Diabetic costs are often a huge cost driver and worrisome impending financial risk for employer-sponsored health plans. Plan members that do not manage their blood glucose can incur huge costs for an employer plan. However, employers are not health providers and they must also toe lines between being viewed as caring vs big brother vs outright discriminatory for numerous reasons. Diabetes and diabetes care can also be complex. There are different types of diabetics whose severity, progression of disease and care needs vary dramatically due to lifestyle, behavior and genetic reasons, or some combination of factors. The drugs and services used for treatment are delivered through a system that, although changing and filled with caring people, has inefficiencies and backwards incentives and can be systematically stacked against both patients and payers.
This article aims to provide a more detailed and clinical perspective to how employers might understand and impact their diabetic spend.
Diabetes (also called “diabetes mellitus”) is a group of diseases that result in too much sugar in the blood. Normally, our bodies produce the hormone insulin to use the energy (or sugar) from our food to function normally. When someone has an issue with insulin, the sugar from the food they eat stays in the blood causing high blood sugar. Eyes, kidneys, feet are a few of the organs that high blood sugar wreaks havoc on and cause the need for the most expensive care services.
The risks of not taking care of any diabetic are increased medical costs and lost productivity from complications, outpatient care, and even acute and long- term hospitalizations. Completing required screening is important to all diabetics in order to provide surveillance of disease progression and can be supported by the employer via reducing barriers (time away from work, distance to clinic etc.) for testing.
There are four common types that have different dysfunctions causing high blood sugar; this article addresses 2 types and the associated costs: Type 1 and Type 2.
Type 1 (or child onset) diabetics are insulin-dependent because their body does not produce insulin on its own. Before insulin, these people would waste away and not live to adulthood. It is important that these members:
Type 2 (adult onset) diabetics have lost their sensitivity to insulin and/or do not produce as much insulin. Pre-diabetics are those who are almost type 2 diabetics. Adult onset diabetes is most prevalent than other kinds of diabetes and is related to obesity, a sedentary lifestyle, having other chronic diseases, genetics and ethnicity. It usually doesn’t require insulin immediately and does respond to changes in lifestyle such as losing weight. Type 2 diabetics will begin on oral pills (rarely insulin) if prescription is made by a provider. It is important beyond members taking their medications that:
Employers often have limited time and resources to research and deploy any program or change in their business, including health management or benefit programs. Using claims data to understand sources of plan payment to identify and evaluate risk management solutions can help employers determine in more granular detail what condition, risks, and potential costs are in their plan member population.
Specific to diabetics, it is important to, at minimum, understand:
It is completely normal that you might find that you have more members or utilization related to high blood pressure, high cholesterol, depression or asthma than you do diabetes.
Once you understand the drivers of your diabetic costs, it is time to determine which solutions can most effectively and efficiently address your risks. Some of them might include:
Associated Benefits and Risk Consulting’s Health Management specialists can assist you with population health management by providing a statistical analysis of your health plan data and assist with accessing carrier and other resources to develop a game plan for your organization. Clients can contact us to learn more about this value-added service.
To learn more about managing high-cost claims, register for our upcoming webinar, Lions, tigers and high-cost claimants: Identifying and managing emerging risk.
Anna is responsible for creating tailored, client-specific solutions supporting the overall health of employee populations. She is passionate about assisting large- and mid-sized employers to manage increasing plan costs, improve health outcomes and promote healthy and engaged employee populations.
Anna is responsible for creating tailored, client-specific solutions supporting the overall health of employee populations. She is passionate about assisting large- and mid-sized employers to manage increasing plan costs, improve health outcomes and promote healthy and engaged employee populations with broadbased and state-of-the-art interventions. Anna’s specialties include strategic health management consulting, care management and coordination, program management, provider relations, clinical performance improvement, promotion of health and wellness programs and population health management.
Risk management and human resources are traditionally two different job functions, and the people in these areas have rarely crossed paths — but that is changing.
Why are these people starting to work together more frequently?
A recent survey by the Society for Human Resources Management (SHRM) reported 94% of leaders feel employee engagement is an important or very important workforce challenge. An engaged workforce increases operational income by over 19%, while a disengaged workforce can drain over 34% of an organizations’ operational income. Additional risks of low engagement can be seen in increased turnover, low customer satisfaction ratings and even increased employment litigation.
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