Happy Memorial Day Mon. We'Ra still in a military mindset here at the 'Mine, with a seem today at what's natural event with diabetes benefits for the manpower and women World Health Organization've served our state.

To hear the Veterans Administration (VA) tell information technology, they're the international leader in diabetes care.

Uh… wait a instant… is this the same VA that's been the lightning rod for the ire of American English veterans for generations?

Yep. It's the same VA, merely today's VA is a far cry from the one your grandfather went to. They've immediately got a up-to-date diabetes playbook that's proving itself with real-world results that are outpacing the rest period of American healthcare. The organizations that represent vets are happy, and so likewise, information technology seems, are the vets themselves.

Is this a healthcare paradise? Non quite a, but you could enunciat that things are better with a upper-case letter B…

A Changing VA

Forget about aging multi-story 400-bed hospitals. The brand-new face of the VA is the community clinic. 1,400 of them, thus far. Following a major revamping 'tween 1995 and 2000, the VA changed its focussing to "universal primary care." It's paying care to a wide variety of health conditions, and has been an primeval adopter of physics medical records (EMR), which many other clinics and hospitals have struggled to implement.

Why the VA Cares All but Diabetes

And you think your class is big? The VA provides health benefits to 1.45 million vets who give birth diabetes (!). This number has risen sharply over the last decade, more doubling since the twelvemonth 2000. That agency the VA is responsible the healthcare of around 6% of Persons With Diabetes (PWDs) in the United States — more than their fair portion out. The prevalence of diabetes amongst vets far outstrips that of the general public. Nearly 25% of veterans in the VA healthcare system have diabetes, compared to about 8.3% of the general semipublic.

The vast majority of vets with diabetes are type 2s. What about type 1s? While specific numbers aren't available, the VA says its phone number of vets with case 1 is "very low" since case 1 historically develops at a puppylike age and generally precludes discipline service — at to the lowest degree historically. Most of the VA's PWDs are as wel men. While women straightaway make up about 14% of active obligation staff office, they micturate up a smaller percent of the veteran population. They also tend to "low-level-utilize" the VA healthcare system. Only about 5% of all VA visits of any kind are aside women vets (a subject of much current search at the VA).

But it isn't just the number of PWDs that's high. So, too, is the price tag for their care. Diabetes is expensive for the VA. Inpatient and outpatient costs of vets with diabetes eats up 4% of the VA's overall healthcare budget and 28% of its pharmacy budget. The VA shells out healed over same-and-a-half billion (!) dollars annually to treasure vets with diabetes.

So are they disagreeable to punctured corners to economise a buck nowadays? Or are they pickings the long reckon that they have these patients for life, and that good care today pays dividends in the future?

The VA's Diabetes Playbook

The VA's clinical practice guidelines for diabetes call for ancestry sugar assure through "diet, do, medication, and patient education." Kind of than adopting geostationary A1C targets like former diabetes guidelines in the U,S, historically ingest, the VA calls for an personal A1C target between 7 and 9, taking into account the patient's age, health, and likely lifespan. It's interesting to note that the American language Diabetes Association (ADA) will adopt a similar coming this summer.

Of course, similar other diabetes guidelines, control of blood forc and lipids is emphasized, American Samoa are recommendations for foot checks, flu shots, kidney checks, and all the rest of it that we are used to seeing.

Like most new health plans, the Old Dominion State's listed medications start cheap and get more big-ticket as you work your way up the food mountain chain. At the top, you stimulate modernistic alternatives like GLP and DDP therapies.

Of note, however, is the fact that the VA dragged its feet for years when it came to adding modern basal insulin, like Lantus, to their statement, not doing then until 2007, under squeeze from Congress and veterans groups.

But in theory, overall, the present-day Virginia "struggle program" for diabetes appears first-class, progressive, and cutting-edge.

What's Working in the Proper World?

With all that money, and a jolly good playbook, how's the VA in reality doing? What do the wellness outcomes for vets look like, you bet does that compare to the civilian universe?

That altogether depends connected how you view the Numbers. The VA states that in 2009 most vets, roughly 85%, birth "acceptable" blood glucose control. "Unimpeachable" is defined by the Old Dominion State as having an A1C below 9%.

That means, of course, that 15%—near 217,500 vets—have dangerously tenor A1Cs.

Is that good?

Well, whether information technology's good enough or non, it's a hell of a good deal better than the civilians are doing. HEDIS data for the same year shows that about 28% of PWDs with commercial message HMO indemnity plans have A1Cs above 9. If you have a PPO, that percentage sky-rockets to 44.6%. The numbers racket are all but the same for Medicare. Medicaid recipients make out the worst, with fully 44.9% having A1Cs higher up 9%.

I think we all could be doing break, but clearly the Old Dominion State is waaaaay ahead of the rest of the pack.

Good Care + Who Pays?

Kraut Manar is National Veterans Servicing deputy director for the VFW (VFW), and a typewrite 2 PWD himself. He tells the 'Mine that the VFW complaint hotline gets hundreds of calls a calendar month griping about the VA, but not about diabetes care. "We don't get complaints hardly at all about diabetes," says Manar. He likewise says he put up't recall anyone ever personally complaining to him at conventions operating theater events about diabetes care or treatment. The VFW has around 2.2 million members, and accordant to Manar, "they're not deficient."

If non diabetes, then what are they complaining about? Manar says most of the complaints called into the VFW hotline hold to do with the wait metre for specialty appointments, which can stretchability to six months, especially in the under-staffed arena of psychogenic health.

Manar himself gets his diabetes care at the VA and reports his last A1C was "a half dozen-something" with daily BG fingersticks usually running in the 100-120 range. Atomic number 2 says he occasionally waits 5-6 weeks for an appointee, but "my care has been dissuasive." He's seen the same doctor semi-p.a. for the last 4-5 long time, and his doc usually spends a full 30 minutes with him, much more sentence that his non-VA Primary Tutelage Physician gives him. To boot, atomic number 2 says he can rescript his diabetes meds on the net, "which is really convenient." (We know!)

Manar's diabetes care is covered 100% as a serve-cognate disability. Protrusive in 2001, the VA listed diabetes as a "presumptive" condition for in-country Vietnam vets. That means if your foundation touched the soil in Vietnam betwixt January 9, 1962 and May 7, 1975—and you're afterwards diagnosed with diabetes—the VA presumes that Agent Orange may give birth had a bridge player in it, based on the results of a National Academy of Sciences study that showed a higher than expected correlation between diabetes and dioxin exposure.

But even for vets non exposed to Agent Orange tree, diabetes discussion is still a covered benefit as part of whole healthcare. The main departure is that, unlike PWDs whose diabetes may have been caused by service-related photograph to dioxin, non-service related PWDs need to make medicine co-pays.

Missing in Sue…

One area where the VA still seems to be lagging behind commercial plans is in the use of insulin pumps. About health plans in the U.S. now cover insulin pumps for typewrite 2s who require some basal and fast-acting insulin, but thus far, the VA will only book binding pumps for those few VA patients who develop type 1 diabetes as adults during or later on their service.

You William Tell Us

Thus PWD vets, what all but you? Sound turned! What's your VA diabetes experience been like? Has the VA become the leader in diabetes care in your view? Or are they just another health plan talking themselves improving? Do you feel their end is to make you healthy and keep you that way, or antitrust to redeem a buck?