Four biggest challenges in diabetes health management

Diabetes seems to have more than its fair share of challenges, when compared to other diseases. Managed Healthcare Executive asked experts to define the top challenges, and offer some suggestions on how to overcome them.

Challenge #1: Coverage for diabetes-related medications and supplies

Now more than ever, individuals must assume greater responsibility for their healthcare costs. “Not only do they have to pay for increasing insurance premiums, but they also have to pay the additional cost of meeting deductibles, copays, and coinsurance,” says Michelle Buysse, director, Commercial Care Management, Priority Health, Grand Rapids, Michigan. 

To help patients overcome this challenge, Priority Health members can contact care managers dedicated to providing price transparency. “By giving individuals more control in the form of pricing information and treatment options, they will have the tools and support to engage in their healthcare spending and overall health,” Buysse says.

Priority Health is making a concerted effort to pull back the curtain on pricing and quality information for consumers. It recently launched the Cost Estimator, a resource on priorityhealth.com and its mobile app, which is designed to give members instant access to their specific costs for more than 300 healthcare procedures such as X-rays, magnetic resonance imaging, laboratory tests, and surgeries. “This information will ensure that members know what their out-of-pocket costs will be before choosing to have a procedure,” Buysse says.

Challenge #2: Medication adherence

Patients with diabetes often point to cost, access, competing priorities, or lack of awareness when they have difficulty taking or sticking with a medication. Some ways to aid with medication adherence, according to Buysse, are:

• Reducing copays for diabetes-related medications;

• Offering care management to help members address barriers and determine an optimal plan of care;

• Attending diabetes self-management education to further educate patients about medications and disease problem solving; and

• Working closely with healthcare provider partners to make sure they can find a plan that works for each member.

Next: Challenges #3 and #4

Challenge #3: High treatment expenses

Treating diabetes is expensive. “The lowest cost care is prevention, early detection, and early treatment to minimize complications,” says Deloris Ann Berrien-Jones, MD, physician champion of diabetes initiatives, Henry Ford Health System, Detroit, Michigan.

Diabetes is costly to treat because it progresses and requires continuous intervention. “Focus on educating the patient, finding the right medication regimen, and preventing complications,” Berrien-Jones advises. “One intervention will not fix diabetes. The patient must develop self-management skills and be committed to making behavioral changes. In order to achieve this, the providers, care team, and patient need to build a trusting relationship.”

Challenge #4: No disease intervention for pre-diabetics

According to the American Diabetes Association, the prevalence of diabetes has increased by 40% in the past 10 years. “Without intervention this number will rise, leading to an unsustainable future for our healthcare system,” Buysse says.

One in three adults currently has prediabetes, and only 7% to 10% of them are aware of it, the CDC reports. Furthermore, without intervention up to 30% of individuals with prediabetes will develop type 2 diabetes within three years, CDC states.

Priority Health partners with leading health and community organizations throughout the year to provide members with access to the CDC’s National Diabetes Prevention Program free of charge. Led by certified lifestyle coaches, the program is a proven way to reduce risk of developing type 2 diabetes by as much as 58%, according to the CDC.

The program was created to increase awareness of prediabetes for its members, providers, and communities. “By using targeted communications to recruit and refer members into Priority Health’s Diabetes Prevention Program, we are supporting adult members by teaching them to make necessary lifestyle changes,” Buysse says.

Lifestyle changes include:

• Lose 5% to 7% of body weight;

• Adopt healthy eating habits;

• Be physically active with weekly goals of 150 minutes of exercise;  

• Learn to recognize and overcome barriers to healthy eating and physical activity;

• Lower medication usage; and

• Improve chronic disease risk factors.

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.