How Payers Leverage Apps to Improve Type 2 Diabetes Management

October 12, 2021 - In October 2021, Capital Blue Cross strengthened its Type 2 diabetes management efforts by introducing two new apps to its members, apps that could enable them to prevent and potentially reverse the progression of Type 2 diabetes.

“Ultimately, Type 2 diabetes is often preventable and we believe easily accessible, versatile, whole-person lifestyle coaching and modification is key not only to prevent but also to help treat and reverse Type 2 diabetes,” Shelley Grant, vice president of population health at Capital Blue Cross, told HealthPayerIntelligence.

From 2012 through 2016, Pennsylvania’s diabetes rate hovered above the national average, according to America’s Health Rankings of 2020 which excludes gestational diabetes and prediabetes from its calculations. During that time, the disease’s pervasiveness fluctuated from impacting 9.5 percent of the state’s population in 2012 to up to 11.3 percent in 2016. 

It was only recently that the national rate began to creep upward to match Pennsylvania’s. In 2019, 10.8 percent of the state’s residents and 10.8 percent of the US population were diagnosed with diabetes.

The growing share of members who experience this disease has motivated insurers to adopt innovative technologies, particularly apps, to support members’ chronic disease management. 

READ MORE: Key Considerations For Implementing Diabetes Management Programs

“Diabetes takes a devastating toll on public health,” Todd Shamash, president and chief executive officer of Capital Blue Cross, said in the press release. “These cutting-edge tools go the extra mile to make our members and their communities healthier.”

The apps themselves are not difficult to find: over 300,000 healthcare apps are available in the US. Identifying the best app for members to use and rolling out the solution effectively are more challenging processes for insurers to navigate.

Selecting a platform that is sensitive to comorbidities

One of the biggest challenges that payers face when implementing new technologies to address diabetes is accounting for the many comorbidities that members may experience.

According to CDC data, 89 percent of patients with diabetes were overweight or had obesity. At least one in five patients were current tobacco users. Nearly four in ten patients with diabetes who were 18 years of age or older had chronic kidney disease and more than one in ten patients had a vision disability.

“Members with diabetes often have a variety of chronic conditions, so it’s important to have a versatile platform to help reduce the risk of comorbidities by engaging members in an active and healthy lifestyle,” Grant explained.

READ MORE: Multiple Chronic Conditions, Race Impact Diabetes Medicare Spending

To build an accurate picture of the patient’s status and engage her in a holistic program, payers may need to connect their apps to remote patient monitoring devices that can gather data on both the member’s diabetes metrics and her comorbidity metrics.

At Capital Blue Cross, members may receive a digital scale, blood glucose monitor, or another device that can help them track their comorbidities as well as their diabetes-specific health indicators.

Mental and behavioral health conditions are another set of comorbidities that frequently accompany diabetes. Millennials with a behavioral health condition are 2.1 times more likely to have diabetes, according to a study from the Blue Cross Blue Shield Association. As a result, app interventions must blend with the payer’s approach to mental and behavioral healthcare.

“Capital Blue Cross uses comprehensive strategies and a holistic approach to help members understand not only their physical needs, but also their social and mental health needs,” Grant explained.

Allying with employers to bolster adherence

In order for diabetes management apps to make the strongest impact, payers have to make sure that members are aware that these apps exist and what they do.

READ MORE: UPMC Diabetes Wellness Program to Cut Drug Spending, Chronic Care

Through the apps’ surveys and connected, remote patient monitoring technologies, Capital Blue Cross gathers data in order to shape members’ personalized diets. The diets incorporate members’ food preferences in order to achieve nutritional ketosis.

Helping members maintain a diet can be difficult, but it is important for condition improvement and, in some cases, for survival. 

For women with diabetes who also had breast cancer, adherence to a diabetes risk reduction diet improved the patient’s chances of survival, a study found. Women who adhered to the diet were 17 percent less likely to succumb to breast cancer and 33 percent less likely to die of any cause during the study’s timeframe than those who did not adhere to the diet.

The apps help members manage their diets and nutrition, but they are only effective if members are aware of them. Capital Blue Cross employs social media, text, email, and other forms of member engagement to ensure that members are aware of the apps.

In addition to the extra data that the apps provide and within the diabetes platform itself, the payer offers nutritional counseling. Medical nutrition therapy can produce the same or better results in reducing hemoglobin A1c (A1C), particularly when provided by registered dietitian nutritionist or registered dietitian, according to a report in the May 2019 issue of Diabetes Care.

It is critical to align employers' efforts with payers' diabetes management programs. 

Employers play a significant role in promoting chronic disease management among members and employees look to employers for support and guidance. Nearly three-quarters of employee participants in a recent Employee Benefit Research Institute study stated that employers have a responsibility for the physical wellbeing of their workforce.

“Capital Blue Cross works with employers to support members’ diabetes management efforts and help ensure member engagement through our Healthy Blue Rewards wellness program. This program encourages healthy lifestyles and offers incentives for healthy clinical outcomes–such as lower BMI–once a member is participating,” Grant shared.

Engaging provider partners

In addition to member engagement and employer collaboration, payers must work with providers in order to ensure the apps’ success.

There are a number of ways that payers can engage with providers in order to improve members’ knowledge of and access to diabetes care and diabetes apps.

Capital Blue Cross includes providers in members’ diabetes care journey through payment models and an interdisciplinary care team design. The payer noted that its value-based arrangements and case management department help align providers’ efforts.

Data from the apps and remote patient monitoring tools may not be automatically tied back to providers. To keep providers informed and aligned with the diabetes reversal program, the clinical care team for diabetes reversal provides regular updates on lab work and medication changes to the member’s primary care provider.

“Capital and our providers continue to work closely to ensure we achieve our mutual goal of improving the health and well-being of our members,” Grant said. “This collaboration and cooperation assists our providers with developing and, if applicable, modifying their comprehensive care plans to include remote tools and apps.”