intermediate outcome targets (ex, having HbA1c measured every 6 months and achieving an HbA1c of <7%).

    The all-or-none bundle measures the proportion of patients who achieve all of the recommended measures, instead of the average or composite of the individual measures. Incentive payments are made to the primary care team based on the number of patients who achieve all of the process and intermediate outcome measures.

    “In short, the all-or-none bundle system differs from typical diabetes care in that the system does not rely on diligence of individual primary care physicians (PCPs) to meet all the clinical guidelines,” Maeng told Medical Economics. “It is truly a ‘system of care’ that enables PCPs to provide the right care for every eligible patient. Moreover, it's a more advanced form of PCP performance measure, because physicians get credit for meeting all of the bundle elements.”


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