INTEGRIS Health, an integrated health care delivery system located in Oklahoma, began an inpatient effort in 1997 at INTEGRIS Baptist Medical Center to improve the quality of care for patients with hyperglycemia. This inpatient effort was a collaboration between INTEGRIS and the ediba Diabetes Center of Excellence, a diabetes education company, with championship by endocrinologist John S. Muchmore, M.D., Ph.D. Initiative results from FY 1997 - FY 2005 were as follows: 

• Increased identification of patients with hyperglycemia/diabetes 
• Improved appropriate coding resulting in increased reimbursement 
• Decreased geometric mean length of stay for patient with diabetes 
• Reduced gap between length of stay for patients with and without diabetes 
• Decreased readmission of patients with secondary diabetes
• Improved financial performance returning $4 for each $1 invested in the program.

Though the inpatient initiative showed considerable success, it was clear that being able to maintain the gains achievable during a four to five day inpatient stay under controlled conditions is not sufficient in many cases to meaningfully impact the longer term aspects of the disease.

Diabetes doesn’t go away. Many patients, at discharge, lack a primary care physician or specialist to assume an evidence-based program for long-term management of their disease. It was obvious there was a need for an ambulatory program to reduce the incidence of diabetes co-morbidities and complications not only for INTEGRIS inpatients, but also for medical staff members and their patients as well as INTEGRIS employees and their dependents. INTEGRIS had tried several independent third party claims administrator based disease management programs during the last several years without great success.