Major Finding: In 2007, the adjusted cost per member per month of plan members with diabetes with commercial insurance was $923 among those who received diabetes education, compared with $1,072 among those who did not. For Medicare enrollees, those figures were $1,241 and $1,322, respectively.
Data Source: Ongoing claims database analysis of approximately 20 million lives, including both Medicare and commercially insured members. In 2007, the database contained 166,931 individuals with diabetes who had commercial insurance and 56,345 on Medicare.
Disclosures: The study was funded by the AADE. Mr. Duncan had no further disclosures.
SAN ANTONIO — Data continue to show that diabetes education saves money.
Last year, the findings of an analysis of 3 years' worth of data from a large national claims database showed that patients with diabetes who receive diabetes education incur lower costs than do those who have not received the education (Diabetes Educ. 2009;35:752–60).
Now, preliminary findings from a new analysis of the same database show that the cost reduction comes mainly from a drop in hospital admissions, and that ongoing diabetes education beyond the initial sessions received at diagnosis are necessary to produce the cost savings.
The findings were presented by actuarial consultant Ian Duncan, president of Solucia Consulting. His firm conducted the analysis for the American Association of Diabetes Educators (AADE) using data from Solucia's claims database of about 20 million individuals, including both Medicare and commercially insured members. In 2007, the database contained 166,931 individuals with diabetes who had commercial insurance and 56,345 who were on Medicare.
“We all know how much you do for patients, how much you improve their lifestyle and help them cope with their condition. But the kinds of people we work with — the insurance payers (Medicaid agencies, Medicare, and health plans) — are interested in whether the investment for the services you provide brings a return to them in terms of the costs and the claims that the patients incur,” said Mr. Duncan, also of the department of health administration at Georgetown University in Washington.
In 2007, the adjusted cost per member per month of plan members with diabetes who were commercially insured was $923 among those who received diabetes education, compared with $1,072 among those who did not. For Medicare enrollees, those figures were $1,241 and $1,322, respectively. Those differences were significant for both groups.
The follow-up, risk-adjusted analysis of patients who were continuously enrolled in 2005–2008 showed a significant difference in costs for the commercially insured patients ($985 for the 3,094 who received diabetes education vs. $1,043 for the 31,075 who did not), but there were no differences in the Medicare group, which included just 898 patients who received diabetes education and 23,342 who did not (nearly $1,400 for both).
However, when the frequency of diabetes education was factored in, it became clear that enrollees who received two or more education sessions incurred lower costs than did those who received one or no sessions.
In the commercially insured group in 2008, costs per patient per month were $845 for those receiving at least two education sessions, $863 for those who had just one session, and $907 for those with no diabetes education. In the Medicare group, the costs for those with zero and one session were nearly identical ($1,343 and $1,337, respectively), whereas the patients who did receive diabetes education that was covered by Medicare cost $1,267.50 per month. Neither quite reached statistical significance.
These differences were seen even though more diabetes education was associated with higher medication compliance and thus greater pharmacy costs. In 2008, costs for glucose-lowering drugs were nearly identical for those with commercial insurance who received no education sessions or just one ($76 and $78, respectively) but were significantly higher for those who had at least two sessions ($99). Similarly, those figures in the Medicare group were $69 and $70, compared with $81, respectively.
Reductions in hospital admissions in the group receiving diabetes education more than made up for the higher pharmacy cost. In 2008, there were just 180 per 1,000 admissions for diabetes patients with commercial insurance who received two or more diabetes education sessions, compared with 212 per 1,000 for those with one session and 221 per 1,000 for no sessions.
The difference was not as striking in Medicare, where those figures were 709, 665, and 735 per 1,000, respectively.
Other than the AADE funding for this study, Mr. Duncan stated that he had no further disclosures.