Healthcare industry takes action to combat soaring diabetes costs

Providers, payers tackle pre-diabetes as well

Faced with a growing population with diabetes and soaring costs for managing the disease, payers and providers are focusing on preventing and managing the disease that costs the American economy an estimated $245 billion a year — a 41% increase over the $174 billion estimated cost in 2007, according to a report by the American Diabetes Association.

The costs included direct medical costs of $176 billion, including hospitalizations, emergency department visits, office visits, and medications, and indirect medical costs of $69 billion including absenteeism, reduced productivity, unemployment caused by diabetes-related disabilities, and lost productivity due to early mortality.

The organization’s report, issued in March, also found that medical expenses for people with diabetes are 2.3 times higher than for those without the disease.

“As the number of people with diabetes grows, so does the economic burden it places on this country. The cost of diabetes is rising at a rate higher than overall medical costs,” said Robert Ratner, MD, chief scientific and medical director of the American Diabetes Association in a news release issued by the organization. He added that more than one in 10 healthcare dollars is being spent directly on diabetes and its complications and more than one in five dollars is going to the care of people diagnosed with diabetes.

According to the Centers for Disease Control and Prevention (CDC), nearly 26 million children and adults have diabetes, and an additional 79 million have pre-diabetes, putting them at risk for developing the disease. People with pre-diabetes have blood glucose levels that are higher than normal but not high enough to be diagnosed as type 2 diabetes. They are five to 15 times more likely to develop type 2 diabetes than people with normal blood glucose levels.

“Diabetes is definitely a disease that can cause a vast number of health problems and complications, and it is growing in prevalence in our country,” says Ellen Rudy, PhD, director of strategic research and epidemiology for Molina Healthcare, a Medicare and Medicaid managed care plan with headquarters in Long Beach, CA.

“It’s a looming problem. The Centers for Disease Control and Prevention estimates that by 2050, one in three Americans will have diabetes if we don’t do something about it,” she adds.

Rudy points out that people with diabetes have two to four times greater risks of developing heart disease and stroke. Other complications include blindness, kidney disease, and amputations of the feet and legs.

“Once people get diabetes, it can’t be cured. It can be managed, but managing the disease is very difficult,” she says.

Molina is offering the CDC’s National Diabetes Prevention Program to at-risk individuals in New Mexico and Florida. The program is a lifestyle intervention that includes 16 weekly group sessions with a health coach and monthly sessions for an additional six months. For details on the program, see related article on page 64.

Diabetes is potentially preventable, and complications from the disease also are potentially preventable, says Karen Bray, RN, CDE, PhD, vice president, clinical care services for Optima Health, a Virginia Beach, VA, health plan. “If we focus on changing people’s lifestyle choices, we can make a difference and change the outcomes,” she says.

The old diabetes disease management model provided disease management only to patients who had already developed the disease, but now the focus also includes people who are at risk for developing diabetes.

“We’ve grown away from the model of people who have already met utilization or cost goals because they already have the problem. Now we also are trying to identify people who might develop diabetes,” Bray says.