As employers struggle with the cost of health care for their workers, they’re increasingly realizing the impact of chronic diseases such as diabetes, which when not properly controlled can lead to major health complications and hospitalizations.
Providence-based Abacus Employer Health Solutions, which creates workplace-based wellness and care management programs, last week released data showing that companies can save more than $5,000 per year on medical claims for each diabetic health plan member who participates in Abacus’ new incentive-based health-management program.
Edward Aberger, the company’s vice president and a clinical assistant professor of community health at The Warren Alpert Medical School of Brown University, spoke about the program with Providence Business News.
PBN: How long have you been doing the Good Health Gateway Diabetes Program, and with how many people?
ABERGER: Over the past 10 years, Abacus has been developing tools and programs to help consumers to be more proactive and effectively engaged in taking care of their health and using the health-care system. We currently work with more than 75 employers with more than 100,000 lives in their health plans. The centerpiece is The Abacus Good Health Gateway, with programs for specific conditions like diabetes, high blood pressure, high cholesterol, depression and asthma, as well as prenatal care and general health and wellness.
Our diabetes program was first launched in January. We have two clients with more than 4,000 employees between them. The program targets employees and dependents with Type 1 and Type 2 diabetes, typically about 4 to 8 percent of an employer’s population. At the moment we are contracting directly with medium and large employers, but we are getting interest from health plans and have a new, cost-effective version for small employers.
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PBN: What does the program entail?
ABERGER: A common thread is the use of incentives, integrated into the health plan benefit design, to drive behavior change. In the diabetes program, health-plan members are asked to follow up with evidence-based guidelines of care (regular screenings, visits to their doctor, etc). As a reward for completing these activities, their pharmacy copays are completely waived, so they can receive diabetic medications and diabetic supplies at no cost.
The costs of the copay waivers to the employer are more than offset by the members’ more proactive involvement in taking care of themselves and an associated reduction in diabetes-related hospitalizations. This type of strategy is building momentum in the market and is often referred to as a value-based benefit plans design. Abacus programs add the next step in those plan designs by adding in incentives and targeted behavior change to the plan member.
This strategy is very relevant to what is going on with health insurance today. More and more companies are asking their health plan members to pay more of the cost, which can often inadvertently erode health outcomes as members don’t follow through with needed care in an effort to save money. Our approach counters this by reducing members’ costs, but only if they follow through with care guidelines.
PBN: Does your program involve primary-care doctors. How does it interact with the primary-care system in general?
ABERGER: The PCP is critical to effective diabetes management, and our programs drive members to their PCP. At no point do they second guess the doctor’s recommendations, but rather the goal is to support the doctor’s care. We had concerns that physicians, already burdened with paperwork and time demands, might react negatively to our program. However, we are very pleased that this has not been the case, and indeed the response from PCPs has been overwhelmingly positive. PCPs appear to be supporting the program out of recognition that it provides additional incentives to their patients to follow through with care and enhances patient access to prescribed diabetes medications, testing strips and supplies.
PBN: You cite very substantial financial benefits from implementing this program. How much does it cost per person, and where do the savings come from?
ABERGER: Abacus fees are typically based on a “per-member, per-month” cost and depend on the size of the client. Accounting for Abacus fees and the cost of the incentive (picking up the full costs for the diabetic medications and supplies) we are finding clients’ year-one return on investment to be between three and six times the program costs.
A key to the success of our programs is high levels of participation. We are finding that approximately half of members with diabetes sign up, whereas traditional disease-management programs often struggle to achieve a 10- to 15-percent participation rate. And participants’ hospitalizations as well as costs have dramatically decreased. Preliminary data has found that per-member, per-month claim costs for participating members are more than $500 lower than non-participating members’.
PBN: How well do most diabetics manage their condition, in your experience? Where do they fall short, and why is the Abacus program particularly effective at helping?
ABERGER: The tragedy of diabetes is that we know what it takes to effectively manage this condition, and yet unfortunately, most diabetics complete only some, but not all, recommended screenings and tests each year. Research has documented that only about 10 percent of people with diabetes follow through with all the evidence-based guidelines of care. The Abacus program provides reminders and incentives to support the members. Initial survey results from program members have been very positive about the financial incentives, but also about the messaging that helps them complete the activities.
Abacus Employer Health Solutions and its principals are nationally recognized behavioral scientists and health experts. The firm has developed numerous evidence-based e-health tools and provide employers with an array of programs and services. For more information, go to www.abacushealth.com.
