The True Cost of Diabetes to Health Insurance Organizations

By Cecelia Health Marketing

The True Cost of Diabetes to Health Insurance Organizations

There’s no getting around it—diabetes is expensive.

Those who plan health services and payments are likely well aware of the high costs of diabetes care in the United States. As healthcare costs continue to rise across the board, the cost of diabetes will only increase—especially since it’s estimated that a new person is diagnosed with diabetes in the U.S. every 21 seconds.

With the epidemic growing each year, how much does diabetes and its related complications truly cost payer organizations? The numbers are staggering, but the toll on people’s lives is even greater.

The Human Cost of Diabetes: High-Risk and Underserved Populations

Diabetes affects over 30 million children and adults in the U.S. That’s one in 11 people. While different types of diabetes can affect people from all walks of life, certain populations are at higher risk of diabetes and its related conditions.   

A small percentage of health plan members with diabetes represent the majority of the cost to payer organizations. Why the discrepancy? That small percentage represents high-risk and underserved populations of people who don’t (or are not able to) seek the proper treatment for their conditions.

Often, these high-risk populations of people face a variety of barriers to care that ultimately lead to poor health, complications, and lower quality of life. Diabetes is a disease that disproportionately affects low-income individuals. A low-income status affects nearly every aspect of diabetes self-management, which often leads to low adherence to care plans and prescribed medications.

The Financial Cost of Diabetes

First, the big number: diagnosed diabetes costs America $327 billion per year.

How is that cost distributed among payer organizations? Considering that people with diabetes have health care costs 2.3 times greater than those without diabetes, payers are recognizing the urgent need to focus resources on actively improving the health of their members.      

Here are more staggering numbers that put the financial cost of diabetes into perspective:

  • $1 in $7 healthcare dollars is spent on treating diabetes and its complications.
  • Care for a person with diabetes in the U.S. costs an average of $16,752 per year.
  • The average price of insulin nearly tripled between 2002 and 2013.

Combined with the costs of medications and comorbidities, it’s not surprising that diabetes is so expensive in the U.S. However, the numbers are no less shocking.

Reducing the Per-Member Cost

At Cecelia Health, we work closely with payers across the country to lower the per-patient costs of their members with diabetes. Through scalable, personalized, one-on-one coaching by Certified Diabetes Educators (CDEs), we positively transform the lives of people living with diabetes. CDEs help individuals focus on:

  • Medication
  • Nutrition
  • Exercise
  • Coping skills

Our approach results in proven outcomes impacting HEDIS and Star Measures, as well as financial outcomes lowering per-patient costs.

  • 3X annual return on investment
  • 35% enrollment rate of identified members
  • $380 annual savings per patient

By engaging directly with high-risk health plan members, Cecelia Health improves diabetes health outcomes, increases quality measures, and lowers the cost of diabetes to payer organizations.

Ultimately, Cecelia Health aims to lower the impact of diabetes on the world—both the financial cost and, more importantly, the human cost.

whitepaper: improving diabetes health through scalable personalized coaching

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Orignially published on April 9, 2019, updated on August 29, 2019

Topic: Improving Health Outcomes

About Cecelia Health Marketing