I understand the logic of tying patient outcomes to financial contract terms but fear patient input in defining these terms will be left out.
Suzanne Winter, vice president of the Medtronic diabetes group in the Americas, said the Aetna agreement will initially focus on whether patients on its pumps achieve their A1c targets, a commonly used measure of blood sugar levels. The American Diabetes Association recommends A1c levels below 7.
In the future it may look at other measures, such as hypoglycemia episodes, time in proper glycemic range, and patient satisfaction, Winter said.
My A1c, for example tracks 0.5% to 1.0% higher than my glucose measures indicate. That includes fingerstick averages, CGM averages, and lab glucose. Studies have shown that the A1c number actually corresponds to a range of blood glucose exposure. For instance, an A1c of 6% maps to a range of blood glucose from 100 mg/dL to 152 mg/dL (5.6-8.4 mmol/L). Any system that does not recognize the limits of the measures used may end up unfairly penalizing outliers.
Will "time in proper glycemic range" be defined at, say, 80-180 mg/dL, 4.4-10 mmol/L (a range I see used at my endocrinologist's office) when my 24/7/365 living with diabetes has taught me that my lower boundary of good glycemia is actually 65 mg/dL (3.6 mmol/L)?
As patients and participating members of this community, we are aware of how much diabetes varies from patient to patient as well as the numerous factors that can influence glycemic measures. I am favorable to the general concept of payment for performance but I can easily see the actual measures be set up without significant weight placed on patient input.