"Diabetes is such a high-impact disease, affecting 10% of the population, and costly, as well," says Dr. Philip Hagen, director of health management resources at the Mayo Clinic, a health research and treatment center.
Diabetes management also is an opportunity for employers to get the best value for health care dollars, since the treatments for diabetes (improved diet and increased exercise) also are very effective at preventing and treating those comorbid conditions. "There's a lot of synergy to be gained by focusing on exercise and nutrition," he confirms.
In fact, it's possible to cut your risk of developing diabetes in half with reasonable adjustments to diet and physical activity, he notes. "It doesn't have to be an expensive drug. It doesn't have to take an expensive program to reduce risk, especially if you have a large population," he tells EBN. "If you get people to lose five or 10 pounds and keep it off, that has pretty impressive effects on preventing diabetes. Every little bit helps."
Identifying prediabetics, those on the verge of developing diabetes, can go a long way toward prevention. "I see a lot of employers doing that better and better. I see a lot of employers doing a know your numbers' campaign and linking that to a health risk assessment," Hagen observes.
"Careful management of the disease is crucial to avoiding complications and onset of other health problems. Employers can encourage their health vendors to identify diabetes risks, encourage individuals to be tested, and to promote effective care management strategies. This is a business imperative," states a recent report from the National Business Coalition on Health.
"Employers increasingly recognize the impact of diabetes on the health and productivity of their workforce, and there is growing evidence that effective management of diabetes reduces complications, reduces health care costs and protects employee productivity," says Andrew Webber, president of NBCH.
Case in pointThe Federal Reserve Bank of Dallas, which has 1,300 employees, has offered an onsite diabetes management program for the last four years, along with an onsite health clinic and an onsite gym. It provides an annual diabetes screening and monthly meetings with a diabetes educator from a local hospital.
It recently started offering one-on-one coaching and waiving the cost of diabetes medications and supplies for the program participants who report their biometric results. They get free glucose monitors and software for keeping track of their insulin variations. About 35 workers join the program each year.
"A number of employees got off their diabetes medications completely, as a result of their lifestyle changes," says Bob Queyrouze, compensation, benefits, health and productivity consultant for the bank. "If we can affect several lives, then we feel like we're making some progress."
It wasn't a hard decision to start the program. "Diabetes is one of the predominant risk factors in our population. It was a high-cost issue for us from a claims perspective, and it seemed to be an area that you can get your arms around. What you're trying to do is influence people's lifestyles more than anything else," Queyrouze comments.
Meanwhile, Hospira, an Illinois-based specialty pharmacy and medication delivery company, provides financial incentives through waived copays and additional education for diabetics.
The company recently participated in the Midwest Business Group on Health's diabetes self-management program, called Taking Control of Your Health. "Hospira chose to participate in [the program] to help reduce the costs and improve the health of our employees with diabetes," explains Pam Hannon, benefits director at Hospira.
"We believe we will have happier and healthier employees as well as lower long-term medical and absenteeism costs for this group. Most importantly, employee response has been overwhelmingly favorable, with more than 130 individuals enrolled in the program to date," Hannon says.
Combating a prevalent conditionMore than 20.8 million people in the U.S. have diagnosed or undiagnosed diabetes, and since the 1980s, the prevalence of diabetes in the United States has more than doubled and is expected to reach 39 million by 2050, according to NBCH. More than 1.5 million new cases are diagnosed per year, and more than 9% of people aged 20 years and older are currently living with the disease.
In addition, recent research from NBCH shows:- Almost all health plans screen diabetic members for both depression and tobacco use.
- Roughly 37% of health plans coordinate comorbid conditions with a centralized case manager, while 49% of plans coordinate behavioral health and chronic care services separately.
- More than 38% of health plans reduce copays for selected medications, tests or services for diabetic members, and 28% reduce deductibles.
- 82% of health plans offer general reminders, while 71% send specific reminders based on missed services, and 85% offer live outbound telephone management programs as standard options.
- About 77% of health plans use reminders to support prescription compliance, while 60% alert the doctor if the patient does not refill a medication, and 39% seek intervention through the pharmacist.
- 37% of health plans use the Internet for online medical consultation.
Meanwhile, 95% of employers offer a disease management program for diabetes in their health plan with the largest enrollment, according to the Kaiser Family Foundation.
Tips for employersHagen believes the best approach is to use a combination of onsite, telephonic, online and printed materials to educate and motivate workers.
He feels it's a mistake to rely solely on one form of communication or a one-time event that's not repeated.
"Start to think about reaching the most people in some way," he advises. "Take a multimodal approach. Know that small, sustained changes result in a big payoff."
Queyrouze recommends the onsite approach, rather than online or telephonic, because "employees create a support network, and it's a very personal message coming from the employer that We care about your health.'"
Financial incentives can be effective, too.The free medication "definitely helps people and gets the interest up, the commitment to participate," Queyrouze admits.
For employers, having a return-on-investment estimate would be useful. However, Queyrouze points out, "It costs more to collect the data and crunch the metrics than it does to do the program."
Hagen asserts: "The ROI for preventive measures is at least 2:1 and probably closer to 3:1. It's time for us to stop wringing our hands about the ROI for preventive services. Our real goal should be to keep people out of the hospital."
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