Case Study
Wellth reduces HbA1c by 1.29 in high-risk diabetes population
72
%
Of cohort members with
verifiable lab data
reduced their HbA1c
92
%
Decrease to avoidable
Emergency Room
utilization in Wellth cohort
86
%
Average daily
adherence through
the Wellth app
Staten Island Performing Provider System (SI PPS), a member of the New York Medicaid DSRIP Program, partnered with Wellth to engage their highest-risk Diabetes populations. As a result of the partnership, SI PPS has significantly improved clinical and quality measures, helping it become one of the highest-ranked networks in the DSRIP program.
Background
Staten Island Performing Provider System (SI PPS) is a member of the New York State Medicaid Delivery System Reform Incentive Payment (DSRIP) Program. Launched in 2014, NYS DSRIP has a primary goal of reducing avoidable hospital utilization by 25% by transforming the New York State health care system into a “financially viable, high performing system”. Each PPS receives performance incentives for meeting outcomes related to System Transformation, Clinical Improvement, and Population Health. Staten Island PPS in particular was evaluated based on implementing evidence-based best practices for diabetes disease management. For more information on the New York State DSRIP program, visit health.ny.gov.
Start Date
June 2018
Location
Staten Island, NY
Disease State
Type 2 Diabetes
Insurance Coverage
Medicaid
Clinical Significance of Lower Hemoglobin A1c Level in Diabetes Disease Management
The Hemoglobin A1c (HbA1c) metric is a measure of an individual’s average blood sugar level over the past 2-3 months. An individual is diagnosed with Type 2 Diabetes if they have an A1c level over 6.5, and high-risk individuals typically have an A1c over 8.0. In Wellth’s program with SI PPS, the average starting A1c level was 10.05, which is indicative of very high clinical risk. As individuals with Type 2 Diabetes lower their A1c levels, they lower their risk of developing complications associated with heart and kidney disease. 

Several studies have demonstrated that improved medication adherence in individuals with Type 2 Diabetes is closely correlated with lower HbA1c. Therefore Wellth’s evidence-based medication adherence solution for Type 2 Diabetes populations results in significant and sustained improvement in A1c level, reducing the clinical risk of the enrolled population.
“The volume to value proposition of value-based payment is not simply a reimbursement phenomenon. Behavior change is at the core of any change in outcomes for individuals with chronic disease.”
— Joseph Conte
Executive Director of Staten Island PPS
How Wellth’s Behavior Change Solution Led to Improved Outcomes at SI PPS
SI PPS and Wellth began working together in Summer 2018 to create a program specifically for the highest-risk portion of the Staten Island PPS diabetes population. The primary goal of the implementation was to implement evidence-based disease management practices in order to reduce the preventable ER visits and hospitalizations that result from Diabetes complications. SI PPS sponsored the implementation of Wellth’s behavioral economics solution across several of its provider partner sites. High-risk diabetes patients were offered the opportunity to enroll into the Wellth program to earn $75 for appropriately taking their diabetes medications and monitoring their blood sugar. Enrolled patients verified these behaviors by submitting a daily photo of their medication and glucometer reading for 70 days. However, if they missed a day, a $2 deduction was made from their $75 rewards balance. This leverages an evidence-based concept known as Loss Aversion to drive better adherence outcomes.
"At first, I never used to take my medications on time and never checked my diabetes, until I was on Wellth and was able to stick to my regimen. I think the financial rewards were a great incentive. It made me care more about my health."
— SI PPS / Wellth Member
HbA1c level reduced from 12.8 to 7.3 on Wellth
Results
The results of the initial program are far reaching. The enrolled cohort of patients had an average adherence rate of 86% throughout the 70-day program and reduced their average HbA1c by 1.29 points, from 10.05 down to 8.76. SI PPS has observed a 92% reduction in utilization of ER services in the enrolled cohort as well as a 77% reduction in preventable short term diabetes complications (Prevention Quality Indicator 1). Staten Island Performing Provider System is now one of the highest-ranked networks in the New York DSRIP program.
"These results are a clear demonstration that a patient-facing tool like Wellth creates a durable client benefit of improved clinical markers representing Quality, reduced avoidable utilization representing Cost, and patient behavior change representing Patient Engagement; the ingredients to VBP success."
— Joseph Conte
Executive Director of Staten Island PPS
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References