Abstract
Type 2 diabetes (T2D) affects over 422 million people worldwide. Within their multi-payer healthcare system, Germany has used standardized, evidence-based interventions called Disease Management Programs (“DMP”s) to manage T2D since 2002. Studies have shown markedly improved health care delivery and health outcomes, including reduced incidence of diabetic secondary complications, decreasing financial burdens of T2D in Germany. No such programs exist in U.S. healthcare. In 2017, diabetes care for 29 million T2D Americans cost $327 billion. Clearly needed reform warrants examination of and comparison with German T2D DMPs’ successful methods. This study employed interviews and surveys to investigate German and American primary care physicians’ opinions of their nation’s T2D management methods’ efficacy in improving health outcomes, healthcare costs, and quality of care. While German physicians reported similar protocol and resource availability for T2D management, American physicians’ responses varied widely by clinical network and individual insurance plans. Strengths of Germany’s T2D DMPs included regularity of visits and the accountability inherent to this structure, while weaknesses included lack of customization and excessive bureaucratic documentation for minimal added value. Strengths of American methods included increasing utilization of technological tools and motivational interviewing techniques, while weaknesses included systematic inequality, lack of insurance-covered diabetes education, and prohibitively high costs of medication. This study provides new insight into primary care physicians’ opinions on best directions forward for chronic care management, which include subsidized diabetes education courses, coverage of dieticians and counselors, and increased implementation of team-based care, telemedicine & apps to improve patient accountability, and value-based care.