Dr Beau Raymond on Value-Based Diabetes Care: How Healthy State Initiatives Prevent Downstream Effects

Beau Raymond, MD, MMM, FACP, chief medical officer of Ochsner Health Network, explains the importance of diabetes and hypertension control to prevent downstream events such as heart attacks and strokes.

Sidney (Beau) Raymond, MD, MMM, FACP, chief medical officer of Ochsner Health Network, highlights Ochsner's use of a diversity, equity, and inclusion dashboard to measure the effects of their Healthy State initiatives and the gaps that still remain, especially in diabetes and hypertension control, and how Ochsner uses these data to determine next steps to help more patients.

Raymond highlighted the importance of value-based diabetes care. "Sure, we can sit there and throw drugs at the problem, but it's much better for us to try to create healthier habits for everyone to try to prevent those things in the first place."


Why are value-based initiatives so important in the diabetes care space, and to Ochsner in particular?

CMS is pretty much stating that they want health equity to be a bigger part of all the initiatives that we have. So, we at Ochsner, actually, we're doing pretty well in understanding where those opportunities are now. We created what's called a diversity, equity, and inclusion dashboard. It takes all of our measures—2 in particular are diabetes and hypertension control, we can talk about that—and it breaks it down by race, ethnicity, payer, other factors as well, sex; we have an idea as to how we're performing in that.

Some highlights that we noticed is that there's a gap in diabetes and hypertension that was demonstrable over the years for hypertension control and diabetes control. Even though we created new initiatives and constantly got better and better and better from an overall standpoint for hypertension and diabetes, there still remains this gap—and here in Louisiana, it's predominantly White or Black or African American, and then everyone else is a smaller percentage—between White and Black or African American. Those are significant numbers of our populations, the 2 of them. But that gap persisted within those 2 populations, and it's amazing to look at the graph, because you can see where we did something new and it goes up, but they both go up the same, and there's just a little bit of narrowing. And we look at it from the entire network standpoint, so we're talking hundreds of thousands of lives, or tens of thousands of lives, depending on whether you're talking about hypertension or diabetes, and still seeing that gap.

What we're doing now is we're looking at that, we're sharing that information with different regions, different groups, different sites, and asking, "What do we need to do differently at those different areas?" Because health care is local, so the influences that you have in one area could be very different than the influences you have in another area. So, it's a way for us to use the local physicians, local clinics, local people, to find those opportunities who they need to partner with, because 80% of your health is determined outside of your doctor's office.

So, 20% is based on when you come in; 80% is based on your zip code, what you eat, your genetic factors, all these other things. This is a way for us to highlight where those opportunities are [and] share that information with the groups so that they can be part of the solution as to how we partner with different people to help with those solutions.

From a healthy state initiative, one overarching thing was our Louisiana Healthy State initiative. It's about partnering outside of your world. so it's us partnering with governmental agencies, insurance groups, employers, and finding different solutions. This is a way for us to work towards a collective goal to improve the care that we have within the state.

So why is it important? It's important to us because we know that diabetes control or lack thereof is an important indicator of your health down the road. So, if we don't help people have better diabetes control, then they're more likely to have heart attacks and strokes. We're trying to help prevent all those downstream events. That's why we care a lot about diabetes control and hypertension control—those are 2 big ones—because we know that combined with those things, being out of control leads to poor outcomes in general.

Louisiana, in particular, we have a significant amount of morbid obesity, and so it certainly plays a role into the population that we care for on a regular basis. So, we need to move further upstream to help what's going on that we're seeing on the back end.

So sure, we can sit there and throw drugs at the problem, but it's much better for us to try to create healthier habits for everyone to try to prevent those things in the first place. And that's kind of where a lot of the healthy state initiatives are coming from: "How do we move further upstream and partnering with different groups to make that happen?"

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