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Diabetes in Depth: The Case for Comprehensive Diabetes Management

Diabetes has reached an epidemic level in the United States, affecting over 30 million people. Over 84 million U.S. adults—more than a third—are estimated by the CDC to have prediabetes, meaning they’re at an increased risk of developing type 2 diabetes, heart disease and stroke. The diagnosis and management of diabetes has become a significant priority for all payers and providers in their efforts to manage population health.

“Diabetes impacts not just individual patients, but also their families and their communities,” said Kate Berry, senior vice president of clinical affairs and strategic partnerships for America’s Health Insurance Plans (AHIP). “The cost of treating diabetes and complications over time can get very serious. We can’t understate the impact it’s having on the American health system.”

Experts say payers and providers looking to minimize the disease’s impact on outcomes must consider the importance of targeted, personalized interventions and the promise of real-time data.

$327 billion

the total direct and indirect estimated cost of diagnosed diabetes in the U.S. in 2017

SOURCE: American Diabetes Association

Connecting Provider, Payer and Individual

In a survey conducted by Modern Healthcare Custom Media on behalf of Envolve Health, nearly all respondents (97%) believe that care coordinators who help manage chronic conditions such as diabetes are “very important” or “important” to a successful Population Health Management (PHM) program. Respondents also said that chronic condition management is one of their top three most significant challenges in managing population health.

Prevention is crucial in managing diabetes, and payer-provider collaboration is key in working directly with individuals to accomplish that. “Insurers and providers are working together to implement new programs to really get ahead of the disease,” Berry said.

Innovation is occurring in the efforts to bring together payers, providers and individuals in an attempt to coordinate care and influence health behaviors.

Successful coordination of diabetes care requires much more than a well-staffed call center. Healthcare leaders must cultivate a comprehensive care coordination program that incorporates evidence-based protocols, individualized attention and targeted solutions toward barriers that prevent success. Care coordinators play a key role in helping individuals with diabetes overcome social barriers that make it difficult to manage the disease.

“Health insurance providers are meeting patients where they are, deploying wellness coaches and dieticians through telehealth, at their own clinics, and even at community locations like the YMCA or grocery stores,” Berry said.


of healthcare leaders believe chronic condition management is “very important” or “important” to a successful PHM program

Digital tools are empowering patients with better access to expertise by extending the reach of care coordinators. A wide variety of apps allow individuals to more easily track glucose levels, submit clinical data, and learn best practices for managing the disease. These apps are supplemented by voice assistants like Amazon Alexa and Google Home, which now have skills that allow members to call a coach or receive care alerts. For example, Envolve Health’s On.Demand Diabetes Management program allows patients to use Amazon’s Alexa to call a coach or case manager, receive care alerts or healthcare reminders, and contribute to clinical and well-being data to enhance care coordinators’ data analysis.

Top 5 population health challenges cited by healthcare leaders

Graph on top 5 population health challenges cited by healthcare leaders. Key and information in following text. 

 63% - Influencing Behavior (e.g., preventive health, nutrition, tobacco use)

 57% - Addressing Social Determinants of Health (e.g., food insecurity, access, homelessness)

 48% - Chronic Disease Management

 43% - Medication Costs and Adherence

 24% - Health Literacy

Building Trust to Influence Behavior

While education is crucial in ensuring individuals with diabetes understand how to manage their condition, most U.S. adults with diabetes understand the nature of their condition. What they need is comprehensive support in managing it, enabled by tools that make it easier—such as automated testing strip refills—and coaching that offers personalized strategies and counseling on how to stay on track.

“Impacting behavior change is more than an educational issue. Individuals who know they have diabetes understand their disease. They know they need to check their blood pressure. They know A1C is important, and they know diet and exercise are important,” said Jeremy Corbett, MD, divisional chief health officer of Envolve Health. “They’re just having trouble. Our ability to help them lies in what we can do to remove barriers and make it easier to be healthy.”

The gold standard in diabetes care management is a one-on-one relationship with a specific coach that works directly with the individual to accomplish key goals. When care coordinators know members well, they can appeal to a particular personality and motive to steer them in a healthy direction and get ahead of potential problems.

“This is not coach by committee,” Corbett said. “If you don’t have a relationship, you don’t have trust. If you don’t have trust, the conversation isn’t going to move in a productive direction.”

Any number of barriers may prevent members from seeing their physician regularly. If patients can be coached on an hour-long conversation by someone who knows their story and has a relationship with them, significant improvements can take place between in-person visits.

“Any time you can tailor an intervention to how a specific patient is presenting, you’re more likely to inspire change,” Berry said.



of healthcare executives reported that their organization currently has a care coordination program for chronic illnesses like diabetes

Real-Time Support Requires Real-Time Data

Payers traditionally use claims data to determine how best to coordinate care and coach individuals. That can be a challenge for people with diabetes, whose conditions may change rapidly from one day to the next and whose claims are likely to be months old.

“Claims data is typically outdated given the time it takes for them to process and be paid out by today’s systems. It’s the same as saying that you shouldn’t dress today based on last week’s weather,” Corbett said.“The effectiveness of diabetes management is multiplied when we’re able to coach members using real-time data.”

“The effectiveness of diabetes management is multiplied when we’re able to coach members using real-time data.”

Jeremy Corbett, MD, Divisional Chief Health Officer, Envolve Health

Even if individuals aren’t testing glucose levels as regularly as they should be, their data is indispensable to care coordinators who can use it to better understand possible interventions for condition management. Problematic data may prompt a care coordinator to reach out, rather than wait for a patient to call.

Noncompliance with glucose monitoring can also signal to care coordinators that an individual may be struggling with medication and treatment adherence. “If we have a real-time data stream, it can give us a reason to connect with the patient about a number of related issues,” Corbett said.

Take the Next Step in Managing Your Population

When technology, proven techniques and early intervention are utilized to combat diabetes, everyone wins. Health plans actively using Envolve Health’s On.Demand have achieved a 22% reduction in Emergency Room (ER) spend per member per month and a 15% reduction in ER use per member per month. On.Demand users also show a 46% increase in engagement through telephonic interventions and a 4.9% decrease in average glucose measurement.

Start realizing cost savings and population health benefits by incorporating On.Demand into your health plans. Contact Envolve Health at 1-844-234-0810, or visit envolvehealth.com.

Download Diabetes in Depth (PDF)

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