Diabetes: Opportunity To Improve Health Outcomes

Approximately 37.3 million Americans (about 1 in 10) have diabetes – over 11% of the population. Among adults diagnosed with diabetes, a disproportionate number of people affected are members of American Indian/Alaska Native, Latinx, and Black racial and ethnic groups.  Further categorizing diabetic incidence data, approximately 20% (21.4%) of adults age ≥65 years have a known diagnosis of diabetes. 

Between the years of 1997 and 2010, the prevalence of diabetes in older adults increased by 62%. Younger adults and children are also increasingly diagnosed with the disease; it’s now a major chronic disease affecting millions of people across their entire lifespan, with cumulative implications for other aspects of health and wellbeing.

These facts and other related data highlight both the prevalence of diabetes as a chronic disease in the U.S., and the importance of addressing risk factors influencing incidence within subpopulations to improve health outcomes.

Best practices foster continual improvement in health outcomes

For best practices to set standards, continual adjustment and refinement must take place in response to medical and technical advancements and trends in population health. 

The National Committee for Quality Assurance (NCQA) recognizes the necessity of meeting the care needs of diabetics and has put two efforts in motion, one for DRP and one for HEDIS®.

NCQA updates target better health outcomes

The NCQA is updating the Diabetes Recognition Program (DRP), setting the stage for more equitable diabetic care and management. Pending efforts prioritize brain health and use of technology tools to help clinicians understand, diagnose, and treat diabetes more effectively for improved outcomes.

Current DRP clinical quality measures

In its current state, the DRP is a 3-year accreditation that recognizes clinicians and practices within ambulatory care settings devoted to providing top care to patients with diabetes. Currently, providers seeking DRP recognition submit performance data of clinical quality measures on these topics:

• HbA1c control
• Blood pressure control
• Eye examinations
• Nephropathy assessment
• Foot examination
• Smoking and tobacco use cessation assistance

Updated DRP measures

Based on stakeholder input, NCQA is instituting programmatic changes to the DRP with a plan to incorporate new clinical quality measures targeting:

• The role of behavioral health in diabetes care management
• Advancements in glucose monitoring technology

The anticipated changes in the NCQA-DRP will allow for program modernization, featuring digital measure adoption and follow updated evidence-based best practices for assessing clinical quality measures and providing care to patients with diabetes.  

Public comment on HEDIS measures

The NCQA recently completed a public comment regarding the proposed expansion of Health Effectiveness Data Information Set (HEDIS®) measures aligned to additional themes that are a factor in the care of patients with diabetes. Input was requested for expansion of race and ethnicity measure stratification and for these proposed clinical quality measures: 

Emergency department visits for hypoglycemia in older adults with diabetes

Calculates a risk adjusted ratio of observed-to-expected emergency department (ED) visits for hypoglycemia in adults 65 and older with diabetes.

Social need screening and intervention

Assesses the percentage of members who were screened for unmet food, housing and transportation needs and received a corresponding intervention if needed.

Solving for healthier patients

It’s unclear at this time when the DRP measure changes will take effect and whether the proposed HEDIS measure suggestions will be adopted.  What is clear, however, is that the incidence of diabetes in the U.S. validates the necessity of these changes to improve health outcomes.

As the healthcare community continues to learn more about the disease, and as treatment tactics evolve in response to new evidence-based care guidelines, provider interests are well-served to remain current with NCQA modernization efforts to drive better health outcomes among diabetic patients.

RTI Rarity: identifies people and their needs to find the best intervention strategies 

The RTI Rarity™ AI tool generates data leading to insight that can inform targeted interventions capable of improving health outcomes for patients.

How can data become actionable? Social and behavioral factors make up for 80% of a person’s health outcomes; medical care alone is believed to be only 10-20% capable of affecting modifiable contributors. This in mind, it’s evident that to effectively improve people’s well-being and health, providers and payers need to understand related and contextual data affecting the behaviors, attitudes, and disease states of their patients and members.

RTI Rarity is an artificial intelligence (AI) risk adjustment tool that measures and adjusts for the behavioral and social factors that impact a person’s health.  Using a deep set of data sources, RTI Rarity generates a Local Social Inequity Score (LSI) that outperforms the commonly used tools such as ADI to explain health outcome disparities in a geographic area. The LSI score provides precise insight to health-related patterns experienced among high-risk populations. This knowledge empowers providers with intervention-based decision support to suit the unique needs of the local community.

Would you like to learn more about RTI Rarity and how we can support your health equity strategies? Visit our healthcare consulting solutions page.