A growing problem: diabetes and obesity are taking a toll on the U.S. health-care system. Health insurers and disability carriers are reaching out to members, physicians and employers about ways to curb the rise of these diseases.Key Points * Diabetes and obesity are reaching epidemic proportions in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. . * Diabetes costs $92 billion annually in direct medical costs and $40 billion in indirect costs Indirect costs are costs that are not directly accountable to a particular function or product; these are fixed costs. Indirect costs include taxes, administration, personnel and security costs. See also
Adjective 1. having ten times as many or as much 2. composed of ten parts Adverb by ten times as many or as much Adj. 1. to $36.5 billion in 2002. * Health plans and disability insurers are reaching out to members, physicians and employers via education efforts, community programs, health screenings and discounted maintenance and prevention programs. When Amy Tenderich was diagnosed with Type 1 diabetes type 1 diabetes n. See diabetes mellitus. in May 2003, she went on a quest to learn more about her disease. But getting insurance coverage for education from a renowned local university's diabetes program and other services related to her care was anything but easy. Today, payers are becoming more aware of the importance of education and helping ensure members get the information they need, said Tenderich, a San Francisco San Francisco (săn frănsĭs`kō), city (1990 pop. 723,959), coextensive with San Francisco co., W Calif., on the tip of a peninsula between the Pacific Ocean and San Francisco Bay, which are connected by the strait known as the Golden resident and host of the www.diabetesmine.com Web log. The incidence of diabetes is on the rise. It, along with obesity, a disease that often goes hand-in-hand with diabetes, are reaching epidemic proportions in the United States. The two diseases are taking a costly toll on the U.S. health-care system. Rising claims from both diseases and from various conditions that result from them and their often costly complications are plaguing health plans and disability insurers at staggering rates. Insurers are fighting back to find ways to mitigate costs and educate members in hope of curbing the rising incidence of diabetes and obesity. Epidemic Proportions Diabetes is the sixth leading cause of death and the fifth leading cause of death from disease, according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. the Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. . Today, two out of every three Americans are overweight. The CDC See Control Data, century date change and Back Orifice. CDC - Control Data Corporation said obesity is fast approaching smoking as the leading cause of preventable deaths in the United States. "The diseases go hand-in-hand," said Dr. Richard Gayes, medical director, network management, for Blue Cross Blue Shield Blue Shield A US not-for-profit health care insurer that is a reimbursement intermediary for physicians. Cf Blue Cross. of Illinois. "Someone might have a genetic possibility to have diabetes, but it's becoming obese that turns that possibility into disease." Dollars and Cents In 1992, the American Diabetes Association The American Diabetes Association, or the ADA, is an American health organization providing diabetes research, information and advocacy. Founded in 1940, the American Diabetes Association conducts programs in all 50 states and the District of Columbia, reaching hundreds of reported that diabetes cost $92 billion annually in direct medical costs and $40 billion in indirect costs including loss of work, disability and loss of life. Things likely won't improve anytime soon. The annual cost of diabetes is expected to rise to $156 billion by 2010 and to $192 billion by 2020, including $138 billion in direct medical costs. Gayes said that the per-member costs from obesity-related conditions rose to $1,200 in 2002. Employers are greatly concerned. One of Illinois Blues' largest clients found that of the top 10 conditions facing its work force, six were a direct result of obesity and accounted for about 75% of all dollars spent on the 10 conditions. Health plans are also feeling the effects. A recent article on the Diabetes Mall Web site said that a client with diabetes costs his or her insurer 3.4 times as much as the average client. Spending on insulin and oral hypoglycemic agents hypoglycemic agents (hī´pōglīsē´-mik), n.pl a large heterogeneous group of drugs prescribed to decrease or control the amount of glucose circulating in the blood; used in the prevention and , along with strips and meters, is increasing. Medco Health Solutions Medco Health Solutions, Inc. (NYSE: MHS) is a leading pharmacy benefit manager (PBM) company based in Franklin Lakes, New Jersey. The current chairman is David Snow. The company formed in August 2003 as a spinoff from Merck & Co.. reported that the daily cost of insulin therapy more than doubled over five years, from $1.06 per day in 1999 to $2.20 per day in 2003. Added to the price tag are costly complications, which Dr. Alan Muney, chief medical officer for UnitedHealthcare Northeast, credits as driving the majority of costs. For example, he said, diabetics are five times more likely to develop heart disease. Compared with diabetes, it's more difficult to put a price tag on tag on Verb to add at the end of something: a throwaway remark, tagged on at the end of a casual conversation Verb 1. the overall cost impact of obesity on the industry, said Muney. "Someone who's obese may not yet be triggering any claims, but costs will be staggering." The problem continues to grow. Kaiser Permanente Kaiser Permanente is an integrated managed care organization, based in Oakland, California, founded in 1945 by industrialist Henry J. Kaiser and physician Sidney R. Garfield. studies show that a weight gain of 20 pounds results in more than $500 per person of increased costs over the next three years, said Dr. Keith Bachman, clinical lead of the Kaiser Permanente Care Management Institute Weight Management Initiative. "So anytime someone gains some weight, there's cost to the health-care system." Those costs, he said, are typically divided among pharmaceuticals, in-patient utilization and outpatient costs. And there are hidden costs with obesity, said Dr. Chris Valerian valerian, in botany valerian, common name for some members of the Valerianaceae, a family chiefly of herbs and shrubs of temperate and colder regions of the Northern Hemisphere; a few species, however, are native to the Andes. , executive medical director for Horizon Blue Cross Blue Shield of New Jersey. "Even those that have [gastric bypass gastric bypass n. A surgical procedure used for treatment of morbid obesity, consisting of the severance of the upper stomach, anastomosis of the small upper pouch of the stomach to the jejunum, and closure of the distal part of the stomach. ] surgery, what costs are avoided 10 years down the road? The jury's still out because there's no proof that they won't later develop diabetes." Alerting Others Carriers are reaching out to physicians. Efforts range from ensuring physicians understand medical guidelines for treating diabetics, to setting up premium designation programs to measure physicians' quality and efficiency of care, to encouraging clinicians to measure patients' body mass index--a measure of height and weight to gauge total body fat. Employers are also being targeted. "We're talking with them not just from a cost perspective but more from a productivity perspective," said Carol Harnett, a physiologist and the national disability and life practice leader with Hartford Financial Services The examples and perspective in this article or section may not represent a worldwide view of the subject. Please [ improve this article] or discuss the issue on the talk page. . "The problem with chronic conditions comes down to lifestyle. While it's not employers' job to worry about their workers' lifestyles, productivity and expenses are related to that. The easiest thing is to create an environment for employees to do things better like exercising more and eating less." Because individuals have, at minimum, a 33% chance of being out of work three months or more due to disability, it's important for them to prepare for such an event, said Harnett. "These are problems that will have a significant impact on the work force. If we continue to grow at the rate we are now with obesity, for instance, it's projected that we could reach almost 100% obesity by 2030." Disease management also is gaining priority for employers. "With the programs, 20% of people who are 80% of an employer's spend are also 10% of employees who are 50% of the disability experience. The changes they have to make are so large that as a population they often can't make them, but as individuals they can make changes long-term," said Harnett. Dr. Kenneth Mitchell For the English cricketer, see . Kenneth Alexander Mitchell (born 25 November 1974, Toronto, Ontario, Canada) is a Canadian actor. Mitchell attended the University of Guelph where he studied landscape architecture and played for the school soccer team as a striker. , vice president, health and productivity development, for UnumProvident, said it's important that employers first understand that health-care costs and lost time are connected. "We make this connection by looking at employers' health-care cost and lost-time data and inviting them to look at the make-up of their work force." The employer needs to take note of claimants' BMI BMI body mass index. BMI abbr. body mass index Body mass index (BMI) A measurement that has replaced weight as the preferred determinant of obesity. , he said. "If someone has a BMI over 30, research strongly suggests they are at greater risk for increased health problems and injury. We invite the employer to offer health and productivity screening to identify health risk factors of their workers and offer solutions to reduce the risk." "One of the most difficult elements for diabetes and obesity is co-morbid or associated health conditions that quietly reduce productivity," said Mitchell. "That's why we look at presenteeism Presenteeism is the opposite of absenteeism. In contrast to absenteeism, when employees are absent from work illegitimately, presenteeism discusses the problems faced when employees come to work in spite of illness, which can have similar negative repercussions on business and lost work days as measurable events." Employers' insurance coverage of obesity is starting to change. While some are carving it out with riders or limits or paying up to a certain dollar amount or placing caps on such services as bariatric surgery Bariatric Surgery Definition Bariatric surgery promotes weight loss by changing the digestive system's anatomy, limiting the amount of food that can be eaten and digested. , others are totally carving out coverage or allowing members to buy up to a certain amount, Valerian said. Looking Ahead Diabetes and obesity will become even more of an issue going forward. Valerian said. For example, the rise in bariatric surgery is keeping health plans on their toes. Between 1993 and 2003, the number of gastric bypass surgeries Gastric bypass procedures (GBP) are any of a group of similar operations used to treat morbid obesity—the severe accumulation of excess weight as fatty tissue—and the health problems (comorbidities) it causes. climbed more than 600%. The government even recently stepped in. In 2005. Medicare removed language from its policy that designated obesity as a non-illness, possibly paving the way for future insurance coverage for such treatments. The CDC estimates that diabetes will affect one in three people born in 2000 in the United States: the prevalence of diagnosed diabetes will increase 165% by 2050. Insurers said they're up to the challenge. For instance, at Blue Cross and Blue Shield of Illinois, Senior Medical Director Dr. Kim David Reed David Reed or Dave Reed may refer to:
Diabetes at-a-Glance * In 2005, approximately 20.8 million Americans--or 7% of the U.S. population--had diabetes, up from 18.2 million in 2003. * Since 1987, the death rate due to diabetes has increased by 45%, while the death rates due to heart disease, stroke and cancer have declined. * More U.S. women than men have diabetes; minorities are at a greater risk for diabetes than non-Hispanic whites. * About 206,000 people with diabetes are under age 20. * Heart disease and stroke account for about 65% of deaths in people with diabetes. * The World Health Organization reports the number of individuals with diabetes globally will reach about 366 billion in 2030, an increase from 171 billion individuals in 2000. * Diabetes patients made 27.1 million visits to physicians in 2004. Sources: American Diabetes Association, National Diabetes Information Clearinghouse The National Diabetes Information Clearinghouse(NDIC) is an information dissemination service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health, which is part of the U.S. , The Ohio State University Ohio State University, main campus at Columbus; land-grant and state supported; coeducational; chartered 1870, opened 1873 as Ohio Agricultural and Mechanical College, renamed 1878. There are also campuses at Lima, Mansfield, Marion, and Newark. Medical Center, World Health Organization, National Center for Health Statistics National Center for Health Statistics (NCHS) is part of the Centers for Disease Control and Prevention (CDC), which is part of the United States Department of Health and Human Services. NCHS is the United States' principal health statistics agency. A Closer Look at Diabetes and Obesity What Is Diabetes? Type 1 diabetes occurs when the body's immune system immune system Cells, cell products, organs, and structures of the body involved in the detection and destruction of foreign invaders, such as bacteria, viruses, and cancer cells. Immunity is based on the system's ability to launch a defense against such invaders. kills pancreatic beta cells beta cells, n See cells, beta. , which make the hormone insulin that controls blood glucose blood glucose Diabetology The principal sugar produced by the body from food–especially carbohydrates, but also from proteins and fats; glucose is the body's major source of energy, is transported to cells via the circulation and used by cells in the presence . Type 1 patients must take insulin. Type 2 diabetes type 2 diabetes n. See diabetes mellitus. , also called adult-onset diabetes, accounts for 90% to 95% of all diagnosed cases of the disease. Type 2 is related to many factors, including age, family history of the disease, obesity and race/ethnicity. Type 2 diabetes is controlled by oral medications and insulin. Gestational diabetes Gestational Diabetes Definition Gestational diabetes is a condition that occurs during pregnancy. Like other forms of diabetes, gestational diabetes involves a defect in the way the body processes and uses sugars (glucose) in the diet. is a type of glucose intolerance occurring in some pregnant women. Other types of diabetes may occur because of surgery, drugs, malnutrition, infections and other illnesses. Sources: U.S. Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS , Centers for Disease Control and Prevention
Prevalence of Overweight And Obesity Among U.S. Adults
Ages 20-74 years.
%
Obese (BMI [greater Overweight (BMI
than or equal to] 30) 25.0-29.9)
(1976-1980) 47 15 32
(1988-1994) 56 23 33
(1999-2000) 64 31 33
Sources: Centers for Disease Control and Prevention, National
Center for Health Statistics, National Health and Nutrition
Examination Survey; insurance Information Institute
Note: Table made from bar graph.
Obesity Facts and Figures * Obesity is expected to cost employers $13 billion annually and result in 39 million lost work days, 239 million restricted-activity days and 63 million physician visits, according to the National Business Group on Health Institute. * Obesity is a chronic disease with a strong familial component. * Obesity is the second-leading cause of preventable death in the United States. * Approximately 62% of female Americans and 67% of males are considered overweight. Sources: American Obesity Association This article or section needs sources or references that appear in reliable, third-party publications. Alone, primary sources and sources affiliated with the subject of this article are not sufficient for an accurate encyclopedia article. , ObesityinAmerica.org, The Centers for Disease Control and Prevention Diabetes Medications Treatment with insulin or oral medications among adults with diagnosed diabetes--United States, 2001-2003 (%) Neither 15 Oral Medication Only 57 Insulin and Oral Medication 12 Insulin Only 16 Source: 2001-2003 National Health Interview Survey Note: Table made from pie chart. Obesity Claimant Cost Average Annual Claimant Cost. Obesity 8,720 Disability Obesity 30,567 Medical Co-Morbid 11,736 Medical Source: UnumProvident Corp. Note: Table made from bar graph. RELATED ARTICLE: Better health--one by one. Insurers are mounting a significant effort to mitigate and prevent obesity and diabetes. A growing number are targeting members with everything from information posted on company Web sites to discounted fitness-club memberships and weight-loss programs. "There are multiple ways we can look at it and try to have a positive impact," said Dr. Kim David Reed, senior medical director of Blue Cross and Blue Shield of Illinois. Each month, UnitedHealth uses datamining capabilities and predictive modeling software to examine patterns of claims and diagnoses to find gaps in care for its diabetic members. For obesity, its efforts focus more on wellness and correction of the disease over time, said Dr. Alan Muney, chief medical officer for United-Healthcare Northeast. "We try to create awareness of a problem, compare members' weight with optimal weight, and promote exercise and good nutrition." Recently, Kaiser Permanente earmarked $16 million to its community outreach program--Healthy Eating, Active Living--to promote the value of lifestyle activity and healthier eating. Kaiser also stresses the value of healthy food choices through the very visible farmers' markets  It has been suggested that this article be split into multiple articles. it now sponsors at more than 30 facilities across its regions. The
markets offer staff, physicians, patients and community members access
to locally grown foods, said Dr. Keith Bachman, clinical lead of the
Kaiser Permanente Care Management Institute Weight Management
Initiative.The company's efforts are paying off. Bachman said members enrolled in the company's weight management program who lost a modest amount of weight experienced significantly decreased health-care costs over the next four years. He said that's equal to $500 less than people who didn't lose weight. "And even those who regained weight over the next year still had lower health-care costs." Disease management programs are playing a growing part in the education about and the handling of chronic conditions. "Through BlueHealthConnection, our health management program, members have access around the clock to topics such as diabetes and obesity and to a nurse health coach. And for the part of the population with a disease who aren't doing necessary things, we have an outreach program where we send them postcard reminders and even sometimes phone them," said Dr. S Dr. Doctor. dr. dram. . George Kipa, deputy corporate medical director of Blue Cross Blue Shield of Michigan. The company also offers members health risk appraisals to measure risks, offer necessary care and services, and help them meet health goals. "Diabetes is always a significant portion of what we're seeing in terms of both overall expense and the trend on that expense," said Muney. "It's important to have different strategies because even if someone has diabetes under control and is relatively low risk, a certain percentage will eventually become moderate risk every year, and those at moderate risk will become high risk. The challenge is trying to find those whom you can have a positive impact on and prevent that migration into a higher risk category." Are the efforts paying off? "There's definitely a growing awareness," said Bachman. "But there's still a sense among patients and physicians that nothing can be done, which is one of the biggest barriers health plans struggle with. But we know there's much that can be done." Even small amounts of weight loss are achievable in many people who are committed to it and are given the right support, he said. He said there's no "one-size-fits-all" solution for everyone. "But there's a portfolio of potential opinions and people need to find the best fit for them--whether it's work-site-based weight-loss programs, formal health education weight-management programs, bariatric surgery or a behavior change Behavior change refers to any transformation or modification of human behavior. Such changes can occur intentionally, through behavior modification, without intention, or change rapidly in situations of mental illness. they choose on their own or with the support of their personal physician." Muney said insurers can't look at diabetes with a single lens. "We have to look at what we're doing not just for mild and moderate diabetics but also around heart disease, kidney disease Kidney Disease Definition Kidney disease is a general term for any damage that reduces the functioning of the kidney. Kidney disease is also called renal disease. and other conditions to make sure if someone gets complications that we can help them get the best outcomes from a bad situation." RELATED ARTICLE: Disability takes a hit. Disability insurers, like health insurers, are feeling the effects of the increased incidence of diabetes and obesity. More than $7 billion worth of productivity is lost annually due to diabetes, according to a study by the University of Michigan (body, education) University of Michigan - A large cosmopolitan university in the Midwest USA. Over 50000 students are enrolled at the University of Michigan's three campuses. The students come from 50 states and over 100 foreign countries. and the U.S. Department of Veterans Affairs Veterans Affairs is a term of the business that deals with the relation between a government and its veteran communities, usually administered by the designated government agency. . The majority of costs are a result of diabetes complications, including cardiovascular disease Cardiovascular disease Disease that affects the heart and blood vessels. Mentioned in: Lipoproteins Test cardiovascular disease , kidney disease and foot problems. UnumProvident is seeing a rise in its disability claims. In its 2004 Type 2 Diabetes." Managing a Costly Disability study, it found a 100% increase since 2001 in the number of workers filing disability claims for Type 2 diabetes. Disability expenses, direct medical costs and related health costs, in which diabetes is a contributing factor, combined for an annual average cost of $33,495 per claimant. UnumProvident saw a tenfold increase over the past decade in short-term disability claims in which obesity was identified as the primary diagnosis. The average annual obesity-related disability cost for employers was $8,720 per claimant, while the average annual direct medical costs were approximately 3.5 times the annual disability cost, according to the study. Often, diabetes and obesity aren't listed as the primary cause for a disability claim, said Carol Harnett, a physiologist and the national disability and life practice leader with Hartford Financial Services. "Instead, they're secondary conditions, such as a diabetic going out with coronary artery disease coronary artery disease, condition that results when the coronary arteries are narrowed or occluded, most commonly by atherosclerotic deposits of fibrous and fatty tissue. or a back surgery. Both diseases complicate a condition, surgery or recovery and lengthen the disability." "Five years ago, obesity or diabetes wasn't a primary reason a person was out of work on disability," Harnett said. "Now, The Hartford is seeing obesity and diabetes as primary disabling conditions, as well as a secondary condition. The conditions are now associated with about two-thirds of our overall claims in such conditions as musculoskeletal musculoskeletal /mus·cu·lo·skel·e·tal/ (-skel´e-t'l) pertaining to or comprising the skeleton and muscles. mus·cu·lo·skel·e·tal adj. Relating to or involving the muscles and the skeleton. , cancers and heart disease." Learn More Blue Cross Blue Shield Of Illinois A.M. Best Company # 69584 (Health Care Service Corp.) Distribution: Independent agents, sales force, brokers, consultants Blue Cross Blue Shield Of Michigan A.M. Best Company # 60081 Distribution: Internal sales force, agents/brokers Hartford Life Group Insurance Co. A.M. Best Company # 07681 Distribution: Brokers, consultants, third-party administrators and trade associations Horizon Healthcare Services Inc. A.M. Best Company # 64022 Distribution: Brokers, benefit consultants, direct Kaiser Foundation The mission of the Kaiser Foundation is to assist individuals and communities in preventing and reducing the harm associated with problem substance use and addictive behaviours. External links
A.M. Best Company # 64585 Distribution: National consulting houses, regional brokers and brokerage firms, membership exchanges, direct United HealthCare Insurance Co. A.M. Best Company # 08290 Distribution: Independent agents, brokers, consultants, exclusive sales force, direct UnumProvident A.M. Best Company # 69743 Distribution: Brokers, benefits consultants and direct sales force For ratings and other financial strength information about these companies, visit www.ambest.com. |
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