Free
Editor's Message  |   April 2015
Diabetes, Patient-Centered Medical Homes, and Accountable Care Organizations, Oh My!
Author Notes
  • From the Department of Endocrinology, Diabetes, and Metabolism at the Cleveland Clinic in Ohio. 
  •  *Address correspondence to Kevin M. Pantalone, DO, ECNU, CCD, 9500 Euclid Ave, Desk F-20, Cleveland, OH 44195-0001. E-mail: pantalk@ccf.org, kp737502@ohio.edu
     
Article Information
Endocrinology / Diabetes
Editor's Message   |   April 2015
Diabetes, Patient-Centered Medical Homes, and Accountable Care Organizations, Oh My!
The Journal of the American Osteopathic Association, April 2015, Vol. 115, eS3-eS4. doi:10.7556/jaoa.2015.056
The Journal of the American Osteopathic Association, April 2015, Vol. 115, eS3-eS4. doi:10.7556/jaoa.2015.056
Between 2007 and 2010, only 52.5% of people with type 2 diabetes mellitus achieved a hemoglobin A1c level of less than 7.0%.1 This statistic is alarming. Inadequate glycemic control not only puts a patient at risk for cardiovascular disease, it also remains the leading cause of blindness, kidney failure, and nontraumatic lower-limb amputations in the United States.2 The total estimated cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity.3 This cost is not sustainable. If we continue to approach diabetes management in the same manner, we will simply continue to observe the same outcomes. Without a significant change in the way we approach patients with diabetes, our country will not be able to withstand the staggering costs associated with diabetes management, especially given that the prevalence of type 2 diabetes mellitus continues to rise, now estimated to affect more than 19.1 million people in the United States, including 8.1 million who remain undiagnosed.3 Changing the way we approach patients with diabetes, as well as those with other chronic health conditions, starts with transforming the model in which we administer health care. 
Movement away from the traditional fee-for-service model of reimbursement has been long overdue, as this method has failed to improve health outcomes or rein in the ever-increasing cost of health care. The fee-for-service model of reimbursement led to a fragmented, inefficient, and poorly coordinated health care system. The new models of health care emphasize improving health outcomes and reducing cost through care coordination. 
The patient-centered medical home (PCMH) model strives to create a strong partnership between the patient and primary care physician, focusing on disease prevention and improving patient safety and the quality of care (ie, improving outcomes), all while reducing cost. In this model, the primary care physician leads the health care delivery team. The accountable care organization (ACO) model has similar goals to that of the PCMH model; however, the ACO reach is much broader, incorporating hospital systems, specialists, and home health care providers. Only time will tell if these models of health care delivery will be effective in reducing the cost of health care and improving access without compromising patient safety and quality of care.4 Although there is much uncertainty surrounding these models of health care delivery, one issue appears very clear: identifying and overcoming the barriers to achieving glycemic targets will become ever-more important, not only to prevent diabetes-related complications, but also to ensure reimbursement for the medical care associated with diabetes management as health care organizations begin to assume greater shared financial risk in the newer payment models. 
The role of the patient is also changing. Patients are becoming “health care consumers” as we shift toward a model of value-based care (high-quality/low-cost care). This evolving role from patients to health care consumers may help to improve their engagement, which seems paramount for either the PCMH or ACO models to work. 
In the current supplement, Ciervo et al5 discuss how the principles of osteopathic medicine may be leveraged in our quest to improve diabetes outcomes in the current era of health care reform. In addition, the authors6 put the PCMH into context in a roundtable discussion, allowing readers to become more familiar with this model of health care. 
All of the authors effectively summarize and highlight the changes and challenges we are facing and how they will affect the care of our patients with diabetes. 
Financial Disclosures: Within the past 12 months, Dr Pantalone has received speaker honoraria from Merck, Bristol-Meyers Squibb, AstraZeneca, and Eli Lilly; consultant fees from Merck and Eli Lilly; and research support from Novo Nordisk and Merck. 
References
Stark Casagrande S, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988-2010. Diabetes Care. 2013;36(8):2271-2279. doi:10.2337/dc12-2258. [CrossRef] [PubMed]
Centers for Disease Control and Prevention. National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011. Atlanta, GA: US Dept of Health and Human Services, Centers for Disease Control and Prevention, 2011.
Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: US Dept of Health and Human Services; 2014.
Lehman EP. The health care ‘iron triangle’ and the Patient Protection and Affordable Care Act. Cleve Clin J Med. 2015;82(2):73-80 doi:10.3949/ccjm.82a.14035. [PubMed]
Ciervo CA, Shubrook JH, Grundy P. Diabetes management within evolving health care delivery models: the osteopathic perspective. J Am Osteopathic Assoc. 2015;115(4 suppl 1):eS5-eS7.
Ciervo CA, Shubrook JH, Grundy P. Leveraging the principles of osteopathic medicine to improve diabetes outcomes within a new era of health care reform. J Am Osteopathic Assoc. 2015; 115(4 suppl 1):eS8-eS19.