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The Problem
 

Diabetes, heart disease, and stroke remain leading causes of death in the U.S. with heart disease and stroke being the most common causes of death in adults with diabetes. As time progresses, high blood glucose, as a result of diabetes, can damage blood vessels and the nerves that control the heart. Adults with diabetes are twice as likely to die from heart disease or stroke. Almost 7 in 10 people with diabetes over age 65 die from some form of heart disease with nearly 1 in 6 dying from stroke.

 

Diabetes continues to grow at an alarming rate affecting healthcare providers, health payers, employers, and individuals nationwide. With over 29 million people currently living with diabetes and over 86 million people with pre-diabetes in the U.S. alone, the need to help patients better understand and manage their condition remains critical.

 

Heart disease ranks number one, with stroke following behind, as top causes of death worldwide. In the U.S., about 610,000 people die of heart disease every year. Coronary heart disease (CHD), the most common type of heart disease, kills more than 370,000 Americans annually and every year nearly 735,000 Americans suffer a heart attack. Of these, at least 210,000 have suffered a heart attack before. Risk factors for heart disease include high blood pressure, high cholesterol, and smoking with 47% of Americans having at least one of the three. When heart disease or stroke doesn’t result in death, it too often causes significant disability.

 

The good news is that taking steps to manage diabetes and preventing heart disease and stroke, reduces risk. dMeetings diabetes and heart health patient education provides high-quality education for the prevention and self-management of these serious chronic diseases. Our web series directly addresses these conditions. Read below to understand how the widespread diabetes, heart disease, and stroke epidemic remains significant for four primary stakeholders.

For Healthcare Providers

 

In 2012, 86 million Americans age 20 and older had prediabetes, a significant increase from 79 million in 2010. Heart disease accounted for more than 830,000 U.S. deaths in 2016, claiming more lives every year than all forms of cancer combined. With someone in the US having a stroke every 40 seconds on average, stroke kills approximately 142,000 people a year. In 2016, stroke accounted for about 1 of every 19 deaths in the US.

 

With 1.4 million Americans being diagnosed with diabetes every year and this disease often leading to heart disease and stroke, the workload for health care providers is overwhelming. To make matters worse, physicians are faced with reduced reimbursement per patient from health plans resulting in lost revenue opportunities. To further explain the magnitude of diabetes, heart disease, and stroke’s effect on healthcare providers:

●    Physicians are increasingly responsible for better communicating clinical information to patients.

●    Being more efficient through patient education allows for successful impact between the physician and patient and the maximization of time.

●    Targeted patient outcomes make room for increased billing.

●    Diabetes patients are encouraged to locate a solid team of healthcare professionals to access the necessary care for their condition.

●    There are different types of diabetes and patient management is not one size fits all.

For Health Plans (Payers)

 

The total costs of diagnosed diabetes in the United States in 2017 was $327 billion of which $176 billion was for direct medical costs paid by health payers directly, including Medicare, Medicaid, and Tricare. Between 2014 and 2015, direct and indirect costs of cardiovascular diseases and stroke was $351.2 billion with $213.8 billion in direct costs and $137.4 billion in lost productivity and mortality. As the nation’s primary health insurance program for low-income citizens, Medicaid plays a key role in financing care for diabetes due to the disease’s strong presence amongst this population. To understand how exactly diabetes and diabetes-related complications remain at the core of this huge financial problem, let’s review these stats:

 

●    Hospitalization rates for heart attack are 1.8 times higher among adults age 20  years or older with diagnosed diabetes than among adults without diagnosed diabetes.  ●    After adjusting for population age differences, cardiovascular disease death rates were almost 2 times higher among adults age 18 years or older with diagnosed diabetes than among adults without diagnosed diabetes.

●    Of adults age 18 years or older with diagnosed diabetes, 71% had blood pressure greater than or equal to 140/90 millimeters of mercury or used prescription medications to lower high blood pressure.

●    After adjusting for population age differences, hospitalization rates for stroke were 1.5 times higher among adults with diagnosed diabetes age 20 years or older compared to those without diagnosed diabetes.

Some of the blame for these massive costs can also be attributed to:

●    A lack of compliance from health plan providers with state and federal regulations

●    Lack of education and wellness programs at local and state levels

●    Little to no member engagement which results in more hospital visits and complications

For Employers

 

The total nationwide cost of diagnosed diabetes in 2017 rose to $90 billion in reduced productivity affecting employers. According to the American Diabetes Association, this $90 billion of reduced productivity can be broken down by:

●    $2.3 billion in reduced productivity for those not in the labor force

●    $3.3 billion in increased absenteeism

●    $19.9 billion in lost productive capacity due to early mortality

●    $26.9 billion in reduced productivity while at work for the employed population or presenteeism

●    $37.5 billion inability to work as a result of disease-related disability

Healthcare is an employer’s greatest expense after the cost of labor. With a large amount of the population receiving health benefits through their employers, employer-supported health plans are the largest amount of coverage nationwide. Thus, employers deal with the burden of rising, diabetes-related complications and costs. These include prescription medications, increases in premiums, and high-deductible health plans. As this number grows daily, it remains a major financial pain-point for employers and it can be easily addressed. Three of the top ten most expensive health conditions for U.S. employers—high blood pressure, heart attacks, and diabetes—are related to heart disease and stroke. Employees at risk for heart disease and stroke can increase the cost of conducting business due to workers’ compensation, absenteeism, presenteeism, worksite strategies, health care costs/benefits, and low productivity. These all inevitably impact the corporate bottom line.

 

Diabetes, heart disease, and stroke effects on employers include:

Worker’s Compensation - Worker’s compensation insurance is required nationwide for larger employers and is generally considered a significant. Because it covers medical bills and the wages of lost time for injured workers in the workplace or at a work-related sites, rates range from 5 - 40% of payroll. If an employee has diabetes and files a worker’s comp claim that’s seemingly not a direct result of a workplace injury, that employee still has a high chance of approval due to having a high impairment rating due to the disease. It would not be difficult for the employee to prove their case.

 

Absenteeism - Among full-time employees, the prevalence of diabetes results in an average of an extra 5.5 days of missed work per person per year and 4.3 missed days per person per year among part-time employees. Missed days include doctor’s appointments and emergency room visits along with inpatient care. If a diabetes patient develops heart disease or has a stroke, this will maximize their recovery time, thus causing them to not only miss work but possibly not return to work at all.

 

Worksite Wellness Strategies - A comprehensive health promotion program that includes sustained individual risk reduction counseling for employees and interventions is effective but requires capacity. If a company doesn’t have the budget, space, or time to implement a worksite wellness strategy for its employees who live with chronic disease, then those employees are more susceptible to miss work due to illness or seeking help elsewhere or increase company dollars spent on chronic disease-related complications. By assisting high-risk individuals to become healthier and more productive employees, this results in substantial savings with the health plan and to the company’s bottom line.

 

Health Care Costs/Benefits - The amount a company spends or matches its employees for healthcare is huge and increasing at a rapid rate. The American Diabetes Association estimates that a company with 1,000 employees has an average annual insurance cost of $2.7 million or $2,700 per employee. Among full-time employees, the diabetes-related total cost to employers is $16 billion or $4.4 billion among part-time employees.

 

Low Productivity - People living with diabetes have increased absence from the workplace due to a range of issues from increased sick days to compounded doctor visits. Further, employees living with diabetes generally don’t feel well when the condition is poorly managed and this creates a lack of focus, exhaustion and even results in sleeping on the job. This condition resulting in reduced productivity is termed presenteeism. These conditions feed into the $69 billion nationwide productivity crisis that diabetes causes. Lost productivity in the workplace can also be measured through absenteeism and early retirement.

For Individuals

 

The absence of necessary awareness and understanding, as a result of a lack of education among individuals with diabetes, is a major cause for concern that presents a threefold problem:

 

Direct Costs - Diabetes patients spend an average of 2.3 times the amount as that of people without diabetes on their health. This is an average of $16,752 a year per person with about $9,601 of it directly attributed to diabetes. Major costs include higher insurance premiums, co-pays for doctor visits, prescriptions, supplies and incidentals.   

 

Indirect Costs - Taking out time for doctor visits, properly taking medications, monitoring sugar levels, administering insulin, and managing a strict diet takes its toll both separately and collectively. In addition, patients who don’t manage their diabetes well generally don’t feel as well as those who do manage their condition. This leads to increased absenteeism and reduced productivity which ultimately affects not only individual and family but also the national economy. Lastly, diabetes-related mortality results in lost productive capacity effecting individual quality of life.

 

Health Risks and Complications - Failing to manage diabetes effectively can lead to further health conditions including heart disease, kidney disease, stroke, blindness, and amputation among other health risks. Additional complications include neuropathy, ketoacidosis and ketones, high blood pressure, HHNS, and gastroparesis. Diabetes can lead to problems for one’s entire body and will affect areas of the body simultaneously if not managed well. In addition, uncontrolled management of the disease can lead to higher incident of and premature death.