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ABSTRACT The rising prevalence, health burden, and cost of chronic diseases such as diabetes have accelerated global interest in innovative care models that use approaches such as community-based care and information technology to improve or transform disease prevention, diagnosis, and treatment. Although evidence on the effectiveness of innovative care models is emerging, scaling up or extending these models beyond their original setting has been difficult. We developed a framework to highlight policy barriers-institutional, regulatory, and financial-to the diffusion of transformative innovations in diabetes care. The framework builds on accountable care principles that support higher-value care, or better patient-level outcomes at lower cost. We applied this framework to three case studies from the United States, Mexico, and India to describe how innovators and policy leaders have addressed barriers, with a focus on important financing barriers to provider and consumer payment. The lessons have implications for policy reform to promote innovation through new funding approaches, institutional reforms, and performance measures with the goal of addressing the growing burdens of diabetes and other chronic diseases.
Diabetes mellitus affects 8.3 percent of the world's population, and over 80 percent of the estimated 380 million adults living with diabetes reside in low- or middle-income countries.1,2 Nearly half of the people with diabetes worldwide are undiagnosed, and there are high rates of missed opportunities to detect and treat diabetes and address risk factors earlier to prevent the onset of disease.3
Failures to address risk factors or effectively manage other conditions associated with diabetes, such as coronary artery disease or renal failure, lead to premature mortality and disability. This results in high direct medical costs and high indirect social costs of diabetes care, including lost labor productivity and reduced national output.4,5 Furthermore, diabetes prevention and treatment may be viewed as an "indicator" condition for the capacity of a nation's health care system to address the rising burden of noncommunicable diseases.6
Consequently,innovations in diabetes prevention and management in development or use today have important implications for public health and health care costs.5 Many innovations in diabetes prevention and treatment involve alternatives to traditional medical treatment, such as team-based care strategies, remote monitoring,theuseofanalytic tools that guidetreatment via patient data, and the coordinated use of community services.
Physician groups, private and public payers, and...