Diabetes is a costly disease — totaling $412.9 billion in 2022 between direct medical costs and indirect costs — which is why insurance companies and medical providers are taking steps to prevent patients from developing and if diagnosed, keeping it under control.
Whether it is genetics or our love of brats and beer, 1 in 3 Wisconsin adults has prediabetes, a serious condition that can lead to Type 2 diabetes, according to the University of Wisconsin Population Health Institute. Several counties in Northeast Wisconsin have the highest percentage of adults with diabetes — Green Lake, Manitowoc, Marinette, Oconto, Shawano and Waupaca. Menominee County leads the state with the highest rate of those with diabetes.
“Diabetes is a preventable disease that requires a high volume of costly care,” says Lisa Grabert, a visiting professor of research at Marquette University. “Prevention programs make a lot of sense since they can prevent other, more costly conditions beyond diabetes, such as cardiac issues or complications like renal disease.”
The cost of diabetes
Helping employees prevent and manage diabetes is also good for business. Healthy employees are happier and more productive, and employers and employees alike will save on health care costs.
Network Health, which is headquartered in Menasha and Brookfield, offers a free diabetes prevention program to residents covered by Medicare and Medicare Advantage insurance policies. The thinking is that by helping people at risk of developing diabetes with lifestyle changes they can improve their overall health and not develop the disease, says Dr. Mushir Hassan, chief medical officer for Network Health.
“We want to work upstream from a potential diabetes diagnosis. That means we are educating people about the importance of their glucose levels and helping them develop healthier habits, such as eating better and moving more,” he says. “We want to uplift the health of people in our state, which includes lower rates of people diagnosed with diabetes.”
Robin with HealthPartners, an insurance plan partnership between HPS, ThedaCare and Bellin Health in Northeast Wisconsin, has multiple programs in place to help its members improve their health and if diagnosed with diabetes, how to stay as healthy as possible, says Melinda Hurley, senior director of disease and case management for the insurer.
Taking claims data, electronic medical records and other information, HPS created an algorithm to help identify patients in need of extra attention to avoid complications.
“As an integrated health care system, we work closely with our providers to improve patient health and make sure everyone is on the same page,” she says.
Type 2 diabetes occurs when the body does not produce enough insulin or resists the effects of insulin. This can cause serious health problems, including heart attack, stroke, blindness, kidney failure and the loss of toes, feet or legs.
Breaking down the $412.9 billion cost, a report in the January 2024 issue of the journal Diabetes Care says 74% of the total is related to direct health care expenditures while 26% is linked to lost productivity from work-related absenteeism, reduced productivity at work and home, premature mortality and unemployment from chronic disability.
“There are a lot of proven interventions to keep diabetes from developing and if it does develop, [for] keeping it under control,” Grabert says. “It’s a wise investment from an insurance perspective to invest in a program like this.”
Prevention efforts
Most people may not realize they are at risk of developing diabetes, which is why people should have their glucose levels checked, says Dr. Steven Gale, a family medicine practitioner with Prevea. For men, he suggests those tests begin annually in their mid-30s while women can begin a decade later.
“You need to know that information, along with your blood pressure and cholesterol levels, to get a true picture of your health,” he says. “If your [glucose] levels are trending higher, you can begin to make lifestyle changes to get those numbers down.”
Gale says most people find out they are pre-diabetic or diabetic from their primary care providers, and that’s when discussions need to start about eating better and getting more exercise.
“Even swapping out white bread and rice for wholegrain bread and rice is a great start,” he says, adding that Prevea can connect patients with Prescription for Wellness, a one-on-one program that guides patients to create and reach health goals. “As for exercise, doing something you enjoy a couple of times a week is a great way to incorporate more activity in your life.”
Seeing the high number of Wisconsin residents with diabetes, Network Health created a diabetes prevention program to turn the tide and help people develop healthier habits to lower their glucose levels. The program is part of the National Diabetes Prevention Program, led by the Centers for Disease Control and Prevention (CDC). The Medicare-approved program has been offered to residents in Oshkosh and Appleton, with Network looking to offer the program in more locations throughout the rest of the year and into 2025.
Hassan says Network’s program is backed by years of research demonstrating that program participants aged 60 and older can cut their risk of Type 2 diabetes by 71% by losing weight, eating better and being more active. People who previously went through the program lost 5% to 7% of their weight and maintained it.
“We want to keep people happy, healthy and out of hospitals,” he says.
Participants in Network’s program receive a full year of support from a lifestyle coach and peers with similar goals, along with tips and resources for making lasting healthy changes. The program, which is free for anyone enrolled in a Medicare or Medicare Advantage plan, provides weekly one-hour core sessions for up to six months and then monthly sessions for the rest of the year.
“We talk about shopping on the outsides of the grocery stores where the fresh food is and not in the aisles where the food is more processed,” Hassan says. “We want people to think differently about what they eat and make better choices. They’ll end up healthier.”
We want people to think differently about what they eat and make better choices. They’ll end up healthier.
— Mushir Hassan, chief medical officer, Network Health
Positive outlook
Cindy Paffenroth of Oshkosh didn’t know she was pre-diabetic until a health care practitioner told her and mentioned Network’s program, which was going to run a session at the Oshkosh Senior Center. She joined the program, attended the sessions, made changes to her diet and began working out.
“I learned a lot about reading labels, the importance of strength training and different recipes. The group sessions are great because you’re talking with other people who are going through the same thing,” says Paffenroth, who lost 40 pounds. “You don’t feel so alone.
“The positive talk really inspired me. I’m thankful our insurance offered this to us so we can be healthier and avoid diabetes and other serious diseases,” she says.
HPS provides a variety of health information to its members to help them become “rested, resilient and active,” says Joel Spoonheim, director of worksite health and population well-being supervisor for HPS.
The information can be accessed from the website, via email or over the phone. The goal is to help prevent diabetes and other chronic diseases from developing. For example, all members have access to health coaches to help them quit smoking and lose weight, he says.
Once patients are diagnosed with diabetes, they receive a lot of information on how to stay healthy and avoid complications. For example, HPS’ Hurley says patients receive reminders about having their glucose levels and blood pressure regularly checked, regular eye exams and regular foot care.
If a patient develops a complication or it looks like their diabetes is not being controlled, they then work one-on-one with a nurse either through video or the phone to get their condition under control, Hurley says.
“It’s not only about treating their condition but also how to treat their condition while dealing with everything else going on in their lives,” she says.
