Financial Impact of Diabetes in the U.S.
The staggering impact of diabetes on our healthcare system cannot be understated. The most recent research from the American Diabetes Association estimates that the total cost of diagnosed diabetes has risen to $245 billion in 2012 from $174 billion in 2007 -- a 41 percent increase in diabetes spend over a five year period.
As of 2015, nearly 10% of the population in the United States (30.3 million Americans) have been diagnosed with diabetes. That number is only expected to increase. 84.1 million Americans 18 years and over have been diagnosed with prediabetes. Without proper care and patient education, they too will be swallowed by this growing statistic.
To say there is a market for diabetes treatments and products is an understatement. The global Type 2 diabetes market is set to double to $58.7 billion by 2025. There is no shortage of drugs, treatments, and products for monitoring and managing diabetes. There is, however, a shortage of patient education.
U.S. Healthcare Crisis: Current State of Diabetes Care
While much of the population mistakenly believes that doctors aren’t eager to participate in chronic disease prevention because diabetes has become lucrative, that couldn’t be further from the truth. The United States is grappling with both a diabetes epidemic, a health care crisis, and a doctor shortage: what amounts to a perfect storm for patients who are chronically ill.
Diabetes is the gateway to a host of chronic conditions such as heart disease, nerve damage, kidney disease, and Alzheimer’s. Since diabetics are often ‘polychronic,’ their multiple conditions require constant care and monitoring beyond an annual wellness visit or routine checkup.
Annual wellness checks add up to a total of 30 minutes of doctor-patient communication annually. Patients ultimately forget 85% of their conversations with their physician. This means that patients recall less than 5 minutes of the information given to them each year by their doctors.
Frequent follow-ups are difficult to facilitate in today’s healthcare environment. Doctors are already overburdened with patients due to a shortage of doctors and an overwhelming number of chronically ill Americans. This reality makes frequent face-to-face visits difficult to schedule. It is nearly impossible for doctors to be reimbursed for follow-ups via phone or email under programs like Medicaid, since private practices are forced to shoulder the burden of additional administrative work -- more overhead.
They make up for the loss in income by taking on additional patients, which contributes to the already overcrowded waiting rooms and results in more burnt-out doctors. The downward spiral continues.
Solution: Transparent Data-Driven Care for Diabetes
Telehealth Services for Simplified Follow-up and Reimbursement
Both patients and doctors want a service that quickly, accurately, and cost-effectively helps them diagnose, treat and connect patients with the right data-driven care. Telehealth services, such as online communication (email, messaging) would ideally be the main communication mode for most patients and in-person or virtual follow ups (phone, video). This approach frees up more time for more in-depth annual wellness checks.
Medicare added additional telehealth procedural codes in 2014 to support chronic care management (CCM). The CCM initiative allows physicians to bill for a minimum of 20 minutes of remote interaction each month with patients and other providers in an effort to improve continuity and coordination.
Telehealth services create more time for evaluation so doctors can stay ahead of potential complications or change course of treatment if necessary. It also opens up additional time for patient education for disease management.
In the case of diabetes, this means a doctor can work with patients to better understand the contributing factors to their blood glucose results. This can include noticing patterns in their readings and helping a patient make adjustments to their food choices and activity levels.
To qualify for reimbursement for this time, physicians must appropriately document each interaction. Rather than add to administrative costs and overhead in a primary care practice, this documentation would be simplified with a comprehensive Transitional Care Management Solution.
Data-Driven Insights for Healthcare Transparency
The same Transitional Care Management Solution provides in-depth data tracking, query options, and reporting capabilities for each patient. This provides physicians with the insight they need to understand their patient’s medical and lifestyle demands when making recommendations for drugs, products, or a wholistic care plan for diabetes.
By far the most important factor when selecting a course of treatment is insurance coverage. Every payer, whether it’s Medicare, Medicaid or a commercial health plan, uses financial incentives to direct enrollees to the preferred products for that plan. Payers may limit patient choice of diabetes products so it’s important that the physician understands which products and brands will be covered on a patient’s plan.
Having all of the information at their fingertips allows doctors to recommend different products for patients according to their unique needs. For example, elderly patients with limited vision and dexterity may prefer glucose meters with large screens and test strips that are easier to handle. Younger, tech-savvy patients might prefer glucose meters with health apps that send readings to their smartphone for ease of tracking.
With a Transitional Care Management Solution, doctors can easily review all of the medications that their polychronic patients are using. This provides an opportunity to review prescriptions and identify possible areas for medication reconciliation.
Oculus Health: Transparent, Data-Driven Care
Oculus Health offers next-level care that benefits primary care practices, physicians, and patients. With Transitional Care Management (TCM) from Oculus Health, primary care providers can maintain their income and improve patient outcomes by creating effective workflows.
Transitional Care Management from Oculus Health simplifies primary care delivery and puts quality, accessible health care in the hands of more patients in the U.S. and time and patience in the hands of more physicians. Learn more about what you can do to achieve excellence in healthcare at blog.oculushealth.com