Role of Health Plans: At the Heart
of Self-Management
We’re all familiar with the numbers—and they are staggering. According to the Centers for Disease Control and Prevention, the number of people diagnosed with diabetes in the United States more than doubled between 1990 and 2005. Today, almost 21 million Americans have the disease. As a health plan decision-maker, you understand the enormous direct and indirect costs of diabetes, especially as the disease becomes more and more prevalent.
The emotional cost of this upsurge in diabetes cases is high—as record numbers of patients deal with the uncertainty, resentment, and resistance to change that accompany a diabetes diagnosis—and the financial costs continue to grow as well. The American Diabetes Association estimates that the total cost of diabetes in the United States in 2007 was $174 billion, including expenses related to direct medical care, disability, lost productivity, and early death.
How you can help
Encouraging your plan members with diabetes to control their disease can be challenging, but you have many tools at your disposal. One tool is the Journey for Control program offered by Merck. It’s designed for health plan administrators like you, diabetes patients, health care professionals, and diabetes educators-a multifaceted approach offering each group unique resources to achieve the common goal of improved diabetes care.
Promote initiatives like Journey for Control to add to your plan’s disease management programs. Facilitate group diabetes education classes—they have been shown to result in clinically significant improvement in disease management vs non–group-based education programs. If your plan offers diabetes self-management education services, communicate the availability of reimbursement of these services to participants. If not, you may want to consider this coverage. By maximizing the tools available to you, you can truly be a part of the solution.
The value of coordinating much more than benefits
The national statistics at the beginning of this article are compelling—but on a day-to-day basis, your concern is the patients enrolled in your plan. How many of them have type 2 diabetes? How often do they see their doctors—and how much more effective might those visits be if they actively self-managed their diabetes? What coverage does your plan offer for self-management education services like nutritional counseling from in-network providers?
Health plans can also support management of diabetes through member education and outreach efforts. Bringing quality diabetes care to individuals at an early stage can help improve patients’ ability to manage their condition effectively.
You can ensure that plan participants—patients and providers alike—know and understand what’s covered and how often. You can enhance communications between patients, physicians, and diabetes educators to facilitate use of these self-management services.
You can improve the numbers in your own plan—and, in so doing, improve the national statistics as well.
