Health

Fighting Diabetes With Integrated Population Health Management

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Although it’s important to acknowledge much work has already started to reduce the rate of new cases being diagnosed, the disease continues to be a growing problem in the United States:

  • According to the CDC, more than one in two Americans are affected by diabetes or at risk for getting it; nearly 29 million Americans live with the chronic condition, which can cause heart disease, stroke, blindness, kidney failure and amputation of the lower extremities.
  • Another 86 million Americans have prediabetes, meaning they’re at risk for developing the condition.
  • What’s more, the CDC reported that one in five health care dollars spent in the U.S. goes toward the care and treatment of people with the disease, leading to higher health care costs and lost productivity at work.

The stakes are high for health care systems to make prevention, early detection and treatment of diabetes as efficient and effective as possible. As an employer, you have an important role to play in helping your employees stay healthy by providing the necessary services and educating your workforce about their benefits.

How to Think About the Condition
I know from firsthand experience as a registered nurse, the human body is a maze of interacting, integrated systems. No one part can exist independently of the other, and together, they’re responsible for sustaining life.

Diabetes is initiated due to an imbalance of critical hormones in the endocrine system, but its effects are felt through the entire body, wreaking havoc on the cardiovascular and nervous system, as well as on vision and dental health. The disease affects an individual’s entire body, so shouldn’t health care treat patients holistically?

A New Way to Think of Treatment
A growing trend in health care plans aims to address this problem by treating a patient’s whole body, rather than individual parts. The approach, called integrated population health management, connects dental, vision and disability data through a patient’s insurance carrier — which, in turn, promotes opportunities including early detection and improved management of chronic conditions. Integrated population health management betters a patient’s health by more effectively coordinating medical and specialty care, making every patient-provider interaction more meaningful with richer information. These programs not only improve patient outcomes, but also reduce medical costs over time.

For example, retinal scans can often lead to early diagnosis of the chronic condition, as eye-care providers can detect early diabetic signs in eyes. With an integrated health plan, vision patients showing early signs of the disease trigger a referral to a care management team, which allows members to receive the best care possible in their new medical reality.

This approach can also help those living with the disease manage their condition through regular checkups and reminders. Since diabetes is a leading cause of adult-onset blindness, regular vision checkups are critical. The health connectivity fostered by integrated health care plans provides free flow of data between an employee’s care provider and their vision specialist, so the latter can monitor your employee’s eyesight even more closely for signs of deterioration.

How the Whole Body Benefits
Just like the various systems of the body are interconnected, integrated population health management programs also manage the chronic condition by managing disease in other areas of the body. People suffering from this specific illness are at an increased risk of periodontal disease, an infection and inflammation of the gums, which can lead to tenderness and tooth loss. Inflammation in the mouth can then make blood sugar management more challenging, leading to a cycle of patient health concerns — and potentially escalating costs.

To address this problem, integrated population health management programs automatically identify and enroll patients with the chronic condition, and who are actively engaged in a care management program, for enhanced dental services. As a result, the patients are notified of an additional dental cleaning (three, instead of the usual two per year) to maintain good dental health. Diabetics who treat their periodontal disease through increased care have about 39 percent fewer hospital admissions and 40 percent lower medical costs overall, according to a study from the American Journal of Preventive Medicine.

Diabetes cases are expected to increase over the coming years, and prevention, early detection and management of the disease will be essential for ensuring the best possible outcomes for patients while also abating the cost burden. Integrated health care programs are the future of better care and can achieve this goal. The disease can’t be treated in a vacuum, and health care plans should seek to mimic the body’s interconnectivity.

Collette Manning, RN, CCM, ONC is the clinical integration strategy and planning director for specialty businesses at Anthem Inc. where she works with a team to identify and implement opportunities designed to deliver a fully integrated health care experience among health, vision, dental, disability, life and voluntary products for members. Collette has more than 30 years of care management experience in the provider and insurance setting. During her 21 years as part of care management programs, she has been involved in the development of a number of clinical programs, including Specialty Pharmacy Management and Enhanced Personal Health Care.

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