Link to the story to see a video of a day in Daisy's and her family's lives

Unless We Make Some Changes…

Read this story from the BBC for yourself. We’ve seen this dramatic increase in type 1 already starting about a year ago in the diabetes centers that we work with in the USA. Basically, the new cases of kids with type 1 diabetes have doubled!

Historically, the statistics on type 1 in kids is roughly 1 in 400 or 1 in 600 depending on the source. So let’s say 1 in 500. With doubling, that number will soon begin to approach 1 in 250 over time. In the USA, there are approximately 200,000 school age kids with type 1. Another source I read in the past states that there are approximately 30,000 new cases of type 1 each year in the USA and that approximately half of those are school aged kids. Based on this story and recent discussion, it’s safe to say that there are 30,000 new onset cases of type 1 in school aged kids. It used to be that a typical age for new onset (the mode) was around 8 to 11 years. Based on discussions with endocrinologists and educators along with the information in the story, the age of new onset is clearly moving to younger and younger kids. That means more diabetes supplies over more years and more risk of trips to the Emergency Department not to mention more time at risk for complications like cardiovascular disease in the teen years.

My experience has shown me that each endocrinologist working with diabetic patients handles approximately 200 to 400 patients. There are only 200 pediatric endocrinologists in the US and very few docs coming out of med school are attracted to the relatively low pay (vs other specialist alternatives), unbilled hours for telephone consults and logbook review, and lack of control (behavior change is the required skillset vs. diagnosing to prescribe pills/dose change to fix the condition).

While there are something like 14,000 diabetes educators in the US, most of them are trained and experienced on how to work with adults with type 2 diabetes - a very different scenario than working with a kid with type 1 who may also come from a broken home or other family issues.

If each patient requires 6 hours per year (30 minutes per office visit 4 times per year plus 20 minutes per month on average for another hour over the course of a year) and there are 700 trained providers, then there are a total of 1,380,000 hours of skilled care required at a minimum since this assumes no complications. If each provider is available for 30 hours per week of patient facing time, then the current skilled pediatric labor pool is able to provide 1,050,000 hours of patient directed care. Not enough providers to deliver standard care especially when you factor in the doubling effect of new onset. The numbers I use here are only rough assumptions to illustrate the gap in the current health care delivery model for type 1 diabetes. At some point there is a scary reality and a breaking point that nobody is aware of.

Sadly, until the economics are changed to incent providers to work with type 1 kids, I don’t believe we’ll get sufficient trained people to help us with this avalanche of new patients. That leaves us with having to develop new models of care that increase the efficiency, effectiveness and reach of the trained providers we already have as well as making patients better at self-care in the absence of their diabetes coaches. A little technology will go a long way if done right and adopted (embraced) by providers. I’m reminded of a slogan we adopted a year or two ago which is now posted at the top of Diabetech’s home page on the Web, “We’re dragging Diabetes Technology ‘kicking and screaming’ into the 21st Century”. With recent successes made on the payer front, we’re soon going to need to swap out the word ‘Technology’ for ‘Providers’.

My reason for making this post is to raise the awareness that the perfect storm is upon us. Who is doing the study to prove that we need to make changes now - based on irrefutable proof that maintaining the status quo is like using a syringe to bail out a sinking ship?

Walmart, Macy's, Best Buy Gift Cards - we call it GlucoCASH

So what’s a Differential Premium?

First of all, I was introduced to the combination of these two words by a health insurance executive during an employer focused health benefits conference back in 2005. Essentially, if you don’t take the actions prescribed for your own care or engage in acts that put you at high risk (ie - smoking) you should pay a higher health plan premium than your counterpart who is taking care and avoiding high risk behavior.

I also happen to remember that old life insurance check list asking me to confirm whether or not I’m an avid skydiver. Of course my premium would be higher. So the fact is that differential premiums have been around for a long time. Only now they are making their way into Health insurance.

Done right I agree with this concept. If you’re the person that goes the extra mile to take care of yourself while the guy in the office next to you always makes the unhealthy choice, why should you both pay the same premium?

However, it all comes down to the accuracy of some process that verifies your promise to be ‘compliant’ and/or that you can prove that you are not engaged in those high risk behaviors… like skipping your meds. How do you prove that you don’t smoke? How are those who decide how much your monthly premium is going to be actually verifying their information?

In a recent post by Amy over at diabetesmine I learned about a new health plan option for some of United HealthCare’s large employer clients (like AT&T for example).

The data from our randomized, controlled clinical trial for AT&T from 2006 - 2007 demonstrated that everyone wins when it’s easy. The difference is in how we go about rewarding for those desired behaviors that lead to lower costs and more productive employees.

If you’re an employee or dependent of one of these large companies, you will probably be very interested to read how Diabetech’s technology makes proving your participation easy while at the same time puts money in your pocket. In the video from United, I’m concerned that their ‘tracking site’ might be a major pita (email me if you want to know what the ‘a’ in pita stands for but here’s a hint: p=pain, i=in, t=the) and that it may be missing the mark when it comes to how their system looks at your data.

We implemented our diabetes programs based on input from large employers, physicians and actual employees with first hand knowledge of what it’s like to get that phone call from the health plan nurse. We decided that eliminating unwanted phone calls from the health plan would be a big win (picture a dark room and a swinging lamp over your head while sitting on the world’s most uncomfortable chair) as long as we can still get insight via trusted data from the patient. Since then a growing number of health plans are also appreciating the fact that our system can help them eliminate unnecessary calls and reduce the time spent on those times when they do call. We also placed the emphasis on easy to digest education by automatically delivering timely, relevant profile-based diabetes education as well as optional reminders. Your data in our programs also supports the determination of who qualifies for GlucoCASH (gift cards from the likes of Walmart, Macy’s, Best Buy, etc…) and for how much $$$. All the while making every day diabetes care easier vs. those employees who don’t have access to our programs. The proof behind these claims including significant reductions in A1c and high participant satisfaction is well documented on our clinical trial experience pages here.

Perhaps one of the biggest reasons for having a program like this from an independent third party like Diabetech vs. your health plan is to maintain privacy and independence from your employer. After all, HIPAA was supposed to be all about making your health benefits Portable thus allowing employees a certain degree of independence from their employers.

So to all those people who have the option to enroll in these new diabetes specific health plans, make sure you tell your employer that you want access to Diabetech’s programs which are now being covered by a growing number of health plans some of which have integrated our program with their own. Our programs are also eligible for coverage through Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA).

Ultimately, a combination of reduced out of pocket expenses and just in time behavior triggered rewards helps to ensure that everyone concerned wins. The key to all of this is making sure that the program content is accurate, relevant and useful and most of all - easy for the patient!