Adherence to Metformin, Statins, and ACE/ARBs Within the Diabetes Health Plan (DHP)

Abstract

BACKGROUND: Reducing patient cost-sharing and engaging patients in disease management activities have been shown to increase uptake of evidence-based care. OBJECTIVE: To evaluate the effect of employer purchase of a disease-specific plan with reduced cost-sharing and disease management (the Diabetes Health Plan/DHP) on medication adherence among eligible employees and dependents. DESIGN: Employer-level "intent to treat" cohort study, including data from eligible employees and their dependents with diabetes, regardless of whether they were enrolled in the DHP. SETTING: Employers that contracted with a large national health plan administrator in 2009, 2010, and/or 2011. PARTICIPANTS: Ten employers that purchased the DHP and 191 employers that did not (controls). Inverse probability weighting (IPW) estimation was used to adjust for inter-group differences. INTERVENTION: The DHP includes free or low-cost medications and physician visits. Enrollment strategies and specific benefit designs are determined by the employer and vary in practice. DHP participants are notified up front that they must engage in their own health care (e.g., receiving diabetes-related screening) in order to remain enrolled. MAIN OUTCOME MEASURE: Mean employee adherence to metformin, statins, and ACE/ARBs at the employer level at one year post-DHP implementation, as measured by the proportion of days covered (PDC). RESULTS: Baseline adherence to the three medications was similar across DHP and control employers, ranging from 64 to 69 %. In the first year after DHP implementation, predicted employer-level adherence for metformin (+4.9 percentage points, p = 0.017), statins (+4.8, p= 0.019), and ACE/ARBs (+4.4, p=0.02) was higher with DHP purchase.

Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis

“…28 Covering copayment costs for medications 7,29,30 for program participation and not tied to reaching set treatment targets may also be considered as an alternative to a premium discount. However, even these types of incentives may yield only modest improvements in medication adherence 31 and presumably smaller improvements in clinical outcomes. The use of standardized treatment goals may also have discouraged participation by those far from the goals.…”

Results from NEXT-D: the association of a pre-diabetes-specific health plan and rates of incident diabetes among a national sample of working-age adults

“…All NEXT-D studies are evaluations of 'naturally' occurring health polices and/or interventions (ie, without randomization), using the strongest observational research designs possible and conducted in close collaboration with organizations implementing those programs. [11][12][13] The academic team members analyzed all data independently and retained sole authority over all publication-related decisions throughout the course of the study.…”

Introductory Overview of the Natural Experiments for Translation in Diabetes 2.0 (NEXT-D2) Network: Examining the Impact of US Health Policies and Practices to Prevent Diabetes and Its Complications

“…NEXT-D2 builds upon activities of the original NEXT-D Network of five centers funded by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) that launched in 2010, called "Natural Experiments and Effectiveness Studies to Identify the Best Policy and System Level Practices to Prevent Diabetes and Its Complications" [19]. Several NEXT-D reports have described the impact of population-targeted policies (e.g., electronic health record screening decision prompts, lifestyle modification programs, targeted copayment reductions for diabetes care, high deductible health plans) on preventive behaviors and diabetes outcomes, quantity and quality of care, morbidity and costs, and unintended consequences of these policies [9,[23][24][25][26][27][28][29][30][31][32][33][34][35][36].…”