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2018 May 11 OneHealth ACO Diabetes Strategy

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Hello everyone this is bob round recording an update on our diabetes strategy with some new ways to look at things and some new information for you all so basically one way to look at diabetes is how it fits into the whole big picture and so this is a report of what from a while back where they basically took and looked at different age categories what are the

Costs of things and what’s also going up the fastest so down here is you know total cost up here as you go higher that’s how fast the costs are growing not surprising in the childbearing age that pregnancy is a significant cost but this isn’t something we’re probably gonna control that much but diabetes is already making a pretty significant dent in the cost and

Then also future growth even in this twenty to forty four year old age group move up to the 45 to 64 year old age group though you see that diabetes is the biggest single cost of spending with all these categories plus it’s also going up pretty fast each year so this is why diabetes is so important and also of course high blood pressure high cholesterol honestly if

You look at the lifestyle factors some of the risks that puts you at risk for diabetes are also responsible for people’s low back pain as well these do kind of go and i heard together the boy are these expensive some of you probably know of course that you know our diabetic rates are going up dramatically because of the obesity epidemic and so that’s also adding

To all of this and we can start doing some things to maybe put a dent in that and our own blue cross blue shield data of course shows that diabetes is our single biggest bucket of costs so what are gonna do about this essentially it helps to look at this and say you know really diabetes is a continuum from lifestyle to getting to the point where you’re a diabetic

With multiple complications there’s different places where you can be intervening along that spectrum if you look at most employee wellness programs that companies put together the employee wellness things are doing with hr hr health risk assessments and biometrics are trying to interrupt this cycle as early as possible because this cost our companies a lot of

Money example i like to use is one of our local companies with a thousand covered lives out of those thousand 37 have diabetes and those 37 patients employs a loan account for 15 to 20 percent of their healthcare costs so what they’re looking for is the earliest things they can do and starting to get people into a health coaching and lifestyle change when they’re

In this metabolic syndrome range and then trying to do anything further along the challenge that employee wellness programs have is that once they get into this environment this is the clinical environment you guys take care of and they really have a hard time doing much here but we as a group can taken an effective plan to basically take it from here for these

Folks and if we can do this effectively we can make a really strong pitch to our local employers that they should help with our insurance product we’re working on so think of the each of these as a potential step along a way that we can intervene to protect these high cost people another to look at is what is the cost of each stage of intervening and so in an

Employee wellness environment doing hras and biometric screening on all your employees would cost about $40 an employee really not too bad that includes the lab costs and then if something if they actually do find some things they put into a health card to place a health coaching plan that can probably be done for about a hundred to two hundred fifty dollars an

Employee really pretty cost effective when you look at what the eventual things you could be avoiding essentially you could fund 500 employees worth of health coaching just for the cost of one die multi complication diabetic now they moved from let’s say they are metabolic some now they’re in the pre-diabetes range they should be seeing their physician definitely

By this point this is again where you can start making intervention a lot of i think in the medical field we’ve spent too much of our time down here and not enough town time here that’s why we’ve added a diabetes educator with a dietitians background molly to work with clinics and several clinics have since already snow hired diabetes educators with the nutrition

Background i think we also need to start looking more at that i think we probably do can justify full-time diabetes educators with a nutrition background in most of our medium to large clinics so look at these costs here and see what what that are thinking of things you could do we’ve put together this formerly priceless that we’re about ready to finalize and send

It out i just had my meetings with a couple of our lead physicians who are a part of this and we will be sending this out to you shortly but look at this for example so you have metformin of course everybody should be starting on that it’s four or five dollars a month really inexpensive very cost effective if anything it can cause some weight loss really so neutral

To weight loss but there’s cardiac and mortality benefits for metformin so a great drug for met for diabetes control at a low price problem is you start moving to other medicines that have equal benefits worry there’s eve some weight loss some cardiac if it’s some mortality benefits unfortunately getting the hundreds of dollars however you have to very comparable

Meds with those risk profile benefits one for twenty one seven hundred dollars on the bluecross prime therapeutics formulary well the picking one versus the other that’s the difference between this multi met diabetic being a $6,000 your diabetic or a $10,000 your diabetic so starting with guardians as opposed to victoza is four thousand dollars a year but going

Back here if we can do anything with lifestyle in this range keeping people and either the pre diabetic or new diabetic met form with lifestyle we can save tens of thousands of dollars and if we can really prevent them from getting the multiple complication diabetics we can print them here our blue cross blue shield quality measures sent it around the a1c diet

Diabetic eye exams and the properties screening that’s mostly trying to permit this diabetic from becoming here but we need to go farther upstream and i think we really need to start looking seriously about adding more dietitians into our clinics and getting people identified in this stage to start making a difference in lowering health care costs because remember

That our biggest customer blue cross blue shield buck anything we do to lower this bucket here we split the savings with blue cross blue shield 5050 so every dollar saved here is $0.50 back into our in our system in our pockets so we could make a real big difference and prove the health of our community and really make things great for our employers but if you have

Any questions shoot me an email we’ll be work trying to work more and more with your clinic so we do already do have the point where we’ve had molly and clinics where we can project the costs of providing this diabetes care and it is self-supporting for your multiple methods so i hope this helps you and uh send me an email if you have any questions thanks

Transcribed from video
2018 May 11 OneHealth ACO Diabetes Strategy By Bob Rauner