It’s known as “bundled care” and it’s worked to produce better outcomes for Geisinger Health System diabetes patients, according to a study in the American Journal of Managed Care.
What is bundled care?
“It’s just paying attention to the details,” said Dr. Thomas Graf, chief medical officer for Population Health at Geisinger Health System.
Type 2 Diabetes patients often have multiple health issues tied to lifestyle that require care providers to look at more than just symptoms. With bundled care, it means tracking diabetes patients, not just recording their weight or glycated hemoglobin (A1C).
Overall, the study measured hazard ratios for 4,095 patients enrolled in the Diabetes System of Care, compared with 4,095 patients not enrolled in the program.
The study revealed adjusted health ratios for myocardial infarction (0.77), stroke (0.79), and retinopathy (0.81) were all significantly lower among patients in the diabetes care group.
In addition, the study found that most of the risk reduction occurred in the first year, which suggests that efforts to change health care delivery to improve quality can work quickly.
“The data ran about five years,” Graf said. “Outcome differences showed up right away. Over a five-year period the care for everyone got better. But the rate of improvement for those who had a system of care in bundled care was better.”
Graf said no extra staff were hired for the study.
Rather, roles and responsibilities were redesigned within the primary care staff to enable a teamwork approach to help patients reach goals.
“In this team-based model, the physician is still in charge as the quarterback of the team, but this system uses other team members to perform other tasks so the physician can focus on making complex medical decisions and motivate the patients to meet their goals,” he said.
Nancy Reitnauer, 72, of Montoursville, has suffered from diabetes for about 20 years.
She said the teamwork philosophy of bundled care has made a positive impact on her battle with the disease.
A nurse navigator assigned to Reitnauer keeps in constant touch with her.
“She calls and sees how I’m doing,” she said. “Thank God, they are right there for you.”
Graf noted that with bundled care team members take a more active role in the patient’s health.
“This study is important because if a health system or health plan is going to invest in this system, they want to know the benefits of those investments,” Graf said.
Type 2 Diabetes results from the body’s inability to produce sufficient insulin levels. Insulin, a hormone produced by the pancreas, moves sugar from blood to cells to use for energy.
A breakdown in this process causes a person’s blood sugar to become too high. Diabetes develops when the immune system destroys pancreatic beta cells that produce insulin, according to the American Diabetes Association.
Diabetes is linked to obesity, poor diet, and lack of exercise.