Diabetes & the Medicare Population: Introduction to the Report Diabetes has a considerable impact on the nation s healthcare system and on individuals living with the condition. This report is intended to support efforts within Washington s communities to monitor and improve diabetes-related quality measures. Data represents the year of July 216 June 217. This report s population also includes individuals under age 65 who qualify for Medicare due to chronic disability (approximately 2 of the Medicare population). It does not include data on individuals living outside the state who may seek care in the state. Through our work as Medicare s Quality Improvement Network Quality Improvement Organization (QIN-QIO) in and Washington, Qualis Health is assisting providers and patients to develop systems to better manage and monitor this disease. We are also working with communities throughout both states to improve care coordination, prevent adverse drug events, and reduce unnecessary rehospitalizations. To learn more about our QIN-QIO activities, please see: Diabetes-related consulting for primary care physicians www.medicare.qualishealth.org/diabetesprovider Diabetes self-management education for Medicare beneficiaries and their family members and caregivers www.medicare.qualishealth.org/edc Consulting related to care coordination and reducing unnecessary rehospitalizations on a community level www.medicare.qualishealth.org/transitions This material was prepared by Qualis Health, the Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for and Washington, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. ID-C3-QH-3249-11-17
Disease Prevalence Over 4, of s Medicare beneficiaries have been diagnosed with diabetes. While diabetes is prevalent throughout the state, the difference between the communities with the lowest and highest rates is stark: the rate of diabetes among Medicare beneficiaries residing in Eastern is more than higher than that of. Figure 1: Prevalence of Diabetes among Medicare Beneficiaries by Community, July 216 June 217 3 25% 2 18.3% 19.4% 21.9% 22.3% 23.4% 25.3% 26.7% 15% 5% Northern North Central Magic Southeast Eastern State Rate (21.4%) Medicare beneficiaries with diabetes also face increased morbidity from other chronic conditions. Figure 2 shows the prevalence for select chronic conditions for beneficiaries with and without diabetes. Figure 2: Prevalence of Select Comorbidities among Medicare Beneficiaries With and Without Diabetes, July 216 June 217 Chronic Kidney Disease (CKD) 9.9% 45.8% COPD 11.4% 2.6% Depression Heart Failure Hyperlipidemia (High 5.8% 19.8% 17.7% 3.9% 35. 67.7% Beneficiaries Without Diabetes Beneficiaries with Diabetes Hypertension 43.6% 81.5% 2 8 1
There are also racial disparities in the prevalence of diabetes, as shown in Figure 3 below. Figure 3: Prevalence of Diabetes among Medicare Beneficiaries by Race and Dual-Eligibility with Medicaid, July 216 June 217 35% 34.8% 32.5% 3 28. 27.5% 26.6% 28.1% 25% 2 21.1% 19.8% 15% 5% Asian Black Hispanic Native American Other White Dual Eligible with Medicaid Not Dual Eligible with Medicaid
Appropriateness of Care People with diabetes have greatly increased risk for cardiovascular disease and other comorbidities, so screening for glycemic and lipid control and neuropathic complications is part of ongoing care management. The charts below show variation by community for recommended care measures. Figure 4: Percent of Medicare Beneficiaries with Diabetes Receiving Annual HbA1c Test by Community, July 216 June 217 92% 9 88% 86% 84% 82% 8 78% 9.9% 89.5% 89.2% 89.1% 88.7% 86. 83.5% Figure 5: Percent of Medicare Beneficiaries with Diabetes Receiving Annual Lipid Test by Community, July 216 June 217 74% 72% 7 68% 66% 64% 62% 58% 56% 54% 72.1% 7.9% Northern Northern Magic North Central Eastern Southeast 7.1% State Rate (88.1%) 68.7% 68.4% 64.8% 61.1% Eastern North Central Magic Southeast State Rate (68.3%) Figure 6: Percent of Medicare Beneficiaries with Diabetes Receiving Annual Eye Exam by Community, July 216 June 217 58% 56% 54% 52% 5 48% 46% 44% 42% 58.8% 57.8% 56. 55.3% 53.2% 51.8% 48.2% North Central Eastern Magic Northern Southeast State Rate (54.6%)
Figure 7: Percent of Medicare Beneficiaries with Diabetes Ever Receiving Pneumococcal Vaccine by Community, July 216 June 217 8 7 5 3 2 Figure 8: Percent of Medicare Beneficiaries with Diabetes Receiving Annual Influenza Vaccination by Community, July 216 June 217 7 65% 55% 5 45% 69.4% 64.4% 64.4% 64.4% 63.2% North Central 62.3% Eastern 58. 55. 53.8% Northern Eastern Magic Southeast State Rate (62.1%) 6.4% 6. 57.5% 55.2% 53.4% Northern North Central Magic Southeast State Rate (59.2%) Figure 9: Percent of Medicare Beneficiaries with Diabetes Ever Receiving Pneumococcal Vaccine by Rurality, July 216 June 217 8 7 5 3 2 68.6% 6.4% 57.7% 53.6% Urban Suburban Rural Town Isolated Rural Figure 1: Percent of Medicare Beneficiaries with Diabetes Receiving Annual Influenza Vaccination by Rurality, July 216 June 217 8 7 5 3 2 64.4% 6.1% 54.8% 51.3% Urban Suburban Rural Town Isolated Rural
Hospital Utilization and Medicare Spending Medicare beneficiaries with diabetes have increased admission, 3-day rehospitalization, and Emergency Department (ED) rates compared to beneficiaries without diabetes. However, that utilization is largely driven by individuals who have diabetes that has progressed to Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD). The figures below show utilization, mortality, and per capita costs for individuals by diabetes status. Figure 11: ED Visits, Hospital Admissions, and 3-Day Re-Hospitalizations by Diabetes Status for Medicare Beneficiaries, July 216 June 217 1,8 1,6 1,577. 1,4 1,2 1, 8 6 4 2 487.5 372.4 878.6 152.9 177.5 54.9 1,228.3 16.8 15.4 85.4 285.9 ED Visits per 1, Beneficiaries Admissions per 1, Beneficiaries Readmissions per 1, Beneficiaries No Diabetes Diabetes Without CKD Diabetes With CKD Diabetes with ESRD Figure 12: Mortality by Diabetes Status for Medicare Beneficiaries, July 216 June 217 Figure 13: Per Capita Costs by Diabetes Status for Medicare Beneficiaries, July 216 June 217 16% 14% 12% 14.56% $5, $45, $4, $35, $3, $44,394 8% 6% 4% 2% 2.31% 2.57% 6.34% $25, $2, $15, $1, $5, $15,874 $5,472 $7,79 Mortality $ Per Capita Costs No Diabetes Diabetes Without CKD No Diabetes Diabetes Without CKD Diabetes with CKD Diabetes With ESRD Diabetes With CKD Diabetes With ESRD
In part as a result of racial disparities in diabetes progression, there are racial disparities in utilization among beneficiaries with diabetes. Figure 14: Admits per 1, Beneficiaries with Diabetes by Race, July 216 June 217 14 12 Figure 15: ED Visits per 1, Beneficiaries with Diabetes by Race, July 216 June 217 14 12 1,259.4 1,248.4 1 1 896.3 8 8 719.3 676.8 6 4 264.6 443.1 328.2 515.6 332.7 242.4 367.5 6 4 54.6 42.4 2 2 Figure 16: 3-Day Rehospitalizations per 1, Beneficiaries with Diabetes by Race, July 216 June 217 Figure 17: LEAs per 1, Beneficiaries by Race, July 216 June 217 35 3 35 3 32.86 25 2 25 2 231.25 15 15 144.21 1 5 24.8 75.8 72.42 97.51 47.53 43.84 53.26 1 5 98.18 52.74 47.43
Diabetes Self-Management Education Outcomes Qualis Health is currently partnering with community organizations to support Diabetes Self- Management Education by offering the evidence-based Diabetes Self-Management Workshops. This gold-standard strategy, originally developed at Stanford University, empowers people with diabetes to manage their symptoms, address day-to-day problems and improve the quality of their lives. Participants learn, practice and master skills such as goal-setting and action -planning, blood sugar monitoring, medication management, meal planning, safe physical activity, stress and depression management, problem-solving and decision-making. Pre- and post-class patient activation surveys indicate that participants 1 Participants were more likely to feel able to ask their doctor questions about their treatment plans after participation (68% before vs. 94% after). Participants were more likely to feel able to make a plan with goals that will help control their diabetes after participation (55% before versus 91% after). 1 Complete national and state results of pre-class and post-class Patient Activation Surveys are available upon request. Organizations partnering with Qualis Health can receive this data for participants of their specific classes in aggregate form after they have had at least 2 individuals complete pre- and post-class surveys.
Community Data Tables Table 1: Utilization and Per Capita Costs for Medicare Beneficiaries with Diabetes by Community, July 216 June 217 Percent with CKD ED Visits per 1, Admissions per 1, 3-Day Rehospitalizations per 1, Lower Extremity Amputations per 1, Per Capita Costs Eastern 44.9% 543.8 318.92 4.68 26.81 $12,65 52.6% 831.93 418.66 65.19 84.6 $12,15 Magic 49.8% 562.33 443.82 72.12 8.21 $12,399 North Central 38.8% 859.27 378.51 54.41 52.28 $11,945 Northern 43.9% 623.9 346.66 47.9 35.37 $11,5 Southeast 43.7% 772.84 372.99 59.64 37.48 $12,696 48.8% 712.81 366.8 54.46 61.9 $11,316 Statewide 45.8% 69.14 367.8 54.23 5.23 $11,89