Envolve White Paper: The Diabetic Epidemic

Date: 2019-10-14

A White Paper focusing on what Medicaid members say about barriers to diabetes management, the impact of behavior change, and the value of data. 

Click to view PDF version


Diabetes is on the rise and has become an epidemic in the United States. Nearly 30 million Americans currently live with diabetes, 90% of which possess type II diabetes. Even more alarming, 84 million Americans are pre-diabetic. The costs, maintenance, and management of this disease are staggering for both payers and individuals. 

Those living with diabetes are more likely to be diagnosed with another serious health condition - illnesses ranging from depression to eye complications to kidney disease to high blood pressure. Feeling isolated, hopeless, or overwhelmed about diabetes management can cause a diabetic to feel depressed, impacting their ability to perform self-care tasks. Sixty percent of an ever-growing global diabetes-related spend is attributed to hospital care and medications to treat the complications caused directly by diabetes.

So how do you begin to tackle a $325 billion dollar problem?

Current State

Currently, the model of diabetes management leaves much to be desired. It goes something like this: Joe is diagnosed with diabetes. His doctor sends him home with a prescription for testing supplies. Joe receives his supplies but is unsure how to use them. Joe’s health continues to decline. Joe visits the ER, twice. 

People diagnosed with diabetes incur medical expenditures of more than $16k per year, of which about $9k is attributed directly to the management of their disease . The historical approach to diabetes disease management was based on a traditional care management model: 

It’s not that this approach doesn’t work; it’s that it doesn’t impact enough of the population to make a lasting change, nor does it impact members at the precise moment of need. This method fails to engage individuals prior to a drastic health event caused by their condition.  

In a recent proprietary research survey conducted with Medicaid members living with diabetes, Envolve identified that member self-awareness of the severity of diabetes as a diagnosis and the implications on individual health was high. These members were quick to recognize that other areas of health including diet, physical activity, and weight were critical to managing their diabetes. However, members were also acutely in-tune to the barriers that impeded their ability to achieve a healthy lifestyle. These challenges led to feelings of isolation, frustration, and helplessness. In fact, depression was often verbalized as an outcome of this struggle and is a common side-effect associated with diabetes yet remains a less than common discussion topic. 

Some of the barriers reported:

  • Availability of childcare for doctor appointments
  • Financial risk of taking off work to go to appointments
  • Access to reliable transportation
  • The need for information to be more digestible and easily  accessible


The research evidences that individuals with diabetes do not lack knowledge related to their disease but rather lack the resources needed for them to effectively manage their condition.  

On.Demand Diabetes™ is designed to ensure that preventable emergencies are a thing of the past while simultaneously enabling a way to intervene on every dangerous reading. The program provides all members with coaching precisely when they need it rather than when the calendar says they’re up for a call. Using cellular technology, real-time glucose readings, and automatic supply refills, On.Demand educates and helps individuals manage their diabetes in the comfort of their home while reducing waste and removing barriers for engagement and self-management.

This connection allows for meaningful interactions and educational opportunities at the exact moment of need. A common reported barrier to health is a feeling of isolation and not knowing when and where to reach out. On.Demand provides immediate care referrals to address additional mental and physical health challenges, making sure that individuals are never left on their own to guess how  best to manage their overall health. 

The care manager creates a triangulated approach to care consisting of the patient, the provider, and the care manager armed with real-time data. Research shows that members don’t view their provider as a partner in managing their diabetes.  In fact, they feel ignored. How can this change? The second-to-second data collected from On.Demand can be shared with the patient’s provider giving a holistic view of the management of an individual’s diabetes, making care more comprehensive while bridging the gap between appointments. Providers armed with this data can explain why medication is needed, discuss results, and validate the need for certain tests, treatments, or medication regimens, all of which improves member-provider relationships and steers members away from uninformed self-management habits and the ignoring of treatment recommendations.

Taking connected health to a new level, a recently launched pilot with Amazon’s Alexa skill, On.Demand Health™, adds a level of member communication and convenience never before seen in a diabetes management program. The ability to ask questions about individual health, and to report feelings and symptoms that are then directly fed to the member’s health coach adds to the member-centric approach to the care of a diabetic patient. Through Alexa, On.Demand allows users to immediately schedule health coaching sessions, access educational resources, receive care alerts 

and healthcare reminders, and even request real-time intervention based on how they are feeling. This skill provides telephonic connection for disease and case management without the need for a computer screen, physical mail, or even a mobile device. The data collected on buying habits, engagement preferences, self-reported clinical data, and subjective well-being assessments is a game-changer in how we look at member-centered diabetes care management.


Introducing appropriate emergency department utilization alone has the potential to save billions in diabetes healthcare expenditures per year. While important, ER diversion alone is only a piece of the pie.  It will take more than a few avoided trips to the ER to create lasting behavior change, the ultimate goal of any worthwhile care management offering.

Eliminate Waste

Cloud based glucose readings allow us to not only track an individual’s second-to-second glucose readings, but to determine when test strips are being utilized. This allows for automatic supply refills directly to a member’s front door. This unique program element eliminates waste, promotes adherence, and brings incredible convenience to members  with enough on their plates.

Drive Compliance 

Real-time biometric data allows for immediate intervention, providing health coaches an opportunity to help members avoid unneeded hospital visits, perform immediate health analysis, and provide education at the point of need. Members enrolled in On.Demand have experienced a 4.9% average decrease in glucose levels  and a 28% increase in testing compliance . Envolve is able to deliver the right intervention at the right time while removing barriers that impede member engagement, compliance, or education.

Change Behavior

A recent proprietary research survey found that many members are interested in using care managers but remain unsure of how to get started. Some didn’t even know that access to care management was a benefit available to them. With On.Demand, members receive a care manager at their fingertips, allowing for:

  • Reduced confusion regarding medication / treatment regimens
  • Assistance with healthcare navigation – scheduling appointments, screenings, and identifying additional healthcare needs
  • A companion to share and discuss individual needs and concerns with while also helping to reduce feelings of isolation often associated with those managing their diabetes

Medical care and disease management for diabetes is rapidly improving, but to create real and lasting change, additional improvements in healthcare delivery are needed. Those managing a disease like diabetes need continuous access to care and information, consistent and proactive intervention, and the right tools to help them succeed. Diabetes is a major US health crisis and will continue to cripple the healthcare system without proper interventions and solutions. 

On.Demand provides a true population health solution to this problem. Through technology-enabled monitoring of all participant readings and immediate delivery of an appropriate intervention in the event of dangerous result, we are both predicting the future, and better yet, changing it. By engaging and educating members in the comfort of their own home, we are changing compliance curves and shepherding members to better health. True health behavior change is the answer to assisting those managing their diabetes, and helping them to get healthy and stay healthy is a mission worthy of work involved. 

Contact us to learn how Envolve and On.Demand can help your diabetic population achieve improved health and reduced costs.