Diabetes Care Group, Jackson, Mississippi

This past week as I was lamenting that our political system does not seem to be able to work to address the serious problems facing our health system, I got a breath of fresh air: a look at something that was working.

Diabetes Care Group is a start up company that specializes in the management of diabetes, and is located in Jackson, Mississippi.** This group has a proven clinical model and a team that has shown remarkable control of patient Hemoglobin A1c levels, in addition to reducing cholesterol and controlling high blood pressure that are so commonly comorbid with obesity forming the bland sounding but deadly 'metabolic syndrome' that is exploding in our nation.

The statistics on type II diabetes (which typically onsets due to obesity and inactivity) in our nation are grim. A recent paper in Health Affairs shows that the costs of diabetes to US society were $153 Billion in medical costs and $65 Billion in reduced productivity in 2007. There are 16.5 Million persons with a diagnosis of type II diabetes, 1 Million with type 1 (which is hereditary and typically onsets in adolescence). Another 6.3 Million Americans have undiagnosed type II diabetes and are at extreme risk of suffering the complications of the disease (heart disease, stroke, retinopathy, renal failure, amputations of lower body extremities). And 57 Million Americans are said to have pre-diabetes--elevated glucose that will likely develop into type II diabetes if not mitigated.

The good news is that there are ways to manage pre-diabetes and diabetes. In addition to insulin and other pharmaceuticals, exercise, weight loss and a balanced diet can manage diabetes, sometimes without pharmaceutical intervention in the case of type II diabetes.

The Southern United States is the heart of the diabetes epidemic, so Jackson, Mississippi is a great place for Diabetes Care Group to be working. This is a start up with a head start in the form of a dedicated group of health care providers who have a proven track record of managing diabetes successfully. In fact, Dr. Marshall Bouldin has been involved along with his colleagues in a variety of diabetes control settings both in Jackson, but also in the Delta region of Mississippi, one of the poorest parts of the United States. They have shown the ability to reduce and maintain A1c levels and control the related risk factors among largely minority, low income and heavily uninsured (groups at higher risk) patient populations around Mississippi. In short, they have shown an ability to get results in places and among patients that would be expected to be harder than average to successfully treat. In fact, part of their success stems from learning to treat diabetes in resource challenged community environments, which forced them to figure out what works best to enlist patients' to become the key to managing their own disease.

Regardless of what does or doesn't happen with health reform, addressing type II diabetes is a tremendous challenge for the health of our nation. Diabetes Care Group is busy doing it.

**For full disclosure purposes, I was there at the Board meeting and open house of this organization because I am doing some consulting with them in the form of statistical/economic modeling of the treatment of diabetes.

More on there is no simple bill

Economix blog has nice post on why the notion that Pres Obama should have just sought a bill banning pre-existing conditions and nothing else won't work. The pre-existing condition ban and insurance regulations come along with the individual mandate. One won't work without the other....and this shows a big problem with 'doing what the people want' because the insurance regulations are very popular in polls, while the individual mandate is not. The econmix blog also notes some of the similarities of the structure of health exchanges between the Dem bills and the Patients' Choice Act....but that is old fare if you have been reading this blog.

Here is a related post about community rating (not setting premiums based on risk, but standardizing them across a risk pool) and what would happen to members of Congress if they didn't benefit from community rating. Employer based coverage is community rated (in Duke's plan, same premium regardless of age or illness, thereby healthy folks subsidizing sick) but in the individual purchase market, there is aggressive underwriting because there are not large pools across which to spread risk. This is why the individual purchase market is so small (only 14 Million Americans shop for and purchase their own private insurance, out of 307 Million people).

More on Obama and House Republicans

The NY Times prescription blog has a 'fact check' of sorts focusing on their health reform interaction. In the first post they note that the assertion from Rep. Tom Price of Georgia that 'our plan' would cover everyone without raising taxes, etc. is not true. And the President was very effective at making clear the notion that Dr. Price asserted you can cover many more folks and no one has to pay (Dem Senate bill cuts future Medicare and raises taxes to pay for the bill) anything is ridiculous.

The second portion of their fact check notes that President Obama did promise health negotiaions on C-Span and that hadn't happened. The President responded the committee hearings were all televised, but there were many private negotiations, last Spring with insurers, pharma, etc., and in the winter the melding of the final bills....obviously, some private meetings are are impossible to get rid of, but the President did promise that in the campaign. And watching yesterday, public meetings with President Obama representing his positions himself might have been alot more effective than Congress being so front and center (remembering the proviso that a President dropping all the details on Congress and saying pass it a la the Clinton plan didn't work). Using a football analogy since the Super Bowl closes in, if Obama were a running back, he only carried about 12 times a game, and his team and the country would be helped if he did so twice as much.

Taking a step back, I thought the most important and effective thing the President did was to confront the House Republicans with the message that the words and tone they use matter. This is certainly the case for him and the Democrats as well. However, the strident, ideological terms of the debate especially around health care used in opposition to the Democratic reform plans have not matched the reality of the plans. We talked about fictitious death panels for 6 weeks last summer.

Whether you like the Senate bill or not, it is essentially what passed for a moderate Republican plan in 1994. And the biggest change it would have brought about was a more than doubling of the number of Americans who shopped for, and bought their own private health insurance plan. From my perspective as someone who thinks about health policy all the time, and not just when it is politically important, the 'socialist, anti-American' over the top rhetoric from Republicans during the health reform discussions make it hard for me to take them seriously when they say 'give our plans a chance.' It makes them seem to be unserious.

Prices

WSJ with interesting story from Massachusetts showing that prices that hospitals charge insurers often vary by a twofold factor for reasons that are not based on what most would probably assume. The report found that price differences were NOT based on (1) quality; (2) patient mix (how sick patients were) (3) payer mix or (4) costs of delivering care.

Reputation and location very important. I specualated back in December that while most folks worried about insurers not competing when one has large market share as Blue Cross Blue Shield NC does, that hospitals not competing I suspect might be much more important in keeping costs (amount paid by insurance for care) high in some markets.

If you think market forces are important for health care, it is not so good that quality and costs of delivering care are not closely linked to how much hospitals charge.

Health Reform in China

I missed this from last week's WSJ on health reform actually passing--China. The plan is substantially increase health spending by around $120 Billion over the next two years. Key goals are to expand insurance coverage and especially reduce the access differential in the rural areas. More from another WSJ article. I taught a class at Peking University last summer on comparative health systems and the students were all abuzz about US health care reform. Maybe I should have been taking notes....

Interesting video

of the Pres addressing and then having questions and give and take with the House Republican caucus today in Baltimore. It is about 90 minutes long, with plenty on health care but other stuff as well. Here is a copy of the GOP better solutions health care document that Minority Leader Boehner gave to President Obama.

A few quick links

The State of the Union obviously didn't have a clear message of 'pass the Senate bill.' For health reform, the most telling was what he didn't say.

Here is NY Times coverage of speech and WSJ.


There are all sorts of paths to a reform bills being painted, but it is just hard for me to believe there is a realistic way other than the House passing the Senate bill and then the Senate making changes via reconciliation in the Senate. The longer it goes with no clear way forward and moves back burner....i just don't see how it comes back front burner.

A few links. Speaker Pelosi saying two track reform, easy stuff now and more comprehensive later. Discussion of moderate Dems worried that reconciliation will end any hope of bipartisanship in Senate for rest of session....freedom is just another word for nothing left to lose and all that. Word of House sending Senate $300 Billion in changes to be done via reconciliation, which makes it sound more likely that reform not going to move but House setting up opportunity to blame the Senate. We would have done it if....etc. More Senate blaming House, House blaming Senate.

Most likely outcome by far is no bill I think. I hope I am wrong.