Population health management (PHM) represents one of the long-term goals of the healthcare industry: building upon the patient-centered medical home concept to provide proactive support to a defined patient population in an attempt to address preventable behaviors that drive up healthcare costs. Through process improvement aided by technology, PHM helps with clinical decision support, thus improving the quality of care as well as patient safety. In diabetes, PHM is an attractive target for the following reasons: its ability to stratify patient populations, the disease’s high prevalence and costs, concerns over patient noncompliance, the risk of hospitalization associated with the disease, and the presence of defined treatment algorithms.

PHM is geared toward high-risk individuals and changes in physician compensation (partly tied to the proliferation of accountable care organizations) are translating into changes in prescribing behavior. As the use of PHM becomes more ingrained in physicians’ practice behavior, specific therapies will gain market share at the expense of others.

Questions Answered in This Report:

  • Development of population health management and effect on behavior. When and why did physicians and MCOs begin the transformation toward population health management? What metrics are measured in the PHM program and what do they mean for the drug industry? How has drug compliance changed as a result of physicians becoming involved with population health management? What HbA1c level and/or compliance rate would justify including a patient or beneficiary in a population health management program? Why are some diabetes patient populations not included in PHM programs?

  • Impact of population health management on prescribing and reimbursement. What percentage of physicians’ patients receives specific therapies? Which DPP-IV inhibitor do physicians and MCOs perceive to be best at achieving HbA1c goals and reducing preventable hospitalizations? Which GLP-1 receptor agonists do physicians and MCOs perceive as best at achieving HbA1c goals and reducing preventable hospitalizations? How has the launch of PHM affected prescribing of specific agents? How likely is it that an emerging therapy with comparable efficacy and a superior compliance rate be included in a population health management program?

  • High-risk diabetes patients and the role they play in PHM. How do physicians and MCOs define a high-risk diabetes patient? What percentage of patients and beneficiaries fall into the high-risk category? What HbA1c level and compliance rate would justify characterizing a patient or beneficiary as high risk?


This U.S. Physician & Payer Forum report contains insights from a survey of 70 endocrinologists, 70 PCPs, and 40 MCO pharmacy and medical directors (28 PDs and 12 MDs) regarding the impact of population health management programs on diabetes. We explore the issues that affect population health management and what they mean for specific therapies.

- Markets covered: United States.

- Primary research: Online survey of 140 physicians (70 endocrinologists and 70 PCPs) and 40 MCO directors.

Author(s): Roy Moore

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