How to Manage Chronic Disease Through Technology, Member Trust

July 17, 2020 - Payers expend billions every year on type 2 diabetes in the US, but the programs that are intended to help members manage chronic disease are not working, charged Amy Meister, DO, chief executive officer of Level2 which is part of UnitedHealth Group research and development.

This was just one of two major problems that Meister had in mind when she launched UnitedHealth Group’s Level2, an initiative that leverages remote patient monitoring to help UnitedHealthcare members with type 2 diabetes manage their chronic disease.

“There's a lot of great programs, resources out there, but the truth of the matter is they just aren't working,” Meister told HealthPayerIntelligence.

Despite payer efforts, the rate of diabetes continues to escalate. At the same time, disease costs remains one of the most expensive chronic diseases in the nation, costing the healthcare industry over $300 billion in 2017.

Meister approached UnitedHealth Group’s scientific team to find out why.

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Type 1 and type 2 diabetes are two distinct diseases, the scientific team emphasized, and require very different treatment regimens. Type 1 diabetes prevents the body from making insulin, whereas type 2 diabetes overproduces insulin and retains fat.

Thus, obesity and type 2 diabetes are conditions that often coincide and affect one another. This is why many programs that seek to help reduce type 2 diabetes risk may focus on wellness programming.

Furthermore, the common measurement of hemoglobin A1C averages blood sugar control over a span of three months. By providing an average, hemoglobin A1C eliminates the sense of fluctuation between highs and lows and sometimes even giving members and providers a false sense of security.

“First and foremost, we've learned that we need to take a look at medications, because many medications on the market that are used to treat other types of diseases, chronic diseases and acute diseases, can cause obesity and can cause diabetes,” Meister explained.

But in addition to this problem, the payer programs were increasing provider burden.

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Level2 set out to address both of these issues through remote monitoring and a proactive payer approach. Meister and her team emerged with some key strategies to creating type 2 diabetes programs.

Leverage existing technologies in new ways

The team decided to use a continuous glucose monitor in order to gather member data more efficiently and more frequently. The continuous glucose monitor is a patch applied to the member’s skin that collects data via hundreds of readings each day. The team also used activity trackers and app-based alerts to help members stay on track with their treatment.

“The continuous glucose monitor is classically used for type 1 and insulin use,” Meister said. “But what we've realized is that it's a great behavioral tool to help you figure out what's fact and fiction about your own diet in real time.”

The tool helped narrow down the correct health action for members to take as well.

“I have the blood sugar spike. Now, what do I do about it, other than chase it with another medication? Can I simply walk? Can I do some yoga, meditation, some relaxation to help bring my blood sugar down? You can't answer that unless you have this type of tool and sophistication to do so,” said Meister.

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While the continuous glucose monitor was already in existence, the team did have to develop a way to compile all of the monitor’s signals into an individual health record.

“The individual health record is really the mecca repository for health information,” Meister explained.

The individual health record gathers data from over 57 million health records including social determinants of health, pharmacy claims, and medical records. The goal is to look for trends over time and to accurately ascertain the underlying cause of changes in a member’s health.

The program blended in non-technological approaches as well. After joining the program, members received coaching and clinical consultations regarding their results.

Make the chronic disease management passive for the member

Through Level2, a member with type 2 diabetes can wear a continuous glucose monitor instead of pricking their finger to gather a single data point, a process that is passive and therefore easier for patients. Then, it is up to the payer to initiate contact if something about the readings’ trend looks negative member outcomes.

“The way our signals work, we would catch that on the drop, proactively outreach before it's too late,” Meister explained.

“The outreach would be directive care in that situation from our physician that would then collaborate with the extended care team to help understand why it is happening and to make sure it doesn't happen again.”

Motivate members and gain member trust through data, positive results

Motivating members to adhere to their treatment regimens can be a major hurdle for programs like this. Working with patients who seem resistant to treatment can also breed pessimism among providers, forming another barrier to success.

Meister admitted that, due to her background in internal medicine, she had to overcome her own skepticism regarding whether the program would be able to motivate new behavior patterns among members.

“Surprisingly, I was proven wrong pretty quickly,” she admitted. “For a lot of people, just giving them a little, tiny sliver of success is enough to motivate and precipitate this chain reaction that allows people to be open to dietary changes and other steps towards a healthier lifestyle.”

She added that gaining patient trust is crucial to ensuring treatment adherence and member motivation.

Part of gaining trust was by empowering the provider through the continuous glucose monitor. The monitor enabled the provider to discern what health steps the member was or was not taking in order to adjust treatment to fit member needs. This reduced the member’s sense that their provider was judging them for nonadherence.

When members started seeing results in their weight and their chronic disease, they became excited and more motivated, Meister found. In fact, some members have been able to achieve remission from type 2 diabetes through the program.

Offer provider support, work to reduce burden

From the beginning, the payer recognized that one of the primary barriers to effective type 2 diabetes treatment was not directly related to patient care but rather had to do with provider burden.

Prior authorizations can add to provider burden and even hamper care delivery, impacting member outcomes. The continuous glucose monitor that Meister’s team intended to use would have required a prior authorization since it is typically not used for patients with type 2 diabetes.

Thus, when Meister’s team chose to use a continuous glucose monitor, the payer released providers from pursuing a prior authorization for the device to diminish the administrative burden for providers.

Another challenge was communicating with providers at such a large scale. With so many providers in-network and dispersed across the states, it was difficult to keep all of the providers in the loop, Meister said.

The payer had to leverage a variety of communication techniques to maintain effective payer-provider collaboration.

Moving forward, type 2 diabetes is not the final stop for Meister’s strategy.

“The next frontier is expanding upon what we're treating to not just diabetes, but really the whole person head to toe,” Meister said. “Diseases don't discriminate in body parts, they impact everything.”