Dive Brief:

• Geisinger Health System found that using a new approach to delivering primary-care services to patients with Type 2 diabetes improved their health outcomes, lowering various health risks over a three-year period. The study appeared June 27 in The American Journal of Managed Care.
• Geisinger created an “all-or-none” bundled management system, looking at the big picture and not just patients' numbers (such as weight and other specific measures).  
• The study involved 4,095 diabetic patients in Geisinger's Diabetes System of Care and 4,095 diabetic patients not enrolled in the program. Researchers measured hazard ratios for each group, and found that adjusted hazard ratios for myocardial infarction, stroke and retinopathy were all significantly lower for patients in the former group. Moreover, most of the risk reduction occurred in the first year, suggesting that such efforts to improve quality care can work quickly.

Dive Insight:

Geisinger said how it achieved these results is as important as what was achieved. No extra staff were added; instead, it used a team-based model that redesigned roles and responsibilities in the primary care office "to have the staff work more together as a team to help the patients accomplish their goals,” said Thomas Graf, M.D., chief medical officer for population health at Geisinger Health System, and an author of the study. The physician remains in charge, but other team members perform other tasks, allowing the physician to focus on making complex medical decisions and motivating patients to meet their goals.

Geisinger conceded that change isn't easy and takes investment. Creating system-wide change requires constant evaluation, researchers said; improvements must be scalable across practice settings, and provider payment must be prompt to ensure ongoing progress and buy-in. Geisinger said its focus on type 2 diabetes makes sense in light of the "soaring incidence" of the disease: up 40% between 2007 and 2010. Nationwide, 26 million Americans have diabetes, most often type 2.