Results: Overview: To quantify the business case for health plan investments to improve diabetes care.
Methods: We used 10 years of health plan clinical and cost data to investigate the business case for improved diabetes care from the perspective of a single health plan (HealthPartners of Minnesota). Potential benefits accruing to a health plan from a diabetes care improvement program delivered through existing primary care clinics include medical care cost savings and higher premiums. Potential costs to the health plan derive from diabetes care improvement program costs and adverse selection.
Results : Implementation of a low-cost, integrated, primary care clinic-based diabetes care improvement program coincided with improvement in median A1c from 8.7% in 1994 to 6.8% in 2004. Amputation rate decreased from 10.7 to 4.5 amputations per 1000 adults with diabetes per year from 1994 to 2004. Substantial improvements in lipid control and heart attacks were also observed.
Cumulative discounted per patient program costs totaled $233 over 10 years, while cumulative discounted per patient net savings to the health plan were $5,345. Medical care cost savings over several years were small in the closed panel medical group but moderate for the health plan overall. We find evidence that adverse selection and the timing of cost and benefits worsen the health plan business case. In addition, the payment systems, from purchaser to health plan and health plan to provider, are very weakly connected to the quality of diabetes care, further weakening the business case for both health plans and for medical groups. Finally, overlapping provider networks create a public goods externality that limits the health plan's ability to privately capture the benefits from its investments.
Conclusion: It is clear that improved diabetes care affords economic benefits to health plans as well as valuable quality of life benefits to adults with diabetes. Improving the business case for investments in diabetes care at the medical group level may further accelerate diabetes care improvement.