- Diabetes remains among the top three most impactful, costly, and common chronic diseases in the nation, says a new report by the Blue Cross Blue Shield Association (BCBSA), significantly affecting more patients than heart disease, cancer, or asthma combined.
Using claims data analytics from more than 40 million Blue Cross Blue Shield members, the report places diabetes behind hypertension and mood disorders, such as depression and anxiety, in terms of its spending, effort to manage, and long-term impacts on patients’ overall health.
Particularly worrisome is the metabolic condition’s growing prevalence among younger people aged 18 to 34, who many struggle to manage the disease long-term.
This age group has seen a 4.5 percent increase in health impact from diabetes between 2013 and 2015, strongly correlated with a similarly sharp rise in obesity rates during the same time period.
In contrast, older Americans aged 55 to 64 have experienced a marked decrease in the health burdens associated with diabetes.
The health of this age group has improved by more than one percent during the three-year period, possibly due to a surge in population health management programs that are prioritizing patient education and care management.
The analysis also showed variations in prevalence and cost across geographical regions. In the Southeast and Central South, which include states such as Georgia, Florida, Mississippi, Texas, Louisiana, and Arkansas, the impact of diabetes is 12 percent more than the national average.
More than 8 percent of patients in the Southeast are living with diabetes – the highest average in the country.
Per member per year (PMPY) costs are also somewhat higher in these areas than the nationwide average of $137, with patients in the Central South regions incurring costs of close to $150 PMPY.
Preventable diabetes costs total $16 billion per year, the Health Care Incentive Improvement Institute found in 2016. These costs are largely due to complications from poorly controlled diabetes, including renal failure and cellulitis, as well as avoidable lab and imaging tests used to diagnose or rule out associated health problems.
On the other end of the spectrum, patients in New England, the Pacific Northwest, and the Mountain states are seeing drastically fewer impacts from diabetes. These three regions are all 20 percent below the national average in terms of health impact, and each has an average prevalence of less than 6 percent.
New England has the lowest PMPY costs of anywhere in the country, at approximately $110 per patient, followed by the Pacific Northwest which hovers just under $120 per member each year.
Blue Cross Blue Shield of Massachusetts attributes New England’s ability to keep the costs of diabetes under control to its large investments in its Alternative Quality Contract (AQC) program.
The value-based care model incentivizes providers based on quality, outcomes, and utilization rates. Participating healthcare organizations receive detailed analytics reports from BCBS, allowing them to stratify patients by risk and plan their outreach activities accordingly.
"Under the AQC, our providers have achieved dramatically improved clinical outcomes for our members, including those with diabetes," said Dana Gelb Safran, Chief Performance Measurement & Improvement Officer at Blue Cross Blue Shield of Massachusetts.
Within the first four years of the program, participating providers achieved a 74 percent clinical control rate – more than 12 percent higher than the national average.
“This improved clinical control of patients with serious chronic illnesses is vital to avoiding complications later – such as heart attacks, strokes, kidney failure, blindness, and amputations – that are both costly and devastating to quality of life,” continued Gelb Safran.
“The improved control achieved among diabetic patients alone under the AQC model has helped to avoid hundreds of these devastating health events each year."
Providers and payers are investing in a number of different innovative strategies to deliver preventive services for pre-diabetics, improve self-care through technology-driven chronic disease management initiatives, and encourage providers financially to bolster their care coordination, follow-up, and patient engagement programs.
Some of the most successful initiatives focus first on patient education and offer a degree of structured coaching and support for individuals motivated to change their diets, increase their exercise, and achieve control over their personal health metrics.
The new National Diabetes Prevention Program (DPP), now reimbursable by Medicare, borrows heavily from a YMCA initiative shown to save hundreds of dollars in costs per patients per annum. The YMCA program uses small group discussions and personal coaching to help patients track their activity and health improvements, offering a low-cost way to guide individuals through difficult lifestyle changes.
Adding financial accountability for providers to similar offerings for patients of all ages and insurance statuses – and supporting providers with claims analytics and other data-driven reporting – may be the key to lowering costs and reducing the negative health impacts of diabetes and its associated complications.