Medicaid Waiver Helping Drive North Texas Efforts Against Diabetes

The Texas Medicaid 1115 waiver has spawned a number of programs aimed at combating diabetes in Dallas-Fort Worth. Representatives of the three Regional Health Partnerships shared their efforts at World Diabetes Day in Grand Prairie last week.

Diabetes is the No. 1 diagnosis at Parkland’s 11 primary care clinics, said┬áNoel Santini, MD, medical director of adult medicine for community medicine at Parkland Health and Hospital System. Region 9, which is anchored by Parkland and includes Dallas, Denton and Kaufman counties, received $20.2 million to create a chronic disease registry to track retinal eye exams, 30-day readmissions, and medication management. It hopes to have 15,000 patients on the registry by 2016. The region also received $23.3 million to expand its chronic care management program for diabetes, congestive heart failure, and chronic kidney disease.

JPS is the Region 10 anchor. Dianna Prachyl, JPS vice president of community health, said 11 percent of JPs hospital admissions are diabetes-related. The region plans to use waiver funds to enhance team-based care, maximize electronic health records, and expand chronic care management.

JPS is seeking NCQA medical-home certification for its primary care clinics. The system has been hiring optometrists and clinical pharmacists for the clinics to create one-stop shopping for patients.

The waiver outcomes include greater monitoring of blood glucose levels and blood pressure, and more frequent diabetic foot exams. JPS treats about 17,000 patients.

Region 18 is concentrating on establishing or expanding services at primary care clinics in Collin, Grayson and Rockwall counties, consultant Claudia Coggin. A primary care clinic opened in September by Texoma Medical Center was Grayson County’s first.

YMCAs in Dallas, Fort Worth, and Arlington are among 17 associations that are offering free enrollment in the organization’s Diabetes Prevention Program to Medicare beneficiaries, according to Cheryl Boswell, vice president of membership and marketing for the YMCA of Metropolitan Dallas. The pilot project is funded by a Centers for Medicare and Medicaid innovation grant to determine whether DPP can save healthcare costs. There are 25 trained DPP coaches in Dallas and about 20 in Fort Worth and Arlington. The program has had more than 12,000 U.S. participants since it began in 2010, and the YMCA is increasing the availability of the program nationally to more than 600 locations.

The program is designed to prevent diabetes in those who are considered pre-diabetic, which includes one out of three U.S. adults, according to the Centers for Disease Control. Only 7 percent of pre-diabetics are aware of their condition.

The goals of the 12-month DPP program include a weight loss of 7 percent and 150 minutes of moderate physical activity. National Institutes of Health research found that the DPP program was more effective than the oral antidiabetic drug metformin in preventing the disease.

Nearly 10 percent of Texans have diabetes, including nearly one out of four over the age of 65. About 2 million residents have the disease, including more than 500,000 in DFW, at an annual cost of $12 billion each year. The number of cases is expected to rise to 3 million by 2040, according to the Texas Diabetes Council.

The American Diabetes Association now offers employers a free turnkey anti-diabetes program, called Stop Diabetes @ Work.

Based on Kaiser Family Foundation data, the ADA estimates that in a 1,000-employee company:

  • 100 employees have diabetes
  • 27 of them are undiagnosed
  • 250 have pre-diabetes
  • $2.7 million is the average annual insurance cost for employees with diabetes and pre-diabetes
  • $912,438 is the annual increased cost if 50 percent of employees with pre-diabetes develop diabetes

Steve Jacob is editor-at-large of D Healthcare Daily and author of the book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.

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