An Insurer-Based Diabetes Educator-Community Partnership: Leveraging Education and Diabetes Support (LEADS).

Abstract

By the end of this decade, diabetes likely will affect 15% of Americans, or ∼39 million people (1). This is particularly alarming given the nature of the disease and its complications. In addition to the humanistic burden, the economic consequences are substantial. The cost of medical care for patients with diabetes averages 2.3 times higher than for similar patients without diabetes, which translates to additional medical expenses of $6,649 per person with diabetes (2,3). Payers are particularly interested in exploring ways to reduce these costs. The annual cost of care for a person with diabetes in the commercially insured population has been reported to be between $8,000 and $12,000, excluding the costs of prescription drugs. Cost data from 2009 in a sample of 10 million commercial insurance plan members showed an average cost of members with diabetes to be ∼$11,700 compared to an average $4,400 for the remainder of the population. The average yearly costs of $20,700 for people with complications of diabetes are almost three times higher than the average cost of $7,800 for those without complications (1). There is now a large evidence base about effective interventions that address the complexities of managing chronic disease. Health plans are expected to use these resources to provide services and preventive care and to explore new partnerships. Interventions shown to reduce the diabetes burden, including practice redesign, coaching, telephone-based support, hospital transitional care, and community programs are being instituted (4–8). The University of Pittsburgh Medical Center (UPMC) Health Plan is the insurance division for UPMC, an integrated health system, including hospital, community, and physician divisions. UPMC Health Plan …