Pay-for-Performance Pilot Program for Diabetes Patients: Practical Example for Risk Group Stratification and Target Biomarker Values

Speaker(s)

Georgieva M1, Todorova V2, Slavchev G3, Dacheva A2, Mironova D4, Djambazov S2, Tankova T5
1HTA Ltd., Bulgaria, Sofia, 23, Bulgaria, 2HTA Ltd. Bulgaria, Sofia, 23, Bulgaria, 3HTA Ltd. Bulgaria, Sofia, 22, Bulgaria, 4Lozenetz Hospital, Sofia, 1000, Bulgaria, 5Medical university Sofia, Sofia, Bulgaria

Presentation Documents

OBJECTIVES: Diabetes mellitus (DM) is a significant health problem with 537 million people affected worldwide in 2021. The prevalence of DM in Bulgaria is currently 10%. Pay-for-performance (P4P) is a healthcare reimbursement model in which healthcare providers are financially incentivized based on the performance of quality and outcome measures. A proposal for implementing the P4P model in Bulgaria has been developed, defining risk groups and biomarkers for diabetes control. This study illustrates risk group stratification and target biomarkers for measuring quality and outcomes in diabetes patients.

METHODS: Literature search and consultation with leading Bulgarian endocrinologists led to stratifying risk groups in diabetes patients and selecting biomarkers for outcome measurement and control.

RESULTS: The selected biomarkers are glycated hemoglobin (HbA1c), total cholesterol, and body mass index (BMI). The patients with type 1 and type 2 diabetes are classified into two risk groups: group 1 (moderate to high risk without comorbidities) and group 2 (very high risk with diabetes related comorbidities). The target HbA1c in group 1 is ≤ 7.5%. For group 2 the target HbA1c value is ≤ 8%. The target value for total cholesterol is < 4.5 mmol/l in adults and < 4.4 mmol/l in children. The BMI target for adults is 18.5 to 24.9 kg/m2, and for adult patients with a baseline BMI above 30, the target is a 5% weight reduction within one year. For children and adolescents, the value is below the 85th percentile.

CONCLUSIONS: The P4P model aims to enhance the therapeutic care for diabetes patients in Bulgaria by adapting risk group stratification and target biomarker values to the local healthcare landscape. This approach ensures that healthcare providers have achievable goals tailored to their specific context. At the end of the three-year pilot program, data will be analyzed, and the target values will be reassessed.

Code

HPR81

Topic

Health Policy & Regulatory

Topic Subcategory

Health Disparities & Equity, Insurance Systems & National Health Care, Reimbursement & Access Policy, Risk-sharing Approaches

Disease

Diabetes/Endocrine/Metabolic Disorders (including obesity), Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)