Maintenance is a Good Investment – Especially With Chronic Diseases Like Diabetes

Maintaining our depreciable assets is typically a no-brainer. We learn early in adulthood that we have to change our car’s oil or face a potentially unaffordable repair bill. If we’re running a manufacturing operation, we invest heavily in equipment maintenance to avoid production delays or shutdowns. Airlines follow very strict and regulated protocols to ensure planes are safe since they know the cost of an inflight failure could be catastrophic.
 

We invest in maintenance because it’s far less expensive than not investing in it. It’s the same with diabetes. Insurance companies tell us that a well-managed patient with diabetes costs one-third of what it costs for someone who is suffering from the complications that frequently result when diabetes is not well controlled. Enabling employees to successfully manage their diabetes is an essential investment in their health and well-being while protecting the business’ bottom line.

Most employers know that diabetes is a major cost driver for their health plans. However, many don’t actually know how or why and, more importantly, what they can do about it.

So let’s first look at the prevalence of diabetes and your employee population. Approximately 1 in 10 adults have either Type 1 or Type 2 diabetes. That’s a significant portion of your employee base in addition to any family members on your health plan who are also dealing with this condition.
 
Now let’s look at the cost impact across all those individuals, factoring in that diabetes is somewhat costly to manage, but much more expensive if not. For example, diabetes costs on average $10,000 per year for someone with well-managed blood sugars, but a whopping average cost of $30,000 for someone suffering from complications. In addition, diabetes costs employers $26.9 billion dollars in reduced productivity.

You can obviously lower the cost by reducing the number of patients with diabetes, which we’ll cover in a future article. Here, we’ll focus on how to reduce the cost per patient by first understanding what a person with diabetes is dealing with.

Very simply, a person with diabetes has high blood sugar usually driven by a lack of insulin or an inability to use insulin effectively. Insulin allows the sugar to leave the bloodstream and feed the cells for energy. Type 1 diabetes (5-10% of cases) is an auto-immune disease where a person doesn’t make any insulin. Those with Type 2 diabetes (90-95% of cases) typically have insulin resistance and need help to either make more of it, use it more efficiently, or take a supplemental dose of insulin.

The high cost of diabetes comes more from the devastating complications that result from uncontrolled, high blood sugars – heart attack, stroke, kidney failure, nerve damage and amputations, and blindness. It also stems from acute episodes of low blood sugar that send too many patients on an expensive cab ride to the ER, resulting in an expensive “hotel” bill.

37 million Americans live with diabetes and generate approximately 16 million ER visits per year. That’s an alarming number! What’s worse is that roughly half of these ER visits turn into inpatient hospital stays. So we’re not “maintaining our equipment” very well and we’re paying the price both economically as well as in human suffering.

So why is diabetes so hard to manage? Adam Brown published a powerful chart illustrating the 42 factors that impact blood sugar. It basically shows that someone with diabetes needs to consider what they eat, medications they take and timing, amount, type and timing of exercise, any physical or emotional stress, and so much more. Everyone struggles with managing their diabetes because it’s so complex and needs to be constantly monitored, 24 hours a day, 365 days a year. There’s no vacation from it.

Still, the good news is that diabetes can be managed with the right resources. To help those employees take care of their diabetes -- and reduce your plan costs -- you need to first understand what they need:

• Insulin and other medications including SGLT2s and GLP1s to control blood sugar
• Insulin delivery devices such as pumps or pens and the supplies necessary to use them
• Blood glucose monitoring devices such as continuous glucose monitors (CGMs)
• Glucagon (rescue drug for low blood sugar that’s cheaper than the ER)
• Diabetes management training, nutritional therapy and mental health services.

These should all be covered on your plans outside of the deductible. If not, and your employees ration their insulin, their largest expense, it’s bad for them and bad for the employer ultimately paying the higher health plan costs.

Express Scripts released a study in June 2022 showing that capping the cost of all diabetes medications at $25/month would result in a 16.3 percent reduction in a plan’s overall diabetes costs. Wouldn’t you like to reduce your plan costs by at least that much? This example clearly shows how maintenance is a good investment. And when you expand the same type of pre-deductible coverage to other chronic disease medications and treatments, the savings are even greater.

Employees are your most valuable asset. Make sure your plan supports them in their health journey.
 

Author Bio

George Huntley is a founding member of the Diabetes Leadership Council and currently serves as CEO of both the Diabetes Leadership Council and its affiliate, the Diabetes Patient Advocacy Coalition. He has been living with type 1 diabetes since 1983 and has 3 other family members also living with type 1. A passionate advocate for people with diabetes, George served as the National Chair of the Board of the American Diabetes Association (ADA) in 2009. George is also the Chief Operating Officer and Chief Financial Officer of Theoris Group, Inc., a professional services firm headquartered in Indianapolis, Indiana that provides engineering and information technology solutions. In his corporate role, George has been the plan administrator of a self-insured health plan for over 20 years.