Diabetes cost drivers
Since type 2 diabetes accounts for the vast majority of all diabetes diagnoses, we will focus our analysis there.
Diabetes is highly dependent on patient self-management.7 Some people with type 2 diabetes can manage their diabetes with healthy eating and exercise.8 In other cases doctors may also prescribe medications and/or insulin to help the patient meet their target glucose levels.8
In either case, it’s very important for patients to carefully follow their prescribed regimen.9 For example, not taking prescribed medications correctly may lower blood glucose, and cause insulin levels to go up. When this happens, the medicines become less effective.9
Unfortunately, studies have shown that almost 50% of diabetes patients fail to reach their clinical blood glucose goals.7
Patients who don’t stay adherent to treatment place a significant burden on both themselves, and on the larger health care system, with increased costs, morbidity, and mortality. It is estimated that diabetes accounts for over $24 billion in wasteful and avoidable spending – the second largest avoidable health care cost in the U.S.7
The OptumRx solution
The OptumRx Diabetes Management program can help members achieve positive health outcomes and control costs. Controlling diabetes helps to improve health outcomes and may reduce average health care costs up to 10% — based on fewer hospitalizations and ER visits.10
The OptumRx Diabetes Management program provides targeted guidance and services designed to prevent costly and clinically dangerous complications. The program consists of fully integrated management strategies that bring together data, insight and clinical skills from a broad range of sources, including pharmacy, medical, ancillary care, and lab results. Using machine learning and artificial intelligence, we focus on controlling diabetes by identifying risk levels of members.
- Lower-risk diabetic members are offered basic diabetes education to improve their understanding of the disease. We monitor these members daily, and intervene at crucial points in their care to help them stay adherent to their medications.
- High-risk members are offered more comprehensive and personalized care, connecting them with certified diabetes educators for more hands-on clinical expertise and support.
Our unique combination of data, analytics and health care expertise serve as the foundation of our diabetes solution. For example, a crucial component of the program is medication adherence monitoring. We monitor medication compliance for antidiabetic therapy and 18 other medical conditions, including common co-morbidities associated with diabetes. In addition, our gaps-in-care program will retrospectively review our member claims for chronic diseases and close any gaps in medication therapy by actively reaching out to the patient’s provider.
The diabetes management program is another example of how OptumRx is tackling the biggest challenges in health care. Click here to see an in-depth discussion of the details. Or, see the list of associated resources on the right-hand side of the page.