Managing diabetes is complicated and costly for patients, payers, and providers. Effective diabetes management keeps costs down and involves motivating people to take their medications as prescribed, to integrate healthy lifestyle behaviors (nutrition, exercise, weight management etc.), to cope with ongoing emotional stresses of the disease, and to use and understand self-management tools such as blood glucose meters and lab test results. Achieving positive health outcomes is complicated by the fact that every person is on a unique journey, faces different hurdles and barriers to successful management, and responds differently to messaging and tactics.
Poorly controlled diabetes is not only harmful to patients, but it is also costly, with 18 percent of people with diabetes accounting for 40 percent of payer cost. According to the Centers for Disease Control and Prevention, medical costs for people with diabetes are twice as high as for people without diabetes. Here are four ways payers and providers can help at-risk populations manage chronic conditions and offset costs for themselves:
1. Start early to influence behavior change
An estimated 20 percent of total diabetes medical costs are attributed to preventable diabetes complications according to the landmark Milliman study. Lower hemoglobin A1C levels, which is a blood test to measure glycemic control, is associated with lower rates of complications such as stroke, end stage renal disease and retinopathy. In order to contain costs related to diabetes complications and prevent unnecessary hospitalizations, patients must be educated and engaged early on in their diagnosis.
Providers and payers tend to target interventions at those with the most progressed conditions. In the case of diabetes, interventions target those with the highest A1C. Early interventions and treatment can help preserve the body’s ability to manage blood sugar levels and prevent prediabetes from becoming type 2 diabetes. In fact, a team of researchers at UT Southwest Medical Center followed a group of newly diagnosed diabetics over six years and showed that early intervention preserved the ability of the pancreases to produce insulin.
A diabetes diagnosis can be overwhelming. Being armed with support and education is vital, especially in the early stages. Early interventions should include a focus on emotional support, healthy diet, exercise, as well as, incorporating medication as needed.
2. Optimize the care team
For most healthcare professionals (HCP), the challenge of providing effective and on-going support is compounded by having limited time during appointments. As a result, they rely largely on in-person engagement that may not fit participant lifestyles and schedules.
Providers must find creative ways to meet patients where they are. Diabetes is a condition that impacts a person 24 hours a day, 365 days a year, and they need care and support in between visits to their doctors. In fact, a recent study in the Journal of Diabetes examined the relationship between patient perception of the quality of their interactions with their physicians and their self-management behavior. Perceived physician inattention and lack of engagement directly affected insulin adherence and glycemic control.
This study demonstrates the need for a dynamic and flexible care team, which can do two important things, 1) help explain medical tests, results, and discuss the effects of clinical management recommended by their HCP and 2) engage with patients outside of their regularly scheduled HCP appointments to ensure they are on track and encourage patients to follow prescribed therapy.
In order to reach patients outside of the office, it is essential to optimize the care team by having nurse educators, certified diabetes educators (CDE), or other patient advocates to compliment the HCP’s direction. People with diabetes can have complicated care teams with primary care physicians, endocrinologists, certified diabetes educators, nutritionists, dentists, podiatrists, nephrologists, optometrists, and more. With more members on the care team, care coordination is extremely important.
Recently, one CDE spoke with a patient and uncovered that this patient was taking double her dosage of insulin. Her endocrinologist and primary care provider had each prescribed her an injectable separately without knowledge of one another and she was taking each as prescribed. The CDE explained the situation to the patient and urged her to call her primary care provider to sort out the confusion. This story demonstrates the importance of care coordination and follow up. Had the CDE not followed up with the patient outside of the office, the result could have been both unhealthy and costly. It is important to optimize the care team to reach people with multiple touch points and follow ups, and to coordinate care, so that the patient is supported on a clear path to successful self-management.
3. Personalize solutions
Education and disease management programs are commonly used by insurers to encourage behavior change. Programs that offer group classes and telephonic outreach via a call-center, supplemented with educational mailings, have been found to have a mixed impact.
To date, motivational interviewing-based health coaching is the only technique to consistently demonstrate causal and independent associations with positive behavioral outcomes. Helping participants overcome the initial barriers to starting new diabetes treatment or therapy, and addressing the obstacles they face in real-time will result in better diabetes self-management and glycemic control. It’s important to help patients as they hit bumps in the road with a focus on managing an individual’s entire diabetes, not just A1C.
The care team must be sensitive to meet patients where they are. Support needs to be delivered at convenient times based on an individual’s schedule, and communicated using the best method for each person via a multichannel approach (text, email, video, phone, etc.).
4. Focus on medication adherence
According to the World Health Organization, 50 percent of medications for chronic disease are not taken as prescribed and this figure is even higher for diabetes. Meaningful diabetes interventions, which incorporates technology to remind patients when to take their medication, helps to improve adherence. However, there are individuals who are not tech savvy and still may need human touch points to provide tips, suggestions and motivation to take their medicines.
With a comprehensive and holistic approach, providers will be better able to address all aspects of diabetes including, but not limited to: blood glucose management, medication adherence, nutrition, physical activity, financial barriers, co-morbidities and complications, stress and overall lifestyle management.
These are key ways payers and providers can help at-risk populations manage chronic conditions and offset costs for themselves. Engaging with patients early, supplementing HCP direction with personalized education and support, and focusing on medication adherence will lead to improved health outcomes for people with diabetes and cost containment for the health care system.