The most recent finalized data, from the Centers for Disease Control division on mortality statistics, reports diabetes as the 6th leading cause of death nationally in the year 2000.  Preliminary data on 2001 deaths show no change in its rank.  According to the State of Maine Diabetes Control Project, approximately 5.5% (70,000) Maine residents have diabetes mellitus (DM), but only about two-thirds have been diagnosed.  In 1997, the direct (medical care) and indirect (lost productivity) cost of diabetes in Maine was approximately $460 million ($98 billion nationally).  The economic burden of diabetes is enormous and disproportionate to the number of affected people in Maine.

In light of these statistics, and others, Medical Network will be working with the Maine Health Information Center (MHIC) and Harvard Pilgrim Health Care to gather, store and analyze outcomes data relating to diabetes care in Maine.  Using past and current Harvard Pilgrim claims information, MedNet will attempt to identify the diabetic population, then forward a list of all diabetic patients to their respective primary care physician as a simple paper based diabetic registry.  PCPs will be updated quarterly regarding testing status of those on their registry.  In addition, the PCP will receive a spreadsheet indicating the dates of the most recent tests each patient has had and for which tests the patient is due.  A letter addressed to the patient, informing him or her that it is time to schedule, i.e. an A1C, will be included in the mailing to aid the PCP in contacting the patient.

Using diabetes management HEDIS metrics over a recent two-year period, MedNet will examine how well physicians participating in the MedNet network compare to other physicians across Maine in the management of their diabetes patients.  At year’s end, in conjunction with the MHIC, we’ll present the PCPs with the analyses resulting from the data plan and also provide them with listings of their patients who may not have received certain tests within the time periods covered by the analyses.  This report is in addition to the quarterly report of patient testing progress throughout the year.

The proposed intervention is essentially an outreach to primary care physicians through the development of a centralized patient registry of all Harvard Pilgrim members with a primary or secondary diagnosis of diabetes.  MedNet will also screen its database of claims captured in the claims re-pricing process to identify enrollees with similar diagnoses in plans administrated by other MedNet payer clients for inclusion in the central registry.  Most physician groups in Maine do not have the systems or resources to track patient populations of any disease condition.   Furthermore, patients are often unfamiliar with or unmindful of the clinical protocols for their condition or are not sufficiently disciplined to ensure that best practices are followed, that medication is taken appropriately, and that necessary testing is performed with the proper frequency.

MedNet’s program is designed to support physicians in managing the patient’s treatment plan and to assist in the communications between physician and patient.  Additionally, physician practices will be informed on their HEDIS results, not just on the HPHC members, but on all of their patients enrolled in the plans of Maine Health Management Coalition ("MHMC") employers relative to the entire MHMC performance.  All aspects of this program will be conducted under strict HIPPA confidentiality guidelines.

If you have any questions regarding this program please contact Penny Thomas at pthomas@mainemednet.com or by phone at 207 773-5116 x118.