Diabetes is expensive — for those living with it, and for health plans providing care for their members with diabetes.
Diagnosed diabetes costs America $327 billion per year. People with diabetes have expenditures that are 2.3 times greater than those without diabetes. So it comes as no surprise that diabetes is one of the most costly diseases for commercial health payers.
The good news is that this problem can be mitigated by honing in on vulnerable member populations that are a much higher risk for complications, and therefore drive increases in per-member costs. With the right help and guidance, these members can better manage their conditions and improve their individual health outcomes, which, in turn, improves your ROI and quality measures.
So who are your most at-risk and vulnerable populations and how do you help them?
Low health literacy populations
Health literacy in the U.S. is an enormous problem. More than 77 million U.S. adults have only basic or below-basic health literacy, meaning they’re not familiar with medical terms or how the human body works. Members with low health literacy struggle to understand their medical condition and how to self-manage, often leading to poorer health outcomes.
If you have a complex condition that requires complicated self-care like diabetes, this is a huge barrier to staying healthy. Studies have shown that higher health literacy is strongly correlated with better glycemic control in adults with type 1 diabetes.
The chronically ill or disabled
Those with chronic diseases are often at higher risk of poor health outcomes, therefore using more healthcare dollars than healthy individuals. After all, the chronically ill are twice as likely to report poor health days as the general population. Those with disabilities, despite their many interactions with the health system, might have difficulty accessing care and face special challenges in obtaining services.
Diabetes is a disease that disproportionately affects low-income individuals; low-income individuals are more likely to have chronic illnesses to begin with.
To add to the burden, diabetes self-management is especially difficult for people who struggle with financial resources. From reliable access to medication to food insecurity to lack of safe and affordable exercise and low health literacy, myriad barriers to sufficient diabetes management challenge low-income individuals with diabetes and other chronic illnesses.
People with lower incomes are also more likely to have co-occurring conditions that make it more difficult to stay healthy, whether it’s depression or substance abuse problems, or comorbid and chronic medical conditions like obesity.
Members in rural areas
For Americans living in rural areas, maintaining good health is often more difficult than for the general population. The reason? Rural populations experience geographic isolation, have a lower socioeconomic status, have limited job opportunities, and tend to be older.
For these reasons, rural populations often have trouble getting the care they need, which is a problem when managing a complex disease like diabetes.
Understanding the medical system is challenging even for native English speakers. Non-English-speaking members may have even more difficulty interpreting care providers, prescriptions, and other healthcare instructions. The unfamiliarity with English can also be linked to discomfort and distrust in the healthcare system, in general lowering a patient’s ability to follow through on diabetes self-management instructions. The domino effect follows: worse patient outcomes means higher costs for the payer and the healthcare industry at large.
People predisposed with higher risk
Trends in diabetes management and healthcare correspond with overall racial, cultural, and socio-economic trends, putting certain racial and ethnic groups more at-risk than others.
Studies have shown that African Americans and Hispanics are over 50 percent more likely to have diabetes than non-Hispanic whites. Blacks and Hispanics also have the lowest health literacy among racial/ethnic groups, with 65% of black and Hispanic people below a basic level knowledge.
Data from the Centers for Disease Control and Prevention (CDC) and Indian Health Service (IHS) has shown that certain American Indian and Alaska Native communities have sprouted diabetes prevalence rates as high as 60%, and one in six American Indian and Alaska Native adults has diagnosed diabetes.
How do you help these at-risk members?
The struggles of each vulnerable population are not mutually exclusive to each one; many populations overlap and face similar barriers that negatively impact their ability to seek out help in managing their own condition. How do you help these members?
At Cecelia Health, our approach has been clinically proven to improve diabetes health outcomes through scalable, personalized coaching — an approach that works especially well when focused on high-risk, poorly controlled populations that are less likely to “raise their hand” in seeking help managing their disease.
Because of the personal, one-on-one relationships patients build with coaches, a patient’s individual diabetes-management barriers can be identified and addressed. Coaches get to know each patient as a person, much more than just a medical history. Our approach has proven successful in improving self-management, driving behavior change, and impacting Star, HEDIS, and Healthy Days metrics. Get started with Cecelia Health solutions today.