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Colorado Clinic Helps Diabetics Avoid Problems With 1-Stop Coordinated Care

February 15, 2011 at 6:36 PM EDT
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Betty Ann Bowser reports on a Colorado clinic that helps patients tackle the symptoms of diabetes before the disease's side effects become major health issues.
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JUDY WOODRUFF: Next, tackling one of the biggest health care issues in America: the growing burden of diabetes.

Increasingly, doctors and insurers are trying to find ways to help patients deal with the disease before their problems get worse.

Betty Ann Bowser reports for our Health Unit on how a clinic in Colorado is trying that approach.

BETTY ANN BOWSER: Bonnie Bell was diagnosed with diabetes when she was pregnant 30 years ago. At the time, she had recently won a struggle with bulimia.

BONNIE BELL, diabetic: The actual diagnosis was like a blast from God. It was like, well, how can you do this to me? I don’t even know how to eat normally without this disorder. And now, all of a sudden, I have to eat perfect; I have to eat everything, or I’m going to die, or I’m going to lose a limb?

BETTY ANN BOWSER: She didn’t get real help, though, until 10 years ago, when her symptoms got much worse.

BONNIE BELL: My blood sugars were very high. My vision was going crazy. I found Clinica, and Clinica held me by the hand. And they just said, you know, you need nutritionists. You need these programs that we offer.

BETTY ANN BOWSER: Clinica Family Health Services, which treats 1,800 diabetics, came to Bell’s rescue. Its four clinics provide medical homes for low-income and uninsured patients in Colorado. That means one-stop shopping for patients not only to see doctors, but fill prescriptions and even see a dentist.

Those with diabetes regularly get their blood pressure and blood sugar levels tested. They get checked to see if the disease has affected their feet and eyes. And in group sessions, they learn how to live with their illness.

WOMAN: Do you think that that’s right that automatically you’re going to die earlier if you have diabetes?

MAN: No.

WOMAN: No.

MAN: No.

WOMAN: So, and why — why is that?

MAN: I’m still here, and I have got diabetes. And I have had it for six years. I really don’t think diabetes is the cause of everything that happens to me.

DR. CAROLYN SHEPHERD, Clinica Family Health Services: It looks like we finally got the goal.

BETTY ANN BOWSER: Using electronic health records, Dr. Carolyn Shepherd, Clinica’s medical director, can track patients’ progress.

DR. CAROLYN SHEPHERD: We try to pay attention to our entire population of patients who have diabetes or other chronic diseases by knowing who they are and what indicated care they’ve had and what care they have been missing.

BETTY ANN BOWSER: If they don’t show up, you go find them?

DR. CAROLYN SHEPHERD: That’s right. That’s right.

DR. ANN ALBRIGHT, Centers for Disease Control and Prevention: And the package for diabetes prevention, that is certainly one of the next steps that we need to get accomplished.

BETTY ANN BOWSER: Left unattended, diabetes can have devastating consequences, says Dr. Ann Albright of the Centers for Disease Control in Atlanta.

DR. ANN ALBRIGHT: Diabetes is the number-one cause of adult blindness. It’s the number-one cause of kidney failure. It’s the number-one cause of non — what we call non-traumatic lower limb amputation. And it’s a huge contributor to heart attack and stroke. So, diabetes is like dropping a rock in a pond, and the ripples go out.

BETTY ANN BOWSER: Shepherd thinks Clinica is stopping that ripple.

DR. CAROLYN SHEPHERD: I think we’re winning the war because we see less long-term complications happening. We have fewer patients winding up with diabetes-caused blindness or with kidney failure.

PETE LEIBIG, Clinica Family Health Services: So, we have got to have some kind of phased approach, which means some things comes first, second, third, fourth.

BETTY ANN BOWSER: And that also saves the system money in the long run, according to CEO Pete Leibig.

PETE LEIBIG: You take the $4,000 per patient per year for the diabetes care that we provide, and you multiply it times the 1,800 diabetes patients we have, and you save about $7 million a year, not in the care we provide, which is actually a little bit more pricey, but in the hospital stays that don’t occur or that are much shorter.

BETTY ANN BOWSER: But the problem is that more and more people are getting diabetes, partly because they are living longer and partly because so many people now are overweight.

DR. ANN ALBRIGHT: Our data shows one in three to one in five people will have diabetes in 2050. There’s an old analogy. It says that your genetics loads the cannon, and lifestyle lights the fuse. And so it is this combination of the changes in our environment and the changes in lifestyle that have increased the rates of obesity.

BETTY ANN BOWSER: And some groups are more at risk than others. Albright found that 11 percent of Hispanics have diabetes, 3 percent above the national average. Many in that community, like landscaper Jimmy Ledesma, go undiagnosed for years.

JIMMY LEDESMA, diabetic: I think this started about 25 years ago, but I wasn’t aware of that until I got sick in the year 2001 or 2002, one of them — I can’t remember — when I — when I was at work and I just — I sat down. It was real hot that day. And I sat down, and I couldn’t get up no more.

BETTY ANN BOWSER: How much diabetes is there in your family?

JIMMY LEDESMA: OK. The sister that was 34 years old, she died of it. OK, my oldest brother, 72, he died of it. My brother that’s 70 years old that died three months ago, he — he died from diabetics, too.

BETTY ANN BOWSER: Clinica is trying to reach out to Hispanics by offering group meetings in Spanish. Its sliding-scale payment system helps patients like Ledesma afford treatment.

JIMMY LEDESMA: When you draw blood out of your finger, a little strip, I — I would never check my blood, because I couldn’t afford to, until I find out that they sold them here for $23 for 50. So, I check my blood every day.

BETTY ANN BOWSER: Clinica has gotten almost $4 million, much of it from the health reform law, to offer more services to more patients.

Leibig says every dollar translates into more care.

PETE LEIBIG: One more care team here is able to serve between 3,000 and 3,200 more people. So, it will bring us up from caring for 25 percent of the low-income people in the community to around 30. So, we’ll still have a long way to go, but it’s certainly a step in the right direction.

BONNIE BELL: How about a sample today?

BETTY ANN BOWSER: A step Bonnie Bell already has taken with a healthy diet and a new attitude.

BONNIE BELL: I have lost almost 100 pounds with the help of the diabetic medications. I’m not on insulin. I’m more stimulated and excited about the fact that I have — I feel like I have the world by the tail, because I have this disease, and it doesn’t have me.

BETTY ANN BOWSER: Clinica has applied for another big federal grant to open a fifth center. But with battle lines being drawn around the budget in Washington, future funding is uncertain.