Connecting National Policy and Local Experience to Reverse Diabetes Disparities

[Ed. Note: Today we're happy to provide you with a guest post by Noreen M. Clark, PhD, Myron E. Wegman Distinguished University Professor, Director, Center for Managing Chronic Disease, University of Michigan]

Health care disparities are perhaps among the most vexing problems in medicine, public health and health policy.  Despite broad public- and private-sector attention to the problem, disparities continue to grow.  At the Alliance to Reduce Disparities in Diabetes, a national program launched and supported by The Merck Company Foundation, we are working to reverse this trend and are finding that it’s critical that national policies aimed at reversing diabetes disparities consider the on-the-ground experience of those working to improve health outcomes for those most affected.

Too often national policies are developed that work well in theory but are divorced from the reality of what’s happening at the community level.  This makes enacting changes to reduce disparities in diabetes difficult, but the work of those on-the-ground is shedding light on ways to overcome the systemic and structural barriers to providing effective diabetes care to those most in need.  For example, the Alliance’s five health care delivery sites have implemented multifaceted evidence-based approaches designed to eliminate gaps produced by inequity and lack of targeted attention to those adults and their families who are most likely to be severely burdened by diabetes.

Based on the experience of the Alliance sites and the knowledge that national policy needs to better reflect local experience, the Alliance developed “Policy Considerations That Make the Link,” a document that connects the local experience of the five Alliance sites with issues facing national policymakers as they consider ways to get more value, quality, efficiency and innovation into our health care system.  The report directly addresses the structural barriers Alliance grantees have encountered in the health care delivery and financing systems and poses a series of considerations surrounding the identified need to realign financial incentives affecting health systems, providers and patients as a mechanism for reducing disparities in diabetes.

Concepts offered to address health system needs include ways to:

  • Encourage greater integration of public health and health care systems
  • Share and report community-wide health data
  • Eliminate incentives that encourage underinvestment in low-income, high-risk patients

Concepts offered to address provider needs include ways to:

  • Optimize Accountable Care Organizations’ (ACOs) abilities to reduce disparities
  • Support deployment of Community Health Workers (CHWs)

Concepts offered to address patient needs include ways to:

  • Enhance diabetes self-management supports

To download the full policy considerations document and learn more about the Alliance to Reduce Disparities in Diabetes, click here.

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