Diabetes Care "Bundle" Produces Better Health Outcomes, AJMC Study Finds

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Geisinger Health System's use of a diabetes care system among high-risk patients produced lower risks of myocardial infarction, stroke and retinopathy over a three-year period, according to a study in The American Journal of Managed Care. Best of all, most of the benefit accrued in the first year of care.

Diabetes Care “Bundle” Produces Better Health Outcomes, AJMC Study Finds

PLAINSBORO, N.J.—A study published today in The American Journal of Managed Care found that an all-in-one or “bundled” approach to primary care, deployed by Geisinger Health System for patients with diabetes, produced better health outcomes and that benefits happened quickly.

More so than most chronic conditions, diabetes offers a window into the nation’s general health. That’s because persons who develop type 2 diabetes typically have multiple health issues at once, and many of them are tied to lifestyle. Treating this disease, then, requires healthcare providers to look at the big picture, not just tackle individual symptoms. That means tracking what actually happens to patients, and not simply record their weight or glycated hemoglobin (A1C). That’s what Geisinger did when it created an “all-or-none” bundled measure for providing care to these patients.

“By doing this bundled management and improving this reliable diabetes system of care, we improved patients’ outcomes—not just their numbers, but their health outcomes–in three years,” said Thomas Graf, MD, chief medical officer for Population Health at Geisinger, and a co-author of the study.

The study measured hazard ratios (HRs) for 4095 patients enrolled in the Diabetes System of Care, compared with 4095 patients not enrolled in the program. Adjusted HRs for myocardial infarction (0.77), stroke (0.79), and retinopathy (0.81) were all significantly lower among patients in the diabetes care group. The study found that most of the risk reduction occurred during the first year, which suggests that efforts to change healthcare delivery to improve quality can work quickly.


How Geisinger achieved these results is as important as what was achieved. “We did not add extra staff. We just redesigned the roles and responsibilities within the primary care office to have the staff work more together as a team to help the patients accomplish their goals,” Dr. Graf said. “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.”

Change, however, is not easy, as the authors note. They report that creating systemwide change requires constant evaluation, and improvements must be scalable across a variety of practice settings. Accountability is key, according to their findings. Payment must be prompt to ensure ongoing progress and buy-in.

“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,” Dr. Graf aid.

The Geisinger results are important in light of soaring incidence rates of type 2 diabetes, which the study notes skyrocketed 40% between 2007 and 2010. According to the American Diabetes Association, 26 million Americans have the disease, with most of them suffering from type 2.

About the Journal

The American Journal of Managed Care, now in its 20th year of publication, is the leading peer-reviewed journal dedicated to issues in managed care. In December 2013, AJMC launched The American Journal of Accountable Care, which publishes research and commentary devoted to understanding changes to the healthcare system due to the 2010 Affordable Care Act. AJMC’s news publications, the Evidence-Based series, bring together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in the areas of oncology, diabetes management, respiratory care, and immunology and infectious disease.

About Geisinger

Geisinger Health System is an integrated health services organization widely recognized for its innovative use of the electronic health record, and the development of innovative care models such as ProvenHealth Navigator® and ProvenCare®. As one of the nation’s largest rural health services organizations, Geisinger serves more than 2.6 million residents throughout 44 counties in central and northeast Pennsylvania. The physician-led system is comprised of more than 21,000 employees, including a 1,100-member multi-specialty group practice, eight hospital campuses, two research centers and a 467,000-member health plan, all of which leverage an estimated $7.4 billion positive impact on the Pennsylvania economy. The health system and the health plan have repeatedly garnered national accolades for integration, quality and service. In addition to fulfilling its patient care mission, Geisinger has a long-standing commitment to medical education, research and community service. For more information, visit, or follow the latest Geisinger news and more on Twitter and Facebook.

CONTACT: Nicole Beagin (609) 716-7777 x 131