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DIABETES AND
OBESITY

works, and (full or partial) capitation . These tools may change enough that the doctor saw the patient, they also need to make
how physicians practice medicine for all of their patients; not just sure that the prescribed treatment is heading in the right directions
those in the managed care plan. regarding outcomes.
As the financial incentives change, so do the behaviors of the
Star Ratings are driving improvements
providers. Paying physicians for improved outcomes as opposed
in Medicare quality. The Star Rating
to episodic care aligns the financial incentive with the desired im-
measures span five broad categories:
proved outcome. Center for Medicare and Medicaid Services
(CMS) is very interested in physicians that understand how to per- OUTCOMES
form population health management functions. CMS understands INTERMEdIATE OUTCOMES
that physicians that understand the benefit of population health PATIENT EXPERIENCE
management should be paid for their patients’ improved health- ACCESS
care outcomes. PROCESS
Population health management involves many aspects of man-
aging a patient. The goal is to assure that for a given disease; the Not every domain is weighted equally, however. For 2017 Star
patient is contacted, treated, followed-up, and the outcome is im- Ratings, outcomes and intermediate outcomes continue to be
proved. There have been some early elementary attempts of trying weighted three times as much as process measures, and patient ex-
to get physicians to adopt components of population health man- perience and access measures are weighted 1.5 times as much as
agement. The Healthcare Effectiveness data and Information process measures. CMS assigns a weight of 1 to all new measures.
(HEdIS) is one such attempt. Of the 364 health plan contracts that participate in Medicare Ad-
HEdIS is a tool used by more than 90 percent of America's vantage, there were only 81 with a STAR rating of 4.5 or higher.
health plans to measure performance on important dimensions Physician’s manage one patient at a time. Throughout a year, if
of care and service. Many health plans use the HEdIS measure- we added up all the patients seen by a primary care physician, the
ments to highlight their scores to prospective employers. HEdIS entirety of that population may have some common characteris-
measures address a broad range of important health issues. tics that may need to be tracked and managed. And to the extent
Among them are the following: a primary care physician averaged 20 patients visits a day for 210
• Asthma Medication Use days out of the year, they would encounter approximately 4,100
• Persistence of beta-blocker Treatment after a Heart Attack patient visits. Some of the visits are repeat follow-up visits and
• Controlling High blood Pressure probably account for over 50 percent of the patient “population.”
• Comprehensive diabetes Care Thus, a primary care physician may have a panel of patients for a
• breast Cancer Screening year of approximately 2,500 to 3,000 patients.
• Antidepressant Medication Management Of that “population” of patients, there are some characteristics
• Childhood and Adolescent Immunization Status of patients that have similar disease classifications. Take type 2 di-
• Childhood and Adult Weight/bMI Assessment abetes for example; The prevalence rate of type 2 is approximately
9.3 percent (i.e., 29 million people) according to the CdC. How-
For the Medicare Advantage population, CMS has used another ever, over 86 million have “pre-diabetes.” And of the 29 million
tracking program called STAR. One of the differences between people who have type 2, approximately 8.1 million people don’t
HEdIS and STAR is that HEdIS is responsible for making sure know they have it and are undiagnosed!
that providers at least perform the activities of measurement as This is a good example where population health management
required by HEdIS and whereas STAR requires both the per- can play an important role for both the patient and the doctor.
formance of the measurement activity with the additional require- Imagine if a physician’s practice ran a report that looked at many
ment of demonstrating improved outcomes. Thus, it is not good of the risk factors for type 2 diabetes. Some of the risk factors
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