Sherry Rohlfing

When most people think about epidemics, they think of Ebola, SARS, and now, especially, the new coronavirus. But until COVID-19, when healthcare executives had thought about epidemics, they should also be thinking about diabetes, because it is growing, expensive - and deadly. 

The impact of diabetes on the lives of patients can be absolutely devastating. It is the underlying cause of serious complications, such as heart disease and stroke. Many people with diabetes are afflicted with chronic pain; it is also the leading cause of kidney failure, blindness, and amputations. Diabetes, and the complications resulting from it, ranks third behind heart disease and cancer as a cause of death in this country.  

Over 34 million Americans have been diagnosed with diabetes, mostly with the type 2 variety that is linked with being overweight or obese. Another 88 million Americans have prediabetes: They have blood sugar levels and other risk factors that could put them on the road to having full-blown diabetes. Nearly $250 billion is spent on healthcare costs related to diabetes, with an average medical expenditure of $15,000 per person with the disease. As far as drug costs are concerned, diabetes is the most expensive traditional therapeutic class on a per-member, per-month basis. 

21st Century-Style Diabetes Disease Management: Coaches and Tech-Enabled

The causal factors of the type 2 diabetes epidemic are well characterized: poor diet, obesity, lack of exercise, and aging. Diabetes also occurs more frequently in some groups because of social determinants of health, such as unsafe neighborhoods with a lack of access to recreation.

The good news is that managed healthcare can have a significant impact on all aspects of diabetes prevention and management. Through analytics and health risk appraisals, health plans can identify members with diabetes and those who are prediabetic. Focused disease management programs, combined with value-based provider contracts, can encourage engagement of members and incentivize providers to improve outcomes. Health plans can help by, among other things,  covering smartpens that can monitor injections. The same goes for stick-free glucose monitoring, which improves adherence to blood testing and insulin management. Health plans are also well positioned to work with community organizations to support efforts to educate people about proper nutrition, exercise habits, and weight management. 

When and how is difficult to say, but COVID-19 will recede. Diabetes will not. It will continue to grow as our society struggles to control the impacts of poor lifestyle habits. However, managed healthcare plans continue to play an important part in ensuring that members receive the most impactful information and care possible to manage and ultimately stop this epidemic.

Don Hall, MPH, and Sherry Rohlfing are principals of DeltaSigma, a consulting firm that specializes in strategic problem solving for managed care.

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Americans have been diagnosed with diabetes, mostly with the type 2 variety linked with being overweight or obese.

Diabetes: The Quiet Epidemic That Is Not Going Away

We recently returned from an educational summit of the Swedish healthcare system sponsored by the TPG International Health Academy. The group of 25 was made up of healthcare executives from Canadian and the U.S. organizations including Kaiser Permanente, LA Care, National Indian Health Board, Centene, Cigna, Affinity Health Plan, and others. We studied a number of aspects of Sweden’s universal, government-sponsored system including its organization, financing, access-to-care, and current challenges.

While there were a number of key points learned from the study, two things stood out to us.

First, their focus is on care delivered in a primary care setting. In the Swedish system, primary care, which does not include pediatricians or internal medicine, accounts for over 20% of all healthcare costs. As a comparison, in the United States we spend about 5% (including pediatricians and some internal medicine and non-delivery OB-GYN). Primary care in the Swedish system is largely delivered in clinic settings that include general practitioners, nurse practitioners, nutritionists, psychologists, and physiotherapists in a holistic approach to patient and family care.

Through this approach, more comprehensive care is provided in the primary care clinics and fewer referrals to specialty and other care are required. In addition, an emphasis is put on patient education and self-care. The result is lower cost and better healthcare results, which demonstrates that primary care medical homes work.
	
	The takeaway is that health plans should improve efforts to create more robust medical homes for their members to improve outcomes and lower overall healthcare costs.

Second, Swedish leadership incorporates an interesting management approach that takes an old Swedish practice called a fika (pronounced fee-ka) and turns it into a communication channel with their teams. Fika is much like our concept of a coffee break, taking time away from work to relax with a hot beverage and some food. Managers take traditional fika further by making it a time for everyone to get together for a break-management and staff. During this time, leaders have the ability to informally hear from their employees and get to know them on a more personal level. It’s like an informal focus group every day.

The takeaway is that executives should develop a similar mechanism, whether a break or lunches, to spend time with more than just the management team to better understand their employees and how to make their company a better place to work and more aligned with their customers.

As we strive to improve healthcare in the United States, it’s useful to travel to other countries to learn about their cultures and healthcare systems. Sweden’s approaches provide useful insights.

Don Hall, MPH, and Sherry Rohlfing are principals of DeltaSigma, a consulting firm that specializes in strategic problem solving for managed care organizations. They work with the TPG International Health Academy on Educational Summits and will study healthcare in Columbia and Italy in 2020. 

U.S. health executives can glean useful insight from studying how other countries approach healthcare.

Author | Sherry Rohlfing

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Diabetes: The Quiet Epidemic That Is Not Going Away

Learning From Others