Becker's Hospital Review

PRACTICE MANAGEMENT THOUGHT LEADERSHIP 145 longer in the blood glucose range for prediabetes. My story has influenced my plans in that we need to turn our attention toward primary care providers and clinicians who deal with this disease everyday — especially type 2 diabetes. With type 2, the war against diabetes is at the front line in the primary care provider's office. We have to find a better way to embrace primary care providers and fight this disease by providing resources and elevating the conversation around type 2 diabetes and prediabetes to prevent as many cases as possible. At this time, we are unfortu- nately unable to prevent type 1 diabetes, but have funded research in this area as well. Q: What, if anything, do you think is currently work- ing with how diabetes and chronic disease are man- aged in the U.S.? KH: Diabetes treatment and care really has improved markedly over the past 20 years. e mission to improve the lives of people with diabetes is evidenced with some serious declines in diabe- tes-related complications. For example, in 20 years [1990-2010] there has been a 68 percent reduction in myocardial infarctions, a 53 percent reduction in strokes and a 51 percent reduction in amputations due to diabetes complications. Obviously those pieces are working, but the real challenge is prevalence, particu- larly of type 2 diabetes. Nearly 30 million Americans are living with diabetes [types 1 and 2] today and 86 million have prediabetes. If present trends continue, by 2050, 1 in 3 adults will have diabetes, and that is un- acceptable. Complications are on the decline, but prevalence is on the rise. at's where our focus and energy need to turn to — how to help people at risk fend off diabetes while continuing high stan- dards for managing and treating diabetes. Q: What, if anything, would you like to change about how diabetes and chronic diseases are managed in the U.S.? KH: ere are a few things I would point out. We need to put greater efforts toward prevention as a whole, considering the escalating trends in type 2 diabetes. e numbers are incompre- hensible and we simply cannot afford what that future looks like. Second, we need to better coordinate the care of people with diabetes. e best care for people with diabetes comes from a team. at includes primary care physicians, dietitians, behav- ioralists, specialists, and for those who are insulin dependent, an endocrinologist. Part of that care network is also the family. All those groups can play a huge role in behavioral and lifestyle change that improves health. ird, for healthcare providers as a whole, we would like to see them more adequately reimbursed for preventive care. As an American populace currently more focused on treating rather than preventing, the biggest bang for our buck will be focusing on the preventive stage. Q: Have population health initiatives led by health- care organizations been effective in helping improve health outcomes for diabetics? KH: At this point, there are a couple of options such as pa- tient-centered medical homes and accountable care organiza- tions. ey are still in their infancy stages, but the preliminary data suggests they are having a positive impact on diabetes. Of course, longer-term, broad-based data is going to be necessary to see if these are ideal delivery systems for people with diabetes. Q: Are there any actionable steps hospitals and health systems can take to help address the social determinants of health? KH: One of the big issues we as an American society need to dis- cuss is that diabetes actually represents a much larger problem. ere are a lot of environmental issues that play into diabetes. Living environment matters — do we have access to sidewalks to walk, playgrounds and exercise equipment? What about the availability of the right food options and the cost of food? Some of the more impoverished areas of the country have the highest incidence rate of diabetes. People who live in food deserts lack access to food, and food policy plays a real role. While health systems do play a role, there are much broader environmental policies that can affect health. Q: Is there anything else you think healthcare leaders need to know about diabetes or population health? KH: ey need to know that this is a big, real American prob- lem. Diabetes is an escalating crisis and we cannot talk about it enough. We need to stop the shame and blame surrounding diabetes and begin having a real conversation about the cost. It is staggering. We have spent $245 billion on diabetes and that's just the cost we know for diagnosed diabetes — it doesn't even count all the other costs of prediabetes-related care. We need to talk seriously and work in a collaborative manner with public policy to inform Congress, local and state governments and corporate America that this is a true priority for the American people and their healthcare system. e cost of us doing nothing is growing day by day. n

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