title: Adherence to Metformin, Statins, and ACE/ARBs Within the Diabetes Health Plan (DHP).
abstract: BACKGROUND
  Reducing patient cost-sharing and engaging patients in disease management activities have been shown to increase uptake of evidence-based care.
  
  
  OBJECTIVE
  To evaluate the effect of employer purchase of a disease-specific plan with reduced cost-sharing and disease management (the Diabetes Health Plan/DHP) on medication adherence among eligible employees and dependents.
  
  
  METHODS
  Employer-level "intent to treat" cohort study, including data from eligible employees and their dependents with diabetes, regardless of whether they were enrolled in the DHP.
  
  
  METHODS
  Employers that contracted with a large national health plan administrator in 2009, 2010, and/or 2011.
  
  
  METHODS
  Ten employers that purchased the DHP and 191 employers that did not (controls). Inverse probability weighting (IPW) estimation was used to adjust for inter-group differences.
  
  
  METHODS
  The DHP includes free or low-cost medications and physician visits. Enrollment strategies and specific benefit designs are determined by the employer and vary in practice. DHP participants are notified up front that they must engage in their own health care (e.g., receiving diabetes-related screening) in order to remain enrolled.
  
  
  METHODS
  Mean employee adherence to metformin, statins, and ACE/ARBs at the employer level at one year post-DHP implementation, as measured by the proportion of days covered (PDC).
  
  
  RESULTS
  Baseline adherence to the three medications was similar across DHP and control employers, ranging from 64 to 69 %. In the first year after DHP implementation, predicted employer-level adherence for metformin (+4.9 percentage points, p = 0.017), statins (+4.8, p = 0.019), and ACE/ARBs (+4.4, p = 0.02) was higher with DHP purchase.
  
  
  CONCLUSIONS
  Non-randomized, observational study.
  
  
  CONCLUSIONS
  The Diabetes Health Plan, an innovative health plan that combines reduced cost-sharing and disease management with an up-front requirement of enrollee participation in his or her own health care, is associated with a modest improvement in medication adherence at 12 months.
authors.affiliation: David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA. kduru@mednet.ucla.edu.
authors.forename: O Kenrik
authors.initials: OK
authors.lastname: Duru
authors.affiliation: David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
authors.forename: Norman
authors.initials: N
authors.lastname: Turk
authors.affiliation: David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.|Fielding School of Public Health, University of California, Los Angeles, CA, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
authors.forename: Romain
authors.initials: R
authors.lastname: Neugebauer
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA.|VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Tannaz
authors.initials: T
authors.lastname: Moin
authors.affiliation: David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
authors.forename: Jinnan
authors.initials: J
authors.lastname: Li
authors.affiliation: David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Kimbro
authors.affiliation: UnitedHealthcare, Minnetonka, MN, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Chan
authors.affiliation: UnitedHealthcare, Minnetonka, MN, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Luchs
authors.affiliation: UnitedHealthcare, Minnetonka, MN, USA.
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Keckhafer
authors.affiliation: UnitedHealthcare, Minnetonka, MN, USA.
authors.forename: Anya
authors.initials: A
authors.lastname: Kirvan
authors.affiliation: UnitedHealthcare, Minnetonka, MN, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Ho
authors.affiliation: David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.|Fielding School of Public Health, University of California, Los Angeles, CA, USA.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
mesh_terms: D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000191:economics / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D017047:Cost Sharing / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D019468:Disease Management; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D007093:Imidazoles / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D000068718:Rosuvastatin Calcium / Q000191:economics / Q000627:therapeutic use; D013777:Tetrazoles / Q000191:economics / Q000627:therapeutic use; D014481:United States; D016903:Drug Monitoring
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D007093:Imidazoles; D013777:Tetrazoles; D000068718:Rosuvastatin Calcium; C437965:olmesartan; D008687:Metformin