Category Archives: diabetes prevention

Honoring Last Wishes through Awareness, Education and Action–Blog by Karen Peterson, Executive Director, Honoring Choices Minnesota

HCM LogoHonoring Choices Minnesota exists to ease and enable conversations about Advance Care Planning (ACP). While it’s not an easy topic to consider, it is important for every adult to have a Health Care Directive — a written plan for loved ones and health care providers to follow — so that patients’ wishes are known if a time comes when they cannot speak for themselves.

People are full of good intentions–but don’t always do the work

Data tell us people have good intentions when it comes to ACP, but we have lots of work ahead to make last wishes realities:

  • 90% of people say talking with their loved ones about end-of-life care is important, but only 27% have done so.
  • 82% of people say it’s important to put their wishes about end-of-life care in writing, but in Minnesota, only 35% have done so.
  • 80% of people say that if they were seriously ill, they would want to talk with their doctors about end-of-life care, but only 7% have had that conversation.

“While we were hoping to encourage employees and their families to consider an Advanced Care Directive Pledge, we realized this was not an easy conversation to start. It’s one that takes careful planning, conversations, and thoughtfulness. With Honoring Choices Minnesota we had the opportunity to engage with a non-profit partner with deep expertise and a supportive philosophy to build trust with our employees. It was important that the University find an avenue to support this important life decision independent of the University as an employer, and to provide an incentive for employees to engage Honoring Choices on their own.”

Ken Horstman
Senior Director, Total Compensation
University of Minnesota


A recent development we are really excited about is that we are beginning to see Minnesota employers take the lead when it comes to promoting ACP. Some are even offering incentives to employees who complete Health Care Directives.

U of M encourages employees to take Advance Care Directive Pledge

As one example, we have the honor of working with the University of Minnesota to add ACP to the Employee Wellness Program, which awards 50 wellness points to those who take the Advance Care Directive Pledge.

When the 50-point Wellness Option was launched in November 2016, Honoring Choices staff members were on hand to make presentations, answer questions, and hand out forms and other information. We visited Employee Health and Benefits Fairs on the Duluth, Morris, and both Twin Cities campuses, and will be giving additional departmental presentations when invited by Wellness Program Advocates. I am pleased to report that in the first month alone, nearly 700 people signed up!

Learn more about adding ACP to your wellness program

If your organization would like to learn more about adding advance care planning to your wellness program, check out The Action Group’s employer toolkit here, or contact me for assistance (kpeterson@metrodoctors.com). As employers become more united about promoting ACP, we hope to make great strides in breaking down barriers to having personal and important discussions about last wishes and dramatically increasing the number of Minnesotans who have Health Care Directives in place.

Recommended reading and learning opportunities:


Karen Peterson is the Executive Director of Honoring Choices Minnesota

Excellence in Health Care can be a Reality for all Minnesotans: Blog by Carolyn Pare, President and CEO, Minnesota Health Action Group

exerciseEveryone deserves top-quality care and the chance for a healthy future. But for some, this is complicated by chronic conditions like diabetes, vascular disease and depression—three top drivers of health care costs. These three chronic conditions have been identified among five diseases that generate approximately 25 percent of health care costs in the United States, according to the Agency for Health Care Research and Quality.

Diabetes, heart disease and depression affect hundreds of thousands in Minnesota,
preventing them from living life to the fullest, and resulting in financial hardship. According to the Minnesota Department of Health:

  • Over 340,000 Minnesota adults had been diagnosed with Type 1 or Type 2 diabetes by 2014. It’s estimated that an additional 1 in 4 Minnesotans are living with undiagnosed diabetes (that’s about 1.4 million people).
  • Heart disease was said to be the second leading cause of death in our state in 2012.
  • More than 262,000 Minnesotans had been diagnosed with depression in 2012.

Power of private and public collaboration in Minnesota

Unlike other states, Minnesota is fortunate be the home of a unique private and public collaboration called Minnesota Bridges to Excellence (MNBTE) that focuses on improving health care — and outcomes — for people with diabetes, vascular disease and depression.

The concept is simple, yet extremely powerful: Public and private health care purchasers collaborating to reward clinics for delivering exceptional care and keeping Minnesotans with chronic conditions the healthiest they can be.

The program, which was developed by the Minnesota Health Action Group in 2006, has been so successful at improving the health of people across our great state that the Minnesota Department of Health partnered with The Action Group to administer a state-led pay-for-performance program called the Minnesota Quality Incentive Payment System (QIPS).

Simplicity key to program success

What sets MNBTE apart from pay-for-performance initiatives that health plans offer? For starters, simplicity. MNBTE is simply about rewarding clinics for excellent care and keeping patients healthy; unlike health plan pay-for-performance outcomes, which are often used as bargaining chips for the health care system to negotiate the best reimbursement rates.

The population-wide benefits of MNBTE also cannot be overlooked. You do not have to belong to a specific health plan to benefit from it, because performance standards are based on a clinic’s ability to improve care for their entire patient population that is affected by depression, diabetes or vascular disease. That means whether you live in Minneapolis or Milaca, Pillager or Pine City, or Willmar or Wanamingo — you and your loved ones will benefit from MNBTE.

An open-book commitment to transparency

Transparency is another defining quality of the program. Because MNBTE relies on public reporting and is run by a collaboration of health care stakeholders from across market segments, nothing is hidden. From the standards and requirements to individual clinic performance and rewards, the books are completely open; which is as it should be in health care. This collaborative of employers, public sector purchasers, care providers, quality improvement organizations, and health care organizations work together to refine and evolve the program from year to year, continually raising the bar on quality for all Minnesotans.

Most important, MNBTE recognizes and rewards real excellence. The quality requirements for the program are significantly higher than the statewide averages for diabetes, depression and vascular disease, which means that MNBTE rewarded clinics truly are the state’s top performers. Consider that the statewide average for percentage of patients receiving optimal care for depression is 8 percent, for diabetes 46 percent, and for vascular disease 66 percent. Meanwhile, the required minimum performance rate for a clinic to qualify for an achievement reward from Minnesota Bridges to Excellence is 16 percent for depression, 63 percent for diabetes, and 77 percent for vascular disease.

This demonstrates the staying power of the program and sends a clear message that high-value health care and outcomes are a top priority for both public and private purchasers and for health care providers in Minnesota.

As Minnesotans, we’re privileged to live in a state that is known for health care innovation. MNBTE is a classic example of out-of-the-box thinking and collaborative spirit that makes our state a healthy place for everyone to live and thrive. The purchasers who provide funding for this program are true community and business leaders who have affected positive change for all Minnesotans.

Whether you are aware of MNBTE or not, chances are you know someone who has benefitted from it. The continued success of this effort sends a clear message that together, we can do more to improve care for the people of Minnesota and to lower costs, than any of us can do alone.


Carolyn Pare is the President and CEO of the Minnesota Health Action Group, the nonprofit organization that administers the Minnesota Bridges to Excellence program and the State of Minnesota’s Quality Incentive Payment System.

Guest Blog: Gretchen Taylor, Minnesota Department of Health, Tackling Diabetes in Minnesota

Diabetes is a serious and costly chronic disease affecting over 310,000 Minnesotans, with an annual cost to our state of about $3.14 billion. Based on national estimates, an additional 1.5 million Minnesota adults have prediabetes, which greatly increases their risk for developing diabetes, heart disease and stroke. Without intervention, 15 to 30 percent of people with prediabetes are expected to develop the disease within five years.

If we are to avoid unsustainable costs to the health care system and society, we must focus on preventing diabetes here in Minnesota. The Centers for Disease Control and Prevention’s (CDC) National Diabetes Prevention Program (NDPP) offers a powerful solution. This program is based on a research study showing that making modest behavior changes helped participants lose five to seven percent of their body weight, which is just 10 to 14 pounds for a person weighing 200 pounds. These lifestyle changes reduce the risk of developing type 2 diabetes by 58 percent in people with prediabetes.

Taking Action in Minnesota

The Minnesota Department of Health (MDH) is contracting with the Minnesota Health Action Group to engage employers and insurers in four communities to make the NDPP a covered benefit for employees. The Action Group will provide valuable support to participating communities by working to make the NDPP widely available and accessible to people at high risk for type 2 diabetes.

The Minnesota Department of Health is one of 21 states and large cities to receive funding from the CDC for a grant called, “State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke (CDC-RFA-DP14-1422PPHF14).” The four-year funding started on September 30, 2015.

This grant supports local communities in improving health. The activities will build on current work to prevent and better manage obesity, diabetes, heart disease, and stroke, while focusing on reducing health disparities. With this funding, selected communities will engage in cross-cutting, creative approaches that can positively impact the health of Minnesota residents, especially those with the greatest health needs. Funds will support four Community Health Boards, including:

  • Minneapolis Health Department
  • Healthy Northland (Aitkin, Carlton, Cook, Itasca, Koochiching, Lake and St. Louis counties)
  • Des Moines Valley and Nobles (Cottonwood, Jackson and Nobles counties)
  • Partnership for Health (Becker, Clay, Wilken and Otter Tail counties)

A portion of the funds will support the MDH and contracted organizations to provide technical assistance to these communities.

The grant strategies fall into four categories:

  • Supporting environmental changes that improve access to healthy eating and increased physical activity.
  • Building support for healthy lifestyle change programs like the NDPP, especially for those at high risk for type 2 diabetes, heart disease, and stroke.
  • Improving the quality of health system care delivery for people with the highest hypertension and prediabetes disparities.
  • Linking clinical and community resources to support heart disease, stroke, and type 2 diabetes prevention.

I am looking forward to working with The Action Group staff and employer members to tackle our state’s rapidly escalating prediabetes and diabetes epidemic, and to improving health and lowering health care costs for all Minnesotans.

Reference for diabetes costs:

Economic Costs of Diabetes in the U.S. in 2012. American Diabetes Association. Diabetes Care 36(4):1033-1046.