November 28, 2012
New Joslin Diabetes Program
This information on the Joslin website does beg some questions. Are they really enthused about the “Joslin Everywhere” program? Or will this become an untenable drain on the funds and be kicked to the curb and abandoned like so many other projects? This article on the Joslin website sounds great and I wish them success. I will be watching and hopefully there will be some transparency. The introduction to the article sounds impressive, “Catherine Carver, M.S., A.N.P., C.D.E., Vice President for Advocacy and Planning is one of the key movers behind Joslin’s bid to bring diabetes care into the 21st century with Joslin Everywhere, a digital care and education platform in the works at Joslin Diabetes Center.”
The next paragraph sounds even more impressive. It says, “Imagine Joslin’s resources being available to everybody, anywhere, on their phone, on their computer or tablet, by live video chat. But not as boilerplate, instead, in a form tailored to the patient’s individual needs. For example, suppose the patient is Mexican and wants to know about nutrition and diabetes- Joslin Everywhere would present him with food choices in Spanish that are common to the Mexican food mores. Expanding beyond face-to-face office visits is the only way we can remain relevant in the face of the tsunami of new diabetes cases coming our way. The only way we can hope to stem this epidemic is to reach people through other mediums.” Since this is still “in the works,” words to watch are “boilerplate” and “patient's individual needs.”
The example really says nothing other than they will use the person's language and nothing about not boilerplating for the average Mexican. The food choices may still be heavy on carbohydrates and low fat. Also, there is no mention about having the patient use a blood glucose meter to see if what they recommend causes blood glucose to spike. This begs another question of what will be the effects for people with diabetes. Will it mean more platitudes and then the one size fits all whole grains, low fat mantra. Will we see more emphasis on testing to help people manage their prediabetes to prevent type 2 diabetes – this is highly unlikely.
Or will Joslin make use of some of the new information to test people early to prevent even prediabetes. “Researchers at Sweden's Lund University have identified a "promising candidate" for a test that will indicate an early risk for type 2 diabetes, up to 10 years before diagnosing diabetes.” If Joslin is sincere in reaching people through other mediums to stop the diabetes epidemic, this should be on the table quickly for evaluation and if it works, all doctors throughout the world should make use of it. However, I doubt Joslin will be this progressive.
Is this only for Joslin patients? And the next question - how is Joslin being reimbursed or paid? Initially this is all it can be as there are many hoops to jump through to be reimbursed for time spent. In the state of Massachusetts, there is a law in place effective November 5, 2012 that states: “Alternative payments have the potential to provide incentives for efficiency in the delivery of services that are absent in the fee-for-service system, while potentially promoting improvements in quality through better coordination of care.” In other words, private insurers are beginning to understand there are benefits of touching patients in the best venue for the patient. This often means reduced costs for the insurer in the long-term.
As I learn more, I may have more questions.