- Diabetes is a major public health concern for the medical industry with 29.1 million Americans or 9.3 percent of the population diagnosed with the disease in 2012, according to the American Journal of Managed Care (AJMC). In fact, the American Diabetes Association reported that the cost of diabetes is $322 billion per year for the US healthcare system. Additionally, 25.9 percent or 11.8 million Americans above the age of 65 live with diabetes. Health insurance companies, hospitals, and physician groups will need to uncover new ways to address the high costs of diabetes treatment such as through partnering with accountable care organizations (ACOs).
Due to a multitude of reforms, healthcare delivery has been heading toward greater coordination, patient-centered clinical decision-making, and quality-based reimbursement structures, the AJMC reports. Greater emphasis has been put on primary care as a pathway toward reducing higher emergency room visits and hospital admissions for patients with chronic diseases like diabetes.
Healthcare payers have responded to the shift in healthcare delivery by partnering with accountable care organizations, which often revolve around strengthening primary care practices. Accountable care organizations are the center point of a number of different medical facilities, which may include hospitals, nursing homes, home health agencies, and clinics. The way accountable care organizations work is by focusing on wellness and prevention, population health management, and greater control of cost across the continuum of care.
Accountable care organizations can play a key aspect of addressing the high costs of diabetes treatment and improve the way patients handle this disease by implementing Diabetes Self-Management Education and Support, according to the AJMC.
Diabetes Self-Management Education or DSME involves ensuring diabetes patients have the knowledge and skill necessary to care for themselves and live with their disease. The interventions that accountable care organizations and primary care practices can implement in DSME include emphasizing a healthy diet, physical activity, medication management, problem solving, risk reduction, and disease monitoring.
When managing diabetes, a multitude of practitioners may be needed to assist patients, which is why accountable care organizations and their focus on care coordination may be one of the most useful entities in diabetes treatment. Nurse practitioners, exercise physiologists, registered nurses, nutritionists, pharmacists, and physicians all play a part in diabetes management within ACOs.
Diabetes Self-Management Education can be beneficial for payers and accountable care organizations since these methods have shown to reduce cost as well as hospital admission and readmission rates.
“Given the projection that one in three individuals will develop type 2 diabetes by 2050, it has been postulated that the US healthcare system will be unable to afford the costs of diabetes care unless incidence rates and diabetes-related complications are reduced,” study authors wrote in the American Journal of Managed Care.
“It is clear that a key way to reduce costs and improve diabetes quality measures is via DSME. One could posit that the aforementioned benefits are realized because DSME is guided by the best available scientific evidence, incorporates the needs, goals, and life experiences of the person with or at risk of diabetes, includes the latest technology such as continuous subcutaneous insulin and continuous glucose monitoring, and addresses the range of costly comorbid conditions such as hypertension, hyperlipidemia, and renal dysfunction.”
Other ways to address the high costs of managing diabetes treatment may come from partnering and contracting with community organizations like the YMCA. For example, the Centers for Medicare & Medicaid Services (CMS) has partnered with the YMCA to operate the Diabetes Prevention Program.
In March 2016, the Department of Health & Human Services expanded Medicare coverage for those participating in the Diabetes Prevention Program. This program is meant to decrease the rates of Americans diagnosed with diabetes and improve patient outcomes. The YMCA plays a pivotal role in the Diabetes Prevention Program by offering coaching and training for prediabetic patients to assist with weight loss, diet, and exercise plans.
“It turns out that YMCA’s Diabetes Prevention Program was shown to prevents new cases of diabetes 58 to 71 percent of the time in people with prediabetes,” Matt Longjohn, MD, MPH, and National Health Officer for YMCA of the USA, told HealthPayerIntelligence.com last November. “The reason why Medicare is covering this is because the science is clear. It helps people with prediabetes prevent new cases of becoming diabetic.”
The Diabetes Prevention Program has led to a decrease in healthcare spending with a savings of more than $2,000 per patient. Commercial health insurance companies could take part in these cost savings by partnering with the YMCA or other community organizations using diabetes prevention strategies and Diabetes Self-Management Education.
Payers could put a dent in their healthcare spending and improve outcomes for diabetes patients by working with accountable care organizations and community resources.