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    How to improve diabetes outcomes under value-based care

    Visitors to the office of Sandra Adamson Fryhofer, MD, might notice it contains a few surprising features.

    First are the two yoga mats—one for her and one for her patients—that she uses to demonstrate stretches. Second are the brochures listing local gyms and community health programs. Sometimes she even downloads and prints upcoming gym class schedules during appointments—all with the goal of empowering patients to control their diabetes. 

    “When you give people specifics, I really feel that this makes a difference,” she says. “I try to use the office visit as an opportunity to not only talk about what they need to do, but also how they can do it.”

    Working diligently to motivate patients—especially those with diabetes—is something that primary care physicians must do if they want to be successful under Medicare payment reform. In particular, physicians must help patients achieve and maintain a healthy hemoglobin A1C level and focus on care coordination with specialists. Doing so helps boost a physician’s Merit-based Incentive Payment System (MIPS) composite performance score, which translates directly to additional reimbursement. 

    Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), physicians must persuade patients to take care of themselves, says Tina Colangelo, MHA, a consultant specializing in value-based reimbursement. The question is, how? 

    Our experts provide nine tips for improving outcomes and care coordination.


    1. Talk about diabetes management 

    Even when the purpose of the visit is unrelated to diabetes, it should be a topic of conversation during the visit. 

    “If it’s a priority for the doctor, then it becomes more of a priority for the patient,” says Mary Ann Bauman, MD, an internist employed by INTEGRIS Health in Oklahoma who also serves on the Medical Economics Editorial Advisory Board. 

    Bauman makes a point of asking about exercise, diet and insulin even when patients present for an ailment such as a sore throat or cough. These conversations keep patients engaged in diabetes management and increase the likelihood of a healthy hemoglobin A1C level.


    2. Brush up on communication skills

    The goal is to keep inspiring patients to take actions that improve outcomes. Here are three tips:

    Start each visit with an open-ended question. Ask patients to identify what’s most difficult in terms of managing their diabetes, says Steven V. Edelman, MD, an endocrinologist and founder of Taking Control of Your Diabetes, an organization that provides diabetes education to patients and physicians. “Then the key is that you have to listen. You can’t interrupt and you also need to have empathy,” he adds. 



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