Consistent, Efficient, and Effective A1C Management to Goal: Novel Approaches from Kaiser Permanente Kern County, San Diego, and Northern California

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https://doi.org/10.7812/TPP/17-140-10

Introduction: New Kaiser Permanente (KP) data show delaying A_1C lowering from > 8% to < 7% by 1 year resulted in a 58% higher microvascular disease risk; however, KP Regions, except Northern California (NC) are not yet above HEDIS 90th percentile for the A_1C < 8% metric.
Methods: A population-based care program design promoted appropriate treatment of patients with high A_1Cs: in Kern County (KC) > 5.7%, in NC > 8%, and in San Diego (SD) 7% to 8%. KC ensured patients with an A_1C > 5.7% received prediabetes/diabetes education and follow-up A_1Cs to monitor prediabetes or diabetes status or to confirm its new diagnosis. NC and SD used processes with an accountable clinician to ensure timely, verified treatment intensification and automated A_1C follow-up for every patient with A_1C above goal. Clinician-level reporting was sent to managers to support performance improvement. All 3 program locations used similar diabetes “Treat-to-Target” protocols.
Results: KC’s population with diabetes increased by 11.9% vs Southern California’s of 8.1% during 1 year. SD increased A_1C < 7 from 40.2% to 45.3% in 6 months. NC achieved > 90th percentile and led all KP Regions for HEDIS A_1C < 8%.
Conclusion: Four features: Moving to a population-based approach, fixing clinician responsibility, promoting timely treatment intensification, and automating A_1C follow-up orders were associated with the programs’ successes.