• Am J Manag Care · Dec 2020

    Evolving strategies for optimal care management and plan benefit designs.

    • John M Cruickshank.
    • Lovelace Health Plan, 4101 Indian School Rd, Altura Bldg, Albuquerque, NM 87111, USA. john.cruickshank@lovelace.com
    • Am J Manag Care. 2020 Dec 11; 18 (10 Suppl): S228-33.

    AbstractAs a prevalent, complex disease, diabetes presents a challenge to managed care. Strategies to optimize type 2 diabetes care management and treatment outcomes have been evolving over the past several years. Novel economic incentive programs (eg, those outlined in the Patient Protection and Affordable Care Act of 2010 that tie revenue from Medicare Advantage plans to the quality of healthcare delivered) are being implemented, as are evidence-based interventions designed to optimize treatment, reduce clinical complications, and lower the total financial burden of the disease. Another step that can improve outcomes is to align managed care diabetes treatment algorithms with national treatment guidelines. In addition, designing the pharmacy benefit to emphasize the overall value of treatment and minimize out-of-pocket expenses for patients can be an effective approach to reducing prescription abandonment. The implementation of emerging models of care that encourage collaboration between providers, support lifestyle changes, and engage patients to become partners in their own treatment also appears to be effective.

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