Diabetes Pro Quarterly - Winter 2018 - 7

PROFESSIONAL NEWS

Four Ways to Save the Provider-Patient Relationship

This is an excerpt from an article produced in collaboration with
Continuum. The full article is available at adainnovation.org/
perspectives.
Providers of diabetes care are under pressure. Lots of it. All
players in the diabetes space know that treating the condition is
inherently complex, leaning heavily on lifestyle and behavioral
change. On top of this, a flurry of exciting medical advances
is challenging providers in their decision-making. All points
intersect to show a greater need for personalized care, with an
intimate understanding of the individual patient as prerequisite-
and at a higher volume. We also know, though, that the incentives are not currently aligned to reward providers for the type of
work and engagement needed to provide this level of quality care.
So, what do providers want?
First and foremost, providers seek to provide great diabetes care.
"The level of responsibility is immense," says Dr. Jeff Dobro,
chief medical officer of One Medical, a member-based, national
primary medical group that directly employs more than 360
providers. "We take patient care very seriously."
At the core of providing great care must be an ecosystem-wide
understanding of the value of the provider-patient relationship.
In speaking to a number of providers, we heard four main categories of need:

1. Time to Provide Patient-Centric Care
It takes time to get to know a patient and build a strong provider-patient relationship. Providers should be recognized, not
penalized, for trying to stay engaged. "To treat diabetes well,
you have to know the patients, who they are, their struggles and
motivations," says Dr. Matthew Freeby, director of the Gonda
Diabetes Center at the University of California Los Angeles
and a trained endocrinologist and diabetes specialist. "The U.S.
health care system does not reward staying engaged in patients'
care, which is vitally important in diabetes. Day-to-day glycemic
management is impacted by so many factors and often requires
more engagement than other disease processes."
A major pain point: the excessive amount of time providers
spend proving themselves to payers rather than treating patients.
Dr. David Harlan, director of the Diabetes Center of Excellence
at the University of Massachusetts Memorial Health Care, argues
that what patients need is a doctor-not someone to fill out
forms or negotiate a payment. "When I have to call an insurance
company and explain, and I'm talking to some recent college
graduate, and I get an automated menu and listen for several
minutes-that's time I could be spending with another patient,"
Harlan says. "Having to speak to someone who knows nothing
about the patient and convince them-that's a waste of time."

Harlan cites a broken health care finance system as the root of
the problem. "Nowhere in the equation of the finances is how
well the patient is doing," he says. "Therefore, we've gotten very
good at writing long patient notes." He adds that the only way
to bill for a 30-minute visit with a patient is for him to document things in the patient's chart, where he'll be asked to talk
about some preconceived number of organ systems, to analyze a
predetermined number of body parts, and to analyze an arbitrary
number of complex situations. Then compliance officers read
these notes, and payers do the same. "In other words, we're
guilty until proven innocent," he says. "You get these very long
elaborate notes that are largely fiction-they're not focused on
patient health."
Dobro says that One Medical has built a model to challenge this,
with 95% of appointments starting on time, the average visit being 27 minutes long, an average waiting time of 30 seconds, and
24/7/365 access to a virtual medical team. In constructing the
company around the patient as the center of the health system,
Dobro's second priority is to avoid provider burnout and produce
a satisfying experience for the provider. These two aims work
congruously, with providers having half the usual patient panel,
being capped at 16 patients a day, and offering same-day or
next-day appointments and patients determining how long their
appointments are. Dobro says that this allows providers to develop a longitudinal relationship with their patients.

2. Tech That Enables Shared Decision-Making
The majority of diabetes patients are treated by primary care
providers (PCPs), not endocrinologists. It is up to PCPs to decide
at what point to engage a diabetes specialist. Typically, diabetes
specialists such as Freeby will accept patients who require insulin
and more medication. Such partnerships require an increased
level of shared medical decision-making. It can get complicated.
And although diabetes has always been a complex condition
to treat, new medical advances have changed the landscape of
decision-making. The era of three straightforward classes of
diabetes medications has come and gone. "It's a blessing and
a curse for my primary care colleagues," Freeby says. With the
influx of new medicines at their disposal, particularly for type 2
diabetes, providers not specializing in diabetes are faced with the
challenges of choice. One Medical's Dobro has an interesting take
on shared decision-making. He wants to see vetted and curated
options among diabetes management solutions, with vetting criteria including outcomes, patient satisfaction data from vendors,
patient budget, and insurance coverage. "Providers need tools to
help them know that they're doing the right thing," Dobro says.
"Otherwise, they may be relying on memory and the difficult
task of staying current on the latest Cochrane review."

3. Tech That Is Built Around the Provider-Patient
Dynamic and 4. Ways to Empower Our Patient Partners

are expanded upon in the full article available at adainnovation.
org/perspectives.
continued on page 8

DIABETESPRO QUARTERLY

http://www.adainnovation.org/perspectives http://www.adainnovation.org/perspectives http://www.adainnovation.org/perspectives http://www.adainnovation.org/perspectives

Table of Contents for the Digital Edition of Diabetes Pro Quarterly - Winter 2018