Unique Program Reduces Blood Sugar Levels in Diabetes Patients

A unique physician “pay-for-performance” program at Montefiore Medical Center has reduced blood sugar and cholesterol levels significantly among many of the patients in South Bronx.

Physicians in each of Montefiore Medical Group’s (MMG) 21 community-based centers are given targets to reach for blood sugar and cholesterol levels in their diabetes patients and can be rewarded up to $3,200 annually for attaining these targets, an incentive paid for by the MMG administration.

“To improve blood sugar and cholesterol in diabetes patients requires a lot of invisible work, follow-up phone calls, counseling, developing rapport with patients and staying on their case over time,” said Sophia Au, MD, an internal medicine specialist in the Montefiore Medical Group for 13 years. She says it takes about two months to bring sugar levels down considerably for most diabetes patients through diet, exercise, medications, and home self-monitoring with a glucometer.

“Physicians are not paid for follow-up care; but, if we don’t follow-up, we will not succeed and more importantly neither will our patients. The incentive pay, while not much, is recognition of the invisible care and doing the right thing,” said Au. “There is another incentive. Because each physician has formalized scores for her patients, and we share these scores, I want to be in the top tier among my peers. I am competitive and being in the top tier is a professional reward.”

“Outcome-based medicine, with comparison scores and monetary incentives, works in this setting where we care for 14,000 diabetes patients,” said Arthur Hopkins, MD, medical director of Montefiore Medical Group 1. “We have been able to keep one standard measure of blood sugar, called HbA1C, below a recognized level of 9 in 85% of our patients, who have some of the most severe diabetes in the nation. Other programs caring for the same population of diabetes patients in the Bronx – e.g. HIP and Oxford have kept HbA1C levels below 9 for only 67-75% of their patients.” (Data from a state report titled “2006 New York State Managed Care Plan Performance”). Dr. Hopkins noted that 54% of patients under care at MMG had HbA1C levels under 7.