Integrated care: One insurance company’s perspective on managing diabetes

person with diabetes testing blood sugar

TesaPhotography / Pixabay

Guest post by Collette Manning, RN, CCM, ONC, Anthem Blue Cross and Blue Shield

Every five minutes, two people die of diabetes-related causes and 14 adults are newly diagnosed, reports the Centers for Disease Control and Prevention (CDC). This means in the time it takes to read this blog post, at least 16 people and their families’ lives have been changed forever.

Types of diabetes

People with diabetes either have type 1 diabetes, where the body does not produce insulin, or type 2 diabetes, where the body does not use insulin properly. Type 1 diabetes is usually diagnosed in children and young adults and according to the American Diabetes Association, only counts for about five percent of people with diabetes. Type 2 diabetes can affect people at any age and is the most common form of diabetes.

A growing problem

Although much work is being done to reduce the rate of new cases, diabetes continues to be a growing problem in our country. According to the CDC:

  • more than one in two Americans are at risk of developing diabetes or are already affected by the disease.
  • One in five health care dollars spent in the U.S. goes toward the care and treatment of people with this chronic condition, leading to higher health care costs and lost productivity at work.

National Diabetes Awareness Month reminds us that the stakes are high for our health care system. We need to make prevention, early detection and treatment of diabetes as efficient and effective as possible. Employers have an important role to play in helping their employees stay healthy by providing the necessary services and educating the workforce about their benefits.

I know from firsthand experience as a registered nurse that the human body is a maze of interacting, integrated systems. No one of these can exist independently of the other, and together they are responsible for sustaining life.

An integrated approach

Diabetes begins from an imbalance of critical hormones in the endocrine system, but its effects are felt through the entire body — wreaking havoc on the cardiovascular and nervous systems, as well as on vision and dental health.

If disease impacts us holistically, shouldn’t health care treat patients holistically?

A growing trend in population health management aims to address this problem by treating a patient’s whole body, rather than individual parts. In the insurance world, this approach is called integrated health care. It connects dental, vision, and disability data through a patient’s insurance carrier, which in turn, promotes opportunities — including early detection and improved management of chronic conditions.

Integrated health care programs help improve patients’ health by more effectively coordinating medical and specialty care, making every patient-provider interaction more meaningful with richer information. These programs not only help improve patient outcomes but can also reduce medical costs over time.

Examples of integrated care

Vision problems

For example, retinal scans often lead to early diagnosis of diabetes, given eye care providers can detect early signs of the disease in the eye. Vision patients showing signs of early diabetes trigger a referral to the care management team.

This approach can also help those living with diabetes manage their condition through regular checkups and reminders. Since diabetes is the leading cause of adult-onset blindness, regular vision check-ups are critical. The health connectivity fostered by integrated health care plans provides free flow of data between a patient’s diabetes care provider and their vision specialist, so the latter can monitor the patient’s eyesight even more closely for signs of deterioration.

Periodontal disease

Just like the various systems of the body are interconnected, integrated care approaches also help manage diabetes by managing disease in other areas of the body. Diabetics face an increased risk for periodontal disease or infection and inflammation of the gums, which can lead to tenderness and tooth loss.

Inflammation in the mouth can then make blood sugar management more challenging, leading to a cycle of patient health concerns and potential escalating cost. Integrated health care programs that offer both medical and dental coverage can automatically identify and enroll patients with diabetes in enhanced dental services.

As a result, patients who are actively engaged in a care management program are notified of an added cleaning — three, instead of the usual two per year — to maintain good dental health. According to the CDC, diabetics who treat their periodontal disease through increased care have 39 percent fewer hospital admissions and 40 percent lower medical costs overall.

The future

Diabetes cases are expected to increase over the coming years and prevention, early detection and management of the disease will be essential to ensuring the best possible outcomes for patients while also mitigating the cost burden. Integrated health care programs are the future of better care and can achieve this goal. Diabetes cannot be treated in a vacuum, and health care plans should seek to mimic the body’s interconnectivity.

Colette Manning, RN diabetes coverage

Source: Anthem

Collette Manning, RN, CCM, ONC is the Clinical Integration Strategy and Planning Director for Specialty Businesses at Anthem Blue Cross and Blue Shield.

Diane Atwood

About Diane Atwood

For more than 20 years, Diane was the health reporter on WCSH 6. Before that, a radiation therapist at Maine Medical Center and after, Manager of Marketing/PR at Mercy Hospital. Now she writes the award-winning blog Catching Health with Diane Atwood.