Treatment strategies for diabetes should include a comprehensive approach involving multidisciplinary care teams.
Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: I’ve seen insurance companies running away from new guidelines. I’ve seen insurance companies choosing older guidelines with less intensive approaches and using older medications rather than newer ones. Do you think you can get a coalition of insurance that will not only adopt the new guidelines but also help distribute them so we can empower everybody to use them?
Jaime Murillo, MD: I’ll speak on what I have seen. The role of insurance companies has evolved. They used to be in the background. When I was practicing, nobody wanted to hear about an insurance company, including me. Now I see the insurance company coming into the front. They said, “We want to be part of the solution. We want to collaborate. We want to be a stakeholder in this solution.” I’m optimistic about it. There’s no question about it. I think as you see more of them coming out, then you’ll see the other ones following soon. This is a perfect example; the forum that we have today. You see it in other places where medical societies never used to include payers in their seminars or forums or meetings. Now, you actually see people coming and speaking. Because we realize, if we don’t solve it together, it will never get solved.
Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: I’ll tell you, as I mentioned before, I was involved in the medical society. I was president of ACE [the American College of Endocrinology] and led a lot of their initiatives. We always invited payers. Payers did not always show up, especially the most important payer. The one that covered the most patients never shows up. It’s still an issue there to get payers to be involved. I’m also cognizant of the fact that we like a team approach, but we don’t have enough people to do the care. Also, full disclosure for the discussion today, we mentioned that Diabetes Cardiometabolic Institute Think Tank. We published last year a multispecialty practice recommendation that comes from the point of view of cardiologists, endocrinologists, nephrologists, and primary care physicians. The way we did this was not for primary care physicians; it was for non-specialists because not everybody knows everything. I believe that the cardiologist may have to do more control over the patient. The primary care physician has to do more control. Based on that, it’s very easy to follow the party’s recommendation. This year, what we did to help in that and to tackle the timing of when to intervene and when to manage—because it’s often lost in guidelines—we had a group of experts, again, a cardiologist, endocrinologist, nephrologist, and primary care physicians. Eugene was there. Jennifer was there. And I was there. A lot of these early interventions and intensity of management is a consensus of the group and it’s been submitted to publications. We hope to see it in a couple of weeks. This is a full disclosure of the discussion of where we are coming from. What we published may help support that approach and maybe help guidelines be written. Does anybody else have anything else they’d like to say or add to this discussion?
Jennifer B. Green, MD: I would just like to add that cost issues aside, good diabetes care and cardiovascular risk reduction is for everyone with diabetes, not just for the select few who can afford these medications. We need to figure out how to make this investment so that the health of everyone with diabetes is improved.
Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: Iabsolutely agree. Jaime, any last words?
Jaime Murillo, MD: I’ll add screening. I think there are a lot of people with undiagnosed conditions. We need to change the mindset of healthcare. We wait for people to come to our office or hospital in an emergency.
Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: Pay for that, pay for that. Just pay for that [LAUGHTER].
Thank you. And to our viewing audience, we hope you found this American Journal of Managed Care® Stakeholders Summit to be rich and informative. The DCMi [Diabetes Cardiorenal & Metabolism Institute] will soon have published a consensus, as I said, paper on early intervention and intensive management of the patient with diabetes in cardio-renal-metabolic diseases, which complemented DCRM Multispecialty Practice Recommendation.We will be hosting additional roundtable discussions exploring the topics of further management care across the cardio-renal-metabolic systems. Thank you all.
Transcript edited for clarity.