Montana Pediatrics, in partnership with The Leona M. and Harry B. Helmsley Charitable Trust, and Blue Cross Blue Shield of Montana, announces the beginning of a two-year project to improve medical care for children with Type 1 Diabetes.
Type 1 Diabetes (T1D) is a time and resource-intensive chronic disease where the pancreas produces little to no insulin, the hormone that helps the body regulate blood sugar for use as energy. The disease is lifelong, has no cure, and requires treatment and management by clinicians with subspecialty expertise. When diagnosed in childhood, children with T1D require close coordination with school nurses, parents, dietitians, and pediatric endocrinologists.
As a frontier state that ranks 4th in the nation for land mass but 46th for population density, Montana’s pediatric healthcare resources are unevenly distributed. Of the state’s 56 counties, 36 do not have a single practicing pediatrician and the communities that do have pediatric-specific care are concentrated almost exclusively in the most urban areas. While the exact number is not known, it is estimated that there are more than 500 children across all of Montana’s urban and rural communities living with T1D, however, there are only five pediatric endocrinologists to care for them.
To better understand the needs of children living with T1D across the state, in 2021, [Montana Pediatrics teamed up with Blue Cross Blue Shield of Montana (BCBSMT) – the state’s largest health insurance company – to analyze claims data from 305 of the state’s pediatric T1D patients. Consistent with the uneven distribution in access to care, the analysis found that more than 50% of the children did not have an attributed primary care provider. Further analysis also found the average cost of care for a child in Montana with T1D, not including expenses for travel, proved to be more than three times the national benchmark, according to data provided by MarketScan which was age, sex, and risk-adjusted to match the study subset.
The limited access to pediatric-specific providers, combined with the complexity of daily care for the disease and high costs of care led Montana Pediatrics to establish a goal of creating opportunities to increase state-wide capabilities to care for children with T1D, to support the isolated providers who care for them, and hopefully to reduce the high costs of care Montana families incur.
In the spirit of collaboration, Montana Pediatrics has been engaging with the five pediatric endocrinologists providing T1D care in the state to also identify unique barriers they face as providers, and, together, they have found a shared vision around collective actions to improve the health and healthcare of every child in Montana with T1D.
Now, under the direction of Montana Pediatrics’ Medical Director of Complex Care Dr. Brian Bost, MD, MPH, FAAP, and Diabetes Program Manager, Matthew Larsen, RDN, LN, CDCES, a collaborative care model, funded generously by The Helmsley Charitable Trust and Blue Cross Blue Shield of Montana, is in development.
The model will link each patient’s pediatric endocrinologist, primary care provider, school nurse, and guardians together via a cloud-based care plan as a way to foster collaboration and better coordinate care.
The program will include the use of Shared Plans of Care to maintain consistent communication between all of a child’s care team and integrate with Montana Pediatrics’ existing capacity to deliver pediatric telemedicine.
The program is expected to save families the time and expenses required for travel to routine endocrinology appointments, to deliver high-quality and accessible care to each patient, and to support the state’s primary care providers, by emphasizing the medical home and supporting coordination with subspecialty care.
“This opportunity for patients and families to realize a system where all of their medical providers are on the same page and easily accessible, even from home, will be groundbreaking for care in Montana,” said Matthew Larsen, who was also just named Montana’s 2022 Diabetes Educator of the Year. “To have the ability for parents and school nurses to play an active role as well will help bridge the gap between the endocrinologist’s plan and what happens in the real world,” he added.
Program outcomes will be assessed in partnership with BCBSMT to ensure the standards used to evaluate the quality of care offered to children are clinically relevant, useful, and truly help to ensure their members are receiving the highest quality and most up-to-date care. To achieve this, Montana Pediatrics and BCBSMT will work directly with the state’s pediatric endocrinologists to establish relevant and shared quality metrics.
“Together, everyone is hoping to demonstrate how optimal diabetes care reduces costs, improves patient outcomes, and reduces burdens on families, including necessary travel and missed work or school time,” said Dr. Brian Bost. “As an internal medicine and pediatric hospitalist, I’ve seen the heartbreaking outcomes from poorly controlled diabetes, so to have a centralized system for communication and a method of keeping track of patient health virtually has the promise to be life-changing and scalable to impact other subsets of children with medical complexities. The support from trusted organizations like The Helmsley Charitable Trust and BCBSMT will help to ensure the long-term sustainability of this collaborative model. “
About Montana Pediatrics
Montana Pediatrics’ is a technology-enabled statewide network of pediatric providers who are motivated to extend care to more of Montana’s children, transcend competitive boundaries, and improve the experience of those practicing in the state. Montana Pediatrics operates with a culture of collaboration and a commitment to ensuring every child in Montana has access to quality healthcare.
About The Leona M. and Harry B. Helmsley Charitable Trust
The Leona M. and Harry B. Helmsley Charitable Trust aspires to improve lives by supporting exceptional efforts in the U.S. and around the world in health and select place-based initiatives. Since beginning active grantmaking in 2008, Helmsley has committed more than $3.5 billion for a wide range of charitable purposes. The Helmsley Type 1 Diabetes Program is one of the largest private foundation funders of T1D in the nation focused on understanding the disease, developing better treatments, and improving care and access in the U.S and low- and middle-income countries. For more information on Helmsley and its programs, visit helmsleytrust.org.
About Blue Cross Blue Shield of Montana
Blue Cross and Blue Shield of Montana (BCBSMT) is a division of Health Care Service Corporation, a Mutual Legal Reserve Company, and an Independent Licensee of the Blue Cross and Blue Shield Association. BCBSMT is the largest and longest-standing statewide, customer-owned health insurer and full-service health benefits administrator in Montana. BCBSMT has provided high-quality health insurance plans and administrative services to Montanans for more than 80 years and is committed to ensuring its members — no matter where they are on the health spectrum — achieve maximum health. Headquartered in Helena with five regional offices, BCBSMT’s purpose is to stand with its members in sickness and in health.