Organizations Look to Take a Bite Out of Diabetes

Workplace disease management programs have mushroomed in recent years as employers try to get a handle on costly chronic conditions like heart disease, cancer and asthma. While many of these efforts have resulted in lowering costs and improving employee health, diabetes still poses a daunting challenge for employers.

Diabetes is one of the fastest-growing diseases with 29 million Americans — nearly 10 percent of the population — suffering from the condition. For employers, it’s one of the costliest diseases to manage. The American Diabetes Association estimates that the financial effect linked to diagnosed diabetes is $250 billion in medical costs and indirect costs such as absenteeism.

Compared with more complex conditions such as cancer or heart disease, treating and managing diabetes is fairly straightforward, according to Laurel Pickering, executive director of the Northeast Business Group on Health. Blood-sugar testing to check insulin levels, medication, diet and exercise are part of an effective treatment program and yet the condition continues to run rampant in the workplace, Pickering said.

“With diabetes, as compared to other conditions, we know what works,” she said. “Despite that, we still have a problem of uncontrolled or unidentified diabetes. Why is it that we know what works but it’s not working?”

Among the reasons are the lack of coordinated medical care at the doctor’s office and a breakdown in employee education in engagement, she said.

“What employers have done to make up for what’s not happening in the physician’s office is to offer disease management programs,” she said. Getting employees to participate in those programs is proving difficult, in large part because of a lack of trust, according to a recent report by the New York-based business group.

Many traditional approaches that involve screening for diabetes and providing health coaches by phone may not go far enough in building the level of trust needed to make these programs work, according to the organization’s report, “Moving the Needle on Diabetes: The Employer Perspective.” The report suggests that customized, face-to-face counseling and education and new technologies are one solution.

“There needs to be the next level of initiatives,” Pickering said. “One is a high touch provider focused intervention. The next level is technology. We think technology holds some promise in engaging folks who are not engaged in a telephonic disease management approach. There are so many innovations like smartphones that track food and activity and glucose and send employees personal messages. These need to be explored more.”

Pitney Bowes Inc. is one company at the forefront of workplace diabetes management, and of other chronic diseases. In 2007 the global communications technology company lowered the cost of diabetic medications, moving all diabetes medicines and supplies into a generic prescription drug classification and absorbed the costs, according to Jennie Pao, manager of health care planning at Pitney Bowes.

Adherence rates went up and cost of care went down over the next three years by about 6 percent, the company reports.

In 2012, the company launched a diabetes prevention program through its insurer, United Healthcare Services Inc., which is offered at several Pitney Bowes on-site clinics and at local YMCA locations, Pao said. It also hired two full-time nutritionists who developed a seven-week webinar series and act as health coaches. In 2014, the company also introduced a telehealth program that provides access to nutritionists online or over the telephone, Pao said.

“We wanted to extend our nurse practitioners’ reach beyond the work site,” she said. “This is available 24/7, and there’s no cost to meet with on-site clinicians on this platform.” Since mid-January, access to pharmacists has also been available, Pao said.

Results from well-run diabetes management programs seem promising.

According to the Northeast Business Group report, regular eye exams and treatment can prevent up to 90 percent of diabetes-related blindness; foot care programs can reduce the chances of amputations by 85 percent; and weight loss through diet and exercise can lower the risk of developing diabetes by 58 percent. And studies show that for every dollar spent on diabetes management, employers can expect a $4 return on investment.

“The health care system and employers both recognize that the most effective programs are face to face, which is why we encourage this care happening in the physician’s office,” she said. “But employers are also bringing physicians, nurses and diabetes care managers on-site. There’s quite a bit happening now around reimbursing providers to manage people with chronic disease. We’re moving from fee-for-service to fee-for-value. We recommend exploring new payment models so that the physician is thinking about how the patient is doing after they leave the office.”