Doctors at Joslin Diabetes Center think America’s emerging healthcare system will greatly benefit those with complex, chronic disorders like type 1 diabetes.
There have been many criticisms of the Affordable Care Act (also called the ACA or “Obamacare”) and how it’s currently working. According to the Kaiser Family Foundation, only 41 percent of Americans have a favorable view of the law. However, the real value of the ACA may not be what it’s doing in the present, but the way it is turning gears to change healthcare in the near future.
Robert Gabbay, M.D., Ph.D., Chief Medical Officer of the Joslin Diabetes Center, recently published an editorial article in the journal Diabetes Technology and Therapies outlining how the ACA is set to improve care for type 1 diabetes patients and complex type 2 cases.
Medical costs for type 1 diabetes are estimated at nearly $10,000 a year, compared with $3,580 a year for those without the disease. For type 1 patients requiring at least one hospitalization, the average yearly cost skyrockets to almost $26,000.
“It’s beneficial to the patient, both in terms of their health and the cost of care, to focus on preventative therapies,” says Dr. Gabbay. Doctors and other members of the diabetes team need to be more easily reimbursed for shorter, “in-between visits” to check on a patient’s insulin dosing, monitor new technology like an insulin pump or a CGM, or answer minor questions through a virtual visit or over the phone.
“Most of the time these are things endocrinologists are already doing,” says Dr. Gabbay. “But it’s difficult to bill this sort of care to the insurance company.”
A new type of reimbursement plan, called “bundle payments,” may make it easier for doctors to oversee patients without in-person visits or unnecessary procedures and tests.
Bundle payments are an all-encompassing lump sum paid to physicians by the insurance company. Early adopters are calling them “care packages” rather than a reimbursement.
Getting a bundle payment is like paying a travel agent for an all-inclusive trip with lots of options, flexible activities, and an overall lower price for basics like hotels, car rentals, and airplane tickets—rather than paying each vendor individually at a much higher price. Instead of paying piecemeal for each lab test, office visit, or procedure, care providers will have personalized goals to meet for each patient.
“The care will be tailored to suit each patient’s needs,” says Dr. Gabbay. If your physician needs to remotely monitor your new pump data every other week and follow up over the phone, but doesn’t really need you to come in for a full workup for a few months, they will be able to follow that plan and still get reimbursed
There is concern, however, that bundled payments may induce a laissez-faire attitude towards patients. If everything is covered up front, what compels care providers to deliver anything above the bare minimum of care?
“It’s a valid point,” says Dr. Gabbay. “However, more and more payers are measuring patient outcomes. Doctors are being incentivized for quality outcomes rather than the quantity of procedures they administer.”
In the case of diabetes, patient health and cost-reduction go hand in hand. If a patient has well controlled A1C levels, normal blood pressure and good cholesterol, they greatly decrease their risk for complications and pricey hospitalizations. If doctors can prevent the need for emergency care, those funds can be re-distributed at the end of the year and reinvested for improved services.
“It’s a much more fluid way of managing healthcare costs,” says Dr. Gabbay. With this new model, providers can use insurance payments for innovative treatments and shift funds to the patients that need them most.
The key will be whether organizations make the appropriate investments in better diabetes care and reinvest savings to support many previously under-reimbursed activities such as weight loss programs and phone consultations. If diabetes care providers can prevent costly diabetes complications, they save money for everyone—patients, insurance agencies, employers, and the hospitals themselves.
“If it’s utilized correctly this could change diabetes from a cost center into a cost savings,” says Dr. Gabbay. It’s a win-win; patients are healthier and over-stressed hospitals save money down the line. Hopefully, healthcare centers will understand the value of controlling complex, chronic diseases like diabetes and take advantage of the new, innovative models supported by the Affordable Care Act.