One effect of the COVID-19 pandemic has been to underscore the importance of managing chronic disease.
This is especially true in the case of type 2 diabetes. Affecting over 28 million Americans, type 2 diabetes is characterized by the body’s improper use of insulin, the hormone responsible for maintaining normal glucose levels.
While having type 2 diabetes does not seem to increase the risk of contracting COVID-19, studies indicate having type 2 diabetes does increase the risk of severe illness from COVID-19, including greater risk of ICU admission and mortality.1
These increased risks are in addition to the already steep cost of treating type 2 diabetes, which imposes a tremendous financial burden on both members and payers. Beyond the direct costs of treating type 2 diabetes, additional costs arise from treating common comorbidities including hypertension, coronary heart disease and chronic kidney disease.2 For employers, the impact of diabetes is also felt in reduced workforce productivity and increased absenteeism.3
A holistic approach
People with uncontrolled diabetes use more prescription medicine, experience more emergency room and physician office visits and are at higher risk of dangerous complications such as fractures, kidney/eye disease and amputations.3 Accordingly, the OptumRx Diabetes Management Program takes a holistic approach to treating the disease. The program encompasses member outreach and education, case management support, gaps in care analysis, as well as adherence monitoring.
The OptumRx Diabetes Management Program relies upon the expertise of OptumRx pharmacists and counselors. The Program was designed to proactively identify and help those with uncontrolled diabetes in order to control costs and help members achieve positive health outcomes. All high-risk diabetic members receive one-on-one counseling – led by specialized pharmacists who are also Certified Diabetes Educators.
Our deep clinical expertise is paired with cutting edge technology. For example, pharmacists will leverage data from cloud-based meters to provide another layer of care should a member’s blood sugar levels trend out of range. The OptumRx Diabetes Management Program also utilizes the OptumIQ™ platform. Here we bring together data from a broad range of sources, including pharmacy, medical, ancillary care, and lab results into a machine learning model to identify varying levels of risk for disease progression and complications at the individual level. Equipped with these patient-level insights, we then adjust clinical interventions to improve overall results.
The merits of this comprehensive, personalized approach are evident in the results. Significantly, 77% of high risk diabetics with signs of disease progression have experienced A1c improvement and engaged diabetic members of the OptumRx Diabetes Management Program achieved a 1.5-point average A1c reduction.4 Moreover, the Program has a 63% adherence intervention success rate at converting nonadherent diabetic members to become adherent in addition to closing gaps in care at a success rate of 11% for all members with cardiovascular intervention opportunities.
Stopping type 2 diabetes before it starts
Studies have long shown that type 2 diabetes can be affected by lifestyle interventions, including improved diet and exercise.
And early interventions are even more necessary when a person has prediabetes, a condition in which individuals have blood glucose levels higher than normal but not high enough to be classified as type 2 diabetes. According to the Centers for Disease Control, more than 1 in 3 American adults, approximately 88 million people, have prediabetes.5 Moreover, 84% of those with prediabetes are unaware they have it.
To prevent disease and address condition progression, OptumRx has leveraged the expertise of Rally Health, Inc., a consumer-centric digital health company and part of Optum to offer Real Appeal with the OptumRx Diabetes Management Program. This solution is a scalable, science-based intensive lifestyle intervention program designed specifically for employee benefit plans. Through proper nutrition, exercise, sleep and stress management, Real Appeal focuses on weight loss, which is essential to lowering the risk of diabetes, and also has beneficial effects on blood pressure control as well.
By fusing the clinical expertise and synchronized care capabilities of OptumRx with the innovative digital solutions and online coaching of Real Appeal, we can better engage plan participants and teach simple, sustainable steps to help them manage their weight and control blood sugar levels. This ongoing education, monitoring and intervention is vital to prevent people from progressing along the continuum running from good health to prediabetes to diabetes.
Tracking participants in intensive lifestyle intervention weight-loss programs confirm the effectiveness and scalability of this program design. One peer-reviewed outcomes study across different locations and different industries, with varying ages, demographics, and individual health profiles, revealed nearly 1 in 3 program participants achieved a 5% weight loss.6
This holistic approach to individual health thus provides substantial medical cost savings and proven ROI for payers looking to address spending related to type 2 diabetes.
OptumRx is committed to addressing the biggest challenges in healthcare. With the number of people with type 2 diabetes continuing to rise and the pandemic still impacting lives across the country, the need to address this chronic disease has never been timelier.
Talk to your OptumRx representative to learn more about how we are addressing the challenges presented by type 2 diabetes and other chronic diseases.
- The Lancet. “COVID-19 in people with diabetes: understanding the reasons for worse outcomes.” Accessed at: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30238-2/fulltext
- BMC Medicine. “The comorbidity burden of type 2 diabetes mellitus.” Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659216/#
- American Diabetes Association. “Economic Costs of Diabetes in the U.S. in 2017.” Accessed at: https://care.diabetesjournals.org/content/early/2018/03/20/dci18-0007
- Optum Internal data.
- Centers for Disease Control and Prevention. “The Surprising Truth About Prediabetes.” Accessed at: https://www.cdc.gov/diabetes/library/features/truth-about-prediabetes.html
- Obesity. “Implementing an Online Weight-Management Intervention to an Employee Population: Initial Experience with Real Appeal.” Accessed at: https://pubmed.ncbi.nlm.nih.gov/30264535/
STATEMENT REGARDING FINANCIAL INFLUENCE:
This article is directed solely to its intended audience about important developments affecting the pharmacy benefits business. It is not intended to promote the use of any drug mentioned in the article and neither the author nor OptumRx has accepted any form of compensation for the preparation or distribution of this article.