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California Health Plans, Physician Groups Agree On Standardized Diabetes Treatment Guidelines

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State's First–Ever Uniform Standards Will Help Fight Deadly Epidemic

San Francisco, CA, August 29, 2001 – Thanks to a unique collaboration of health plans, physician groups and the state's largest employer coalition, nearly every major health plan in California has agreed on basic treatment guidelines for diabetes that will help manage a disease that afflicts one out of 23 people in the state.

Diabetes is a pervasive and deadly disease that poses a major threat to public health. To date, the medical community's response has been hampered by multiple treatment guidelines from major health plans, guidelines that disagree with each other and often confuse doctors and patients about the best way to manage the disease.

The pocket–sized guidelines were mailed to 25 medical groups this week by the California Cooperative Healthcare Reporting Initiative (CCHRI), a collaborative of health care purchasers, plans and providers that promotes cooperation instead of competition in data collection and reporting. In turn, the medical groups are distributing the guidelines to their combined primary care physicians. In early September, the guidelines will also be mailed directly to more than 10,000 California primary care physicians in cooperation with the California Medical Association.

Until now, each health plan has had its own recommended schedule for diabetes tests and consultations, as well as its own standards to trigger a doctor's actions, e.g., the level of LDL or "bad cholesterol" that indicates the need for drug therapy. For patients changing health plans or doctors, the result has often been confusing changes in treatment. Inconsistent guidelines also have made it difficult for health plans to measure physician performance and to use performance reports to encourage better practice.

"In a first for chronic disease management activity in California, we have absolute agreement on what the scientific evidence is compelling us to do for each and every diabetic patient," said Gifford Boyce-Smith, MD, head of CCHRI's Diabetic CQI Steering committee and Director of Quality Management at Blue Shield of California, one of CCHRI's participating health plans. "With this unprecedented cooperation among plans, we can focus all of our efforts on delivering better care to hundreds of thousands of people in California with diabetes."

Physician group leaders applauded the new guidelines. "I am absolutely confident that consistent guidelines will improve clinical outcomes," said Wells Shoemaker, MD, Medical Director for Physicians Medical Group of Santa Cruz County. "Doctors need to make sure our patients receive the education and motivation to uphold their responsibility for self care-it helps immensely that finally we will all be giving the same message."

Diabetes is among the top causes of death in California and the country. People with diabetes are also at substantially greater risk for heart disease, stroke and end–stage renal disease. Nearly 2 million Californians have the disease–four percent of the population—yet one–quarter of them don't yet know it. Much of the health and economic burden of diabetes can be averted through known prevention and control measures. Research shows that mismanagement of the diabetic population costs the nation more than $98 billion annually in direct medical costs, as well as other costs–disability, work loss and premature death.

In addition to standardized treatment guidelines, CCHRI's diabetes project has achieved standardized performance measurements by which health plans hold medical groups accountable for care, said David Hopkins, PhD, CCHRI project leader and Director of Health Information Improvement at Pacific Business Group on Health, which manages CCHRI. "Competing health plans reaching this level of cooperation is a true breakthrough for disease management in California," he said.

The guidelines can be viewed at the website of Pacific Business Group on Health, www.pbgh.org. They are consistent with the recommendations of the American Diabetes Association and were adopted from the guidelines published by the California Diabetes Control Program and the Diabetes Coalition of California. The participating health plans are Aetna, Blue Cross of California, Blue Shield of California, CIGNA HealthCare of California, Health Net, Health Plan of the Redwoods, Inter Valley Health Plan, Lifeguard, Maxicare, National Health Plans, PacifiCare of California, Universal Care and Western Health Advantage.

The California Cooperative Healthcare Reporting Initiative (CCHRI) is a collaborative of health care purchasers, plans and providers. Eighteen California health plans participate in a variety of CCHRI data-collection activities, and many plans participate in several different projects.

Pacific Business Group on Health (PBGH), a major non-profit coalition of 44 purchasers, is dedicated to improving healthcare quality while moderating cost. Its members annually spend more than $3 billion to provide health coverage to approximately 3 million employees, retirees and their families. PBGH seeks to promote health plan and provider accountability and to provide consumers with standardized, comparable data to make the best health care decisions at all levels of care. PBGH also operates PacAdvantage, a small group purchasing pool providing health insurance to more than 10,000 small employers in California.

Contact:
Clark Miller
Senior Communications Manager
Pacific Business Group on Health
Telephone: (415) 615–6302
E–mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

 
 

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