Minorities Had Lower Risk of Coronary Heart Disease Than Whites

Blacks, Latinos, and Asians had lower risks of coronary heart disease compared to whites, according to a 10-year study of Kaiser Permanente members in Northern California. The findings echo those of a 2014 study published in the New England Journal of Medicine. That study looked at racial disparities between black and white Medicare beneficiaries covered by Kaiser Permanente in the western United States. Disparities have been nearly eliminated for cardiac risks and diabetes markers, even as these disparities persist among patients in managed health care systems in other regions. Blacks, Latinos, and Asians without a prior history of coronary heart disease have a lower risk of coronary heart disease compared to whites, regardless of whether they also have diabetes.

Among members with prior coronary heart disease and no diabetes, blacks had slightly increased risk of future heart disease compared to whites. However, no such increased risk was noted in the highest risk group with prior history of heart disease and diabetes. Latinos did not have any difference in risk compared to whites in of these groups, and Asians had decreased risk.

Wellness program sees success cutting chronic disease risk, trimming waistlines

University of Pittsburgh researchers said the work-based Group Lifestyle Balance program tested at Bayer MaterialScience helped employees reduce their risk of diabetes and heart disease. The program was based on the National Diabetes Prevention Program used mainly in community settings, and at the end of one year, workers who participated lost an average 5% of body weight and doubled their physical activity. The study was published in the Journal of Occupational and Environmental Medicine. Pittsburgh Post-Gazette (5/26

How a Network Can Improve the Health of Medicare Beneficiaries

Medicare beneficiaries with diabetes, high blood pressure, or high cholesterol may achieve better health outcomes when using pharmacies that are part of performance-based networks, according to a study by SCAN Health Plan and Express Scripts. Phase I results demonstrated that, when compared to a national sample of retail pharmacies, the pharmacies in the Quality Network achieved 60% higher performance scores for reducing the use of high-risk medications among SCAN members, and 23% higher scores for improving compliance with diabetes treatment guidelines among SCAN members. When compared to a sample of non-SCAN members using the same Quality Network pharmacies, the Quality Network achieved 34% higher scores for high-risk medications and 8% higher scores for diabetes treatment among SCAN members.

Californians with the Top Chronic Conditions: 11 Million and Counting

Chronic conditions are the leading cause of death and disability in the United States, and are the biggest contributor to health care costs. But there is wide variation in their incidence. Major differences depend on age, income, race and ethnicity, and insurance status, according to a report by the California HealthCare Foundation. The report finds that many Californians with chronic conditions are delaying needed care because of cost. The following are key findings:

  • About 40% of adults have at least one of the five chronic conditions studied.
  • High blood pressure is the most common chronic condition, affecting about one in four, or 7.6 million, adults in California.
  • The prevalence of chronic conditions falls as income rises. Fourteen percent of adults living under 138% of the federal poverty level have two or more chronic conditions compared to 8% of adults in the range of 400% or more of the federal poverty level.
  • 34% of Californians with psychological distress delayed getting needed medical care, and 27% delayed filling prescriptions. Cost or lack of insurance was frequently cited as the reason for these delays.
  • 70% of Californians who are 65 or older have at least one chronic condition, compared to 26% of those  18 to 39.

Have Insurers Found a New Way to Weed Out Members?

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Eliminating discrimination on the basis of preexisting conditions is one of the central features of the Affordable Care Act (ACA). But there is evidence that insurers are resorting to other tactics to dissuade high-cost patients from enrolling, according to a study by Harvard’s School of Public Health. The findings suggest that many insurers may be using benefit design to dissuade sicker people from choosing their plans. A recent analysis of insurance coverage for several other high-cost chronic conditions, such as mental illness, cancer, diabetes, and rheumatoid arthritis showed similar evidence of adverse tiering, with 52% of marketplace plans requiring at least 30% coinsurance for all covered drugs in at least one class. Thus, this phenomenon is apparently not limited to just a few plans or conditions.

A formal complaint submitted to the Dept. of Health and Human Services (HHS) in May 2014 contends that Florida insurers offering plans through the new federal exchange had structured their drug formularies to discourage people with HIV from selecting their plans. These insurers categorized all HIV drugs, including generics, in the tier with the highest cost sharing.

Insurers have used tiered formularies to encourage enrollees to select generic or preferred brand-name drugs instead of higher-cost alternatives. But if plans place all HIV drugs in the highest cost-sharing tier, enrollees with HIV will incur high costs regardless of which drugs they take. This effect suggests that the goal of adverse tiering is not to influence enrollees’ drug utilization, but to deter certain people from enrolling in the first place.

Researchers analyzed adverse tiering in 12 states using the federal marketplace: six states with insurers mentioned in the HHS complaint (Delaware, Florida, Louisiana, Michigan, South Carolina, and Utah) and the six most populous states without any of those insurers (Illinois, New Jersey, Ohio, Pennsylvania, Texas, and Virginia).

Researchers found adverse tiering in 12 of the 48 plans — seven of the 24 plans in the states with insurers listed in the HHS complaint and five of the 24 plans in the other six states. There were stark differences in out-of-pocket HIV drug costs between adverse-tiering plans and other plans. Adverse tiering plan enrollees had an average annual cost per drug of more than triple that of enrollees in regular tiering plans ($4,892 vs. $1,615), with a nearly $2,000 difference even for generic drugs. Fifty percent of adverse tiering plans had a drug-specific deductible, compared to only 19% of other plans.

Enrollees may select an adverse tiering plan for its lower premium, only to end up paying extremely high out-of-pocket drug costs. These costs may be difficult to anticipate, since calculating them would require knowledge of an insurer’s negotiated drug prices — information that is not publicly available for most plans.

Second, these tiering practices are likely to lead to adverse selection, with sicker people clustering in plans without adverse tiering. Over time, plans offering generous prescription-drug benefits may see a large influx of sick enrollees, which would reduce profits and lead to a race to the bottom in drug-plan design. The ACA’s risk-adjustment, reinsurance, and risk-corridor programs provide some financial protection to insurers whose enrollees are sicker than average. But the existence of adverse tiering in 2014 suggests that selection opportunities remain. Furthermore, the reinsurance and risk-corridor programs will be phased out after 2016, which will only increase insurers’ incentives to avoid sick enrollees.

Price transparency is one approach to address unexpectedly high out-of-pocket costs for people with chronic conditions. Insurers could be required to list on their formulary each drug’s estimated price to the enrollee, based on the negotiated price and the copayment or coinsurance. However, price transparency would probably accelerate the adverse-selection process if adopted in isolation.

One would be to establish protected conditions in drug formularies. Medicare Part D has designated several protected classes of drugs, including those used for HIV, seizures, and cancer. A similar approach in the exchanges could set an upper limit on cost sharing for medications for protected conditions. Such a policy would reduce financial exposure for people with these conditions even if they chose sub-optimal plans. Other safeguards for protected conditions could also be implemented, such as limits on prior-authorization requirements.

An important additional step would be to require marketplace plans to offer drug benefits that meet a given actuarial value, meaning that the percentage of drug costs paid by the plan (rather than the consumer) would have to exceed a particular threshold. This level could be set at the actuarial value for a given plan (i.e., 70% for silver plans) or above it. In order to significantly increase cost sharing for one drug, an insurer would have to reduce cost sharing for another drug. This step is crucial because it encompasses treatment of all health conditions, not just protected conditions and addresses non–formulary-based methods of passing costs on to consumers that may induce adverse selection (e.g., drug-specific deductibles), according to the report.

Stopping adverse drug tiering will not completely eliminate discrimination in the insurance marketplace. Some insurers will think of new ways to dissuade sick enrollees from joining their plans. Eliminating premium discrimination on the basis of health status was one of the ACA’s chief accomplishments in the non-group insurance market and one of the law’s most popular features. Preventing other forms of financial discrimination on the basis of health status — with the attendant risks of adverse selection in the marketplace — will require ongoing oversight, according to the report. The ACA has already made major inroads in designing a more equitable health care system for people with chronic conditions, but the struggle is far from over

Addressing Growing Cost of Diabetes

As diabetes cases increase worldwide, curbing the personal and financial toll will become a high priority, according to the American Academy of Actuaries. Diabetes is expected to become more common globally, increasing from 8.3% prevalence in adults in 2011, to 9.9% in 2030, according to data from the International Diabetes Federation. At the same time, spending on diabetes varies widely. In 2010, the United States spent $197.8 billion, accounting for 53% of global spending on diabetes, whereas India, with the largest population of diabetics, spent $2.8 billion, less than 1% of the global total. An issue brief developed by the Academy examines the projected future global prevalence and costs associated with diabetes. It also examines efforts in seven different countries (Australia, Canada, Israel, Singapore, South Africa, the United Kingdom, and the United States) to develop better ways to measure, prevent, treat, and slow the cost of, the disease. The results are cautionary yet hopeful. For more information, visit http://goo.gl/P9v5SC.

Patients Are in Denial About Diabetes Risks

Nearly 80% of patients who are at elevated risk for Type 2 Diabetes seem to be deluding themselves by assuming that they are in excellent or very good health, according to a survey from the American Diabetes Association (ADA). “These findings suggest it is critical for providers to connect the dots with patients between risk factors and disease development,” said Virginia Peragallo-Dittko, R.N., C.D.E., incoming chair of the ADA’s Prevention Committee. For more information, visit www.ada.org

Diabetes is a Ticking Time Bomb in the Workforce

Diabetes is a workforce time bomb. Employees with diabetes report more lost work time due to absence and impaired performance than do workers with normal blood glucose, according to research by the Integrated Benefits Institute. If current trends continue, one in three adult Americans will have diabetes by 2050.

“Given the ever-increasing rate of diabetes and its consequences, the time for employers to act is now. Introduce clinical screening programs; adopt lifestyle intervention programs for those in the pre-diabetic stage; and provide targeted disease management for those already diagnosed. Finally, broadly measure the results of your interventions so you can show the full value of your programs,” said IBI Research Director Kim Jinnett, PhD.

The odds of missing at least one day of work in the last month were 47% higher for workers with diabetes than for employees with normal fasting blood glucose. In contrast, the odds for a worker with pre-diabetes were only 16% higher than the odds for a worker with normal blood glucose.

Diabetic employees report slightly lower job performance than employees with normal blood glucose levels even after adjusting for other health conditions. Performance for employees with pre-diabetes levels of blood glucose is not discernibly different from that of employees with normal blood glucose, underscoring the potential for positive outcomes by achieving moderate blood glucose improvements.

IBI president Thomas Parry, PhD said, “Treatment could help limit the toll of the disease, but many employees with diabetes may be unaware of their condition. Employers could benefit by improving diabetes awareness, encouraging healthy lifestyles and facilitating disease management.”

Employers can take the following steps to help prevent Type 2 diabetes and help control the effects of diabetes among workers:
• Improve access to blood glucose testing, paying special attention to employees with a high likelihood of elevated blood glucose levels. Work with supplier partners to ensure that employees have access to education and services.
• Promote weight loss among employees with unhealthy body mass. Even moderate weight loss can improve blood glucose levels.
• Promote disease management. Diet, exercise and coping skills can be effective for people who have been diagnosed with Type 2 diabetes. Different types of insulin control mechanisms and medication may also be added. Employers should be aware that, for proper disease management, multiple providers must have excellent care coordination, and diabetic employees must be involved in their treatment.

For more information, visit www.ibiweb.org.

Diabetes-related deaths among U.S. youths are down

An analysis of data from the National Vital Statistics System showed a 61% decline in the rate of children and teens age 19 and younger dying from diabetes-related causes from 1968 to 2009. Improved treatment, greater awareness of symptoms and better disease management education may have contributed to the drop in deaths, CDC researchers said. The findings appear in the Morbidity and Mortality Weekly Report. InternalMedicineNews.com (11/1)

AHIP partners with CDC on diabetes prevention program

AHIP and the CDC will collaborate on the implementation of the National Diabetes Prevention Program, a four-year initiative designed to prevent the onset of type 2 diabetes in patients with prediabetes. The program will focus on four strategies in the fight against type 2 diabetes: promoting health marketing activities, creating intervention sites, developing a diabetes prevention recognition program and workforce training. Healthcare Finance News (10/10)

Last Updated 09/22/2021

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