VRI Blog

Everyone sees it coming. Every Health Plan Chief Medical Officer in the country knows it’s an issue. The USA Today recently wrote about it. Diabetes is quickly becoming the most expensive and expansive disease in the country. Some quick facts:

• Total costs of diabetes: $174 Billion
• Just under 10% of the population has diabetes in 2010 and an estimated 30% will have diabetes by 2050.
• 65% of those with diabetes die of a heart attack or stroke
• Persons with diabetes have 2.3x more medical costs than those who do not have diabetes.

So why isn’t the healthcare system doing anything about it? I asked this question to a Chief Medical Officer at a large Health Plan. His response “Given the transient nature of our system, by the time we see savings from treatment of diabetes the patient is probably going to be either covered under Medicare or will be enrolled with a different plan.” What he is saying is that diabetics usually only get really expensive after long term uncontrolled exposure to the disease which can have a severe impact on the heart, kidneys, eyesight and can result in amputations, dialysis, heart attacks, stroke. Diabetics are not that expensive in the short term. Yes, plans pay for strips, glucometers, etc but that costs $30-$50 a month. Additionally, early stage diabetics don’t typically go to the ER for reasons associated with diabetes and when they do they are rarely admitted. Therefore the plan has two choices. Option 1: Continue the status quo and hope that by the time the patient gets expensive they are either with a different plan (which is not unusual given we tend to change plans often) or the taxpayer is footing the bill (Medicare). Option 2: Spend a lot of money on changing the behavior of someone with diabetes, hope that it lowers cost, and hope that the plan spending the money is the recipient of those savings. Most Plans have historically gone with Option #1. Continue reading →