Diabetes is a massive epidemic afflicting both providers and patients as they grapple to effectively manage the disease. The industry at large recognizes this reality, yet the data needed to drive innovations in care remain too high level to yield the desired population health outcomes.
For example, the Centers for Disease Control and Prevention (CDC) recently released the 2017 National Diabetes Statistics Report revealing that nearly one out of every 10 Americans are suffering from diabetes, with an additional 33.9 percent of that population suffering from prediabetes. The report sheds further light on the scale of the issue, such as the fact that diabetes is attributed to $245 billion in annual costs, as well as 7.2 million hospitalizations and 14.2 million emergency department visits. While this information underscores the scope of diabetes as a top public health concern, a major hole in the data currently exists—a breakdown of average cost per patient by A1c levels to illustrate which diabetes patients are costing the most.
It makes sense; the more severe the disease, the more common the complications and hospitalizations. To minimize complications, treatment goals aim to keep A1c levels less than 7, but neuropathy and nephropathy can be prevented even if the A1c is less than 8. While industry evidence points to “7” as the magic number, there is much greater opportunity to realize improvement and drive down costs. Yet, until this kind of granular information is available, providers and payers will be limited in their ability to adopt better strategies.
Data Limitations
The report states that diabetic patients cost nearly 2.3 times more than those without the disease, reaching nearly $13,700 annually per person. However, this number is likely skewed significantly by patients with A1c levels greater than 7 percent and even more so by patients with A1c levels greater than 9 percent who are more at risk for complications and thus, cost significantly more than other diabetics.
For instance, patients with A1c levels greater than 9 percent suffer from uncontrolled diabetes and are more frequently hospitalized due to severe yet preventable and costly complications including hyperglycemia and diabetic ketoacidosis. Additionally, the prevalence of A1c levels greater than 9 accelerates the rate at which diabetics experience other conditions connected to diabetes complications, such as heart disease, kidney failure, blindness, amputation and death.
Currently, there is little published literature that addresses the relationship between A1c severity and the resulting complications and costs that occur over time, which makes it difficult for providers and payers to gain an accurate prospective on the problem. This ultimately hinders the development and adoption of evidence-based strategies and allocation of efficient and effective resources needed to improve care and maximize return on investment.
The Effect of Targeting Uncontrolled Diabetes
Industry clamor over the growing diabetes epidemic should create urgency around the need for better data and more effective solutions for disease management. Studies highlighting the correlation between healthcare costs and increased A1c levels will enable providers to effectively utilize new data to identify at-risk patient populations more efficiently. This will help prevent high-risk patients from falling through the care management cracks and further compromising their health. By identifying these patients and utilizing impactful interventions, such as telemedicine, providers can improve the population health outlook, while gaining further insight into how diabetes affects organizational costs.
For instance, lowering the most severe A1c levels will create a domino effect of payer return on investment, lowering hospitalizations, emergency department visits and long-term care facility stays. While initial ROI may be somewhat offset by increased outpatient care costs, these reductions coupled with a decline in preventable complications will yield significant ROI as the years progress.
In turn, avoidance of these resource-intensive interventions will enable significant reductions in long-term diabetes care. Revenues will also strengthen through improvements in care and processes that can help providers avoid potential financial penalties and secure performance-based revenues by meeting quality metrics.
Empowering Patients to Take Control
In conjunction with data, providers must transition from traditional approaches to use of innovative tools to truly improve care and outcomes, as well as significantly reduce costs associated with uncontrolled diabetes. Providers are increasingly turning to telemedicine, for instance, to address gaps in care. These solutions consistently monitor patients and proactively alert physicians to any potential diabetes-related complications to minimize escalation. Further, these solutions empower patients to successfully self-manage their condition, promoting patient engagement and positive health behavior changes that effectively lower and maintain healthy A1c levels.
The benefits of leveraging data along with telemedicine is exemplified in a study detailing a patient who was hospitalized after suffering from a stroke. While hospitalized, his healthcare team diagnosed him with diabetes and recorded that he had an A1c level of 18 percent. To self-manage his condition and prevent another costly hospitalization, the patient began to use a telemedicine solution that simplifies physician instructions to ensure patients clearly understand actionable items. After inputting his blood sugar levels into the application, he received real-time insulin dose feedback.
Additional monitoring and insulin titration capabilities overseen by the telemedicine physicians provided the patient with the medical support and resources required to appropriately self-manage his condition between clinic visits. After three months, the patient successfully dropped his A1c level of 18 percent down to 8.1 percent.
Titrations and check-ins made by telemedicine physicians ensure medication adherence, while lowering the need for high-cost interventions. This support allows primary care providers to focus their time and resources on patients that require more individualized, timely treatment and care oversight. Further, monthly patient reports are sent back to primary providers, enabling greater insight into a patient’s health status.
To gain further insight into the impacts of critically high A1c levels, multiple peer-reviewed studies are needed that detail the effects of uncontrolled diabetes compared to that of controlled diabetes. Organizations with access to large data sets, such as healthcare payers, are best poised to procure this information and conduct such studies that will identify the best investment opportunities for advancing diabetes care delivery.
With more evidence at their disposal, healthcare stakeholders can accurately determine which patients require additional support managing their diabetes and how best to allocate limited resources. This insight coupled with the right solutions, such as telemedicine, can then maximize outcomes, care and financials.
Better industry data equates to better care innovation. By gaining more awareness of the average cost per patient by A1c levels and prioritizing the widespread adoption of impactful solutions and processes, healthcare professionals and organizations can take momentous strides in optimizing the long-term health of millions.