Cost of Diabetes. Laura Keller Director State Advocacy AK CO HI ID MT ND OR SD WA WY

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1 Cost of Diabetes Laura Keller Director State Advocacy AK CO HI ID MT ND OR SD WA WY Christopher Stanley, MD, MBA American Diabetes Association Colorado Advocacy Chair Vice President of Population Health Physician Practice Management Catholic Health Initiatives

2 Mission To prevent and cure diabetes and improve the lives of all people affected by diabetes.

3 The number of people with diabetes continues to rise rapidly, every 19 seconds someone is diagnosed with diabetes. This costs the US more than $322 billion each year. 3

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5 Economic Importance of Diabetes Prevention Over the past three decades, the number of Americans with diagnosed diabetes has more than tripled, from 6 million in 1980 to 21 million in 2010.* *The Lifetime Cost of Diabetes and Its Implications for Diabetes Prevention Xiaohui Zhuo, Ping Zhang, Lawrence Barker, Ann Albright, Theodore J. Thompson and Edward Gregg Diabetes Care September 2014 vol. 37 no

6 Cost of Diabetes Given the current size of the U.S. population with diabetes, coupled with more than 79 million people with prediabetes who are at a high risk of developing type 2 diabetes, lifetime cost estimates suggest that medical spending associated with diabetes will add an enormous burden to health care costs and will persist for at least the next several decades.

7 Cost of Diabetes

8 Cost of Diabetes People with diagnosed diabetes incur average medical expenditures of about $13,700 per year, of which about $7,900 is attributed to diabetes. 2.3 times higher than what expenditures would be in the absence of diabetes.

9 Cost of Diabetes For the cost categories analyzed, care for people with diagnosed diabetes accounts for more than 1 in 5 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes.

10 Cost of Diabetes The largest components of direct medical expenditures are: Hospital inpatient care (43% of the total medical cost) Prescription medications to treat complications of diabetes (18%) Harmful effects of diabetes such as damage to the eyes, heart, blood vessels, nervous system, teeth and gums, feet and skin, or kidneys. Anti-diabetic agents and diabetes supplies (12%) Physician office visits (9%) Nursing/residential facility stays (8%)

11 Cost of Diabetes Diabetes Costs in Specific Populations Most of the cost for diabetes care in the U.S., 62.4%, is provided by government insurance (including Medicare, Medicaid, and the military). The rest is paid for by private insurance (34.4%) or by the uninsured (3.2%).

12 Cost of Diabetes Indirect costs include (2012): Increased absenteeism ($5 billion) Reduced productivity while at work ($20.8 billion) for the employed population Reduced productivity for those not in the labor force ($2.7 billion) Inability to work as a result of disease-related disability ($21.6 billion) Lost productive capacity due to early mortality ($18.5 billion)

13 Cost of Diabetes Diabetes is a serious and costly epidemic that poses a major public health problem. The American Diabetes Association believes that if we are to truly make strides against this devastating disease, we must fund diabetes research and programs, improve health care, and support proven prevention measures.

14 U. S. Health Care System Barriers for People with Diabetes Insufficient coverage for diabetes care Transparency of plans and coverage Unintended consequences of health policies Access to care Medications, Supplies, Education Healthy foods

15 Consumer Costs Diabetes Specific Supplies Medications Education

16 Transparency Information available to the public needs to be in easily understood plain language. Plan data should be publicly available from all plans and provided in plain language, so consumers can easily obtain and understand the data when comparing plans. Tools in place to mitigate language barriers.

17 Unintended Consequences Work place wellness programs Are an attempt by employers to improve the health of their employees and reduce health insurance costs. Although most of these are private programs offered directly to consumers in the individual insurance market, a few states have begun to incorporate wellness programs into their Medicaid or state employee health insurance programs. Workplace wellness programs should encourage employees to adopt healthy lifestyles, provide support for doing so, and even offer rewards.

18 Major Concerns: Unintended Consequences Programs using rewards or penalties tied to biometrics that increase costs for patient. Financial incentives based solely on participation in wellness programs. Barriers may exist making it difficult for certain people to participate. General Cuts to Durable Medical Equipment

19 Christopher Stanley, MD, MBA American Diabetes Association Colorado Advocacy Chair Vice President of Population Health Physician Practice Management Catholic Health Initiatives

20 Access to Care What People With or at Risk for Diabetes Need Screening and services as required by a treating physician Prescriptions Durable medical equipment Eye care Podiatric services Diabetes self-management education Medical nutrition therapy services

21 Diabetes Medical Standards of Care Access to Care

22 What policies should we support? People with diabetes, their families and caregivers need you as legislators to help shape public policies that prevent and improve outcomes for people with diabetes in your state.

23 Access to Care Prior Authorization Easy for Health Care Providers to use Expectations for renewal or follow up are easily understood and not burdensome Authorization are granted in a timely fashion

24 Access to Care New technology reviews Timely Include the appropriate specialist for the technology in the review process Consult ADA standards of care for diabetes specific technologies

25 The ADA highly recommends the following to reduce the economic cost of diabetes. Ensure all appropriate populations have access to the Diabetes Prevention Program.

26 Make sure diabetes self-management education is a covered benefit in all health insurance policies-both private and public.

27 Ensure Medicaid and all state health plans provide coverage for: Diabetes screening for individuals at high risk Services as determined by a treating health care provider Prescriptions Durable medical equipment, including blood glucose testing equipment and supplies and insulin pumps and associated supplies Services related to pregnancy, including screening for diabetes, monitoring and treatment for women with preexisting diabetes and gestational diabetes, and postnatal screening A yearly dilated eye exam by an eye-care professional with appropriate follow-up care as medically needed; Podiatric services Diabetes education, including diabetes outpatient self-management training services Medical nutrition therapy services.

28 Enact Diabetes Action Plan Legislation Ensure all people have access to adequate health insurance Ensure insurance policies cover DPP for people with prediabetesand DSME for those who have diabetes Enact legislation that establishes a commission charged with reducing health disparities including those associated with diabetes Enact legislation that creates healthier communities

29 Colorado Diabetes Caucus

30 Diabetes Self Management Education inclusion in Medicaid.

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32 Thank You! Questions? 32