HCM632 Unit 5 Individual Project CH

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UNIT 5 INDIVIDUAL PROJECT 1 Unit 5 Individual Project: The Impact of Diabetes on the American Healthcare System Colorado Technical University HCM632

UNIT 5 INDIVIDUAL PROJECT 2 Unit 5 Individual Project The term “chronic disease” can have varying implications depending on what medical field the definition is derived from, or which set of data is used to identify the diseases states that qualify as chronic. Various health organizations categorize several, often overlapping, diseases as chronic in nature, most commonly cardiovascular diseases, pulmonary diseases, obesity, and most types of cancer. The Centers for Medicare and Medicaid Services (CMS) maintains a more extensive chronic condition list, expanded to include Alzheimer’s, dementia, hepatitis, human immunodeficiency virus (HIV), and mental illnesses such as depression (Bernell & Howard, 2016). At its core, a chronic disease is defined by the duration and persistence of symptoms, the necessity for ongoing medical treatment, and the negative impact to the afflicted individual’s quality of life. The generally accepted duration of a disease or condition for it to be considered chronic is a year or more. Chronic diseases and the associated symptoms can be lived with and mitigated with treatment for long periods of time, so while death may be the ultimate outcome due to chronic condition-related complications, they are distinct from terminal diseases. Beyond individual impact, chronic disease cause overburdening of the healthcare system and an extreme strain on the national economy. According to National Health Council reports, the annual economic cost of the top seven most prevalent chronic conditions is $1.3 trillion (Bernell & Howard, 2016). Not all chronic conditions can be prevented, such as congenital heart disease or asthma, but complications related to obesity like hypertension and type 2 diabetes can be prevented with the proper education and a healthy lifestyle and even reversed in some cases. Whether or not a chronic condition is curable or preventable, self-management education, access to routine medical care, and proper treatment protocols can improve the quality of life for

UNIT 5 INDIVIDUAL PROJECT 3 afflicted individuals and lower healthcare costs in the long term by preventing costly emergency care and hospitalizations. Diabetes mellitus, commonly and throughout this paper referred to as simply diabetes, is a metabolic disease caused by irregular function of the pancreas. Type 1 diabetes is an incurable, genetic form of the disease caused by the pancreas producing little to no insulin. Type 2 diabetes, the most common form of diabetes affecting 91% of individuals with the disease, is caused by persistently high blood sugar levels and the body’s inability to use and regulate insulin to correct blood sugar levels (APHA, 2021). Both types of diabetes require regular medical services and generally some form of synthetic insulin or diabetic medication to keep the disease under control. Type 2 diabetes will be the focus of this research paper, as it is not caused by genetic factors, has a long onset of symptoms, and if caught early and treated properly, can be prevented entirely. As of 2019, an estimated 84 million Americans had elevated blood sugar levels high enough to be considered prediabetes; the state where blood sugar levels are just below the levels for full diabetes, and which is the most critical time to intervene and prevent full onset (Rosputni et al., 2019). While minor symptoms of diabetes like increased thirst, frequent urination, and tingling in the hands or feet may be less noticeable near the onset of the disease, uncontrolled diabetes can lead to major complications such as cardiovascular disease, stroke, lower-extremity amputations, hyperglycemic crisis, diabetic keto acidosis, and chronic kidney disease. The healthcare cost of diabetes patient treatment can increase exponentially when these comorbidities are taken into account. Risk factors for developing the aforementioned complications in addition to a diabetes diagnosis include smoking, obesity, poor nutrition, physical inactivity, high blood pressure, and high cholesterol (CDC, 2023). Public health education, preventative healthcare

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UNIT 5 INDIVIDUAL PROJECT 4 services, and regular diagnostic screenings are crucial to controlling diagnosed diabetes and preventing new cases and related comorbidities from developing. Diabetes and diabetes-related conditions have a tremendous impact on the United States population and the United States healthcare system as a whole. As of November 2023, the CDC reports that 38.4 million people, 11.6% of the American population, have diabetes. In addition to that, 97.6 million people aged 18 or older have prediabetes, which with time and lack of medical intervention will most likely advance to full diabetes. Also of note, the CDC estimates that there are 8.7 million of the 38.4 million people with diabetes that are undiagnosed and unaware of the condition or unable to receive essential medical care to diagnose and treat the condition. In 2021, diabetes was the eighth leading cause of death in the United States (CMS, 2023). These statistics are unacceptable given the level of research, understanding, and prevention or treatment options of this disease that has been cultivated over the past several decades. The American healthcare system has become outpaced by the increase in new cases of diabetes and related conditions, healthcare facilities overburdened, and healthcare costs for diabetes treatment rising rapidly despite policy attempts to control the disease. Emergent care and hospitalizations, the most costly types of healthcare utilization, reported a combined visit total of nearly 25 million in 2020, due to high risk diabetes complications such as diabetic ketoacidosis, ischemic heart disease, and stroke (CMS, 2023). Even the cumulative cost of routine medical care for diabetes patients is higher than may be anticipated, due to the fact that diabetes is a multifactorial disease that often plays a part in causing periodontal, eye, and lower-extremity complications. Care coordination for at-risk diabetes patients is complex and costly, requiring the integration of annual comprehensive primary care, dental, vision, and podiatry examinations along with regular

UNIT 5 INDIVIDUAL PROJECT 5 pharmacy visits (APHA, 2021). Progress in large-scale prevention and treatment of diabetes across the nation has been all but stalled over the past decade, while diabetes-related healthcare costs, for both individuals and the national economy, continue to rise. The total estimated cost of diagnosed diabetes, based on direct costs and indirect costs such as work productivity loss and premature mortality, has increased from $227 billion in 2012 to $307 billion in 2022 (CMS, 2023). Various healthcare laws and policies have, in part or in whole, addressed the public health issue that is diabetes prevalence in the Unites States. The sweeping healthcare reform initiated by the Patient Protection and Affordable Care Act (ACA) of 2010 contained numerous provisions that could prove beneficial for individuals struggling with the symptoms and treatment cost of diabetes. At its base, the ACA extended public and private health insurance coverage to millions of previously uninsured individuals, improving access to cost-effective and routine medical care. The ACA achieved this goal by offering federal funding to expand state Medicaid programs and lowering the Medicaid income eligibility thresholds, and by creating an Insurance Marketplace for those who still do not qualify for Medicaid and cannot afford private insurance. Another pivotal provision of the ACA is the elimination of preexisting condition denials. Private insurance companies could deny coverage to individuals based on the presence of diagnosed preexisting conditions, such as type 1 and type 2 diabetes, making securing insurance coverage difficult for already disadvantaged people. The mandatory inclusion of free preventative services in all public and private insurance plans in one of the most impactful healthcare reform provisions within the ACA. This provision ensures access to free diabetes screenings, nutrition counseling, and chronic disease management education among other

UNIT 5 INDIVIDUAL PROJECT 6 services that promote early detection and intervention to mitigate complications of diabetes (Burge & Schade, 2014). The Inflation Reduction Act of 2022 was enacted in response to the high out of pocket diabetes treatment supply costs, particularly for insulin, in the Medicare population. This law caps insulin copay costs at $35 per month’s supply for Part D and Part B Medicare beneficiaries (Sayed et al., 2023), leading to massive patient savings and a reduction in insulin-rationing related deaths. The successful implementation of the Inflation Reduction Act will hopefully lead to a similar law for commercial insurance enrollees. Public health initiative at the state and federal level are crucial to promote the education, management, and prevention of diabetes. At the federal level, the National Diabetes Prevention Program was created in 2010 to help address the increasing prevalence of diabetes in the United States population and the burden it places on the United States healthcare system. The development and promotion of the lifestyle change program, comprised of research-based recommendations regarding healthy eating and physical activity, has been proven to reduce the risk of people with prediabetes developing type 2 diabetes (NDPP, 2023). An example of state level public health policies addressing diabetes is the Michigan Health and Human Services Diabetes Prevention and Control Program. This internet-based resource provides diabetes education, provider services maps, diabetes self-management education (DSME) program supplier lists, and reports and statistics regarding diabetes-related condition indicators and complications (MHHS, n.d.). Looking toward the future, a possible strategy for increasing prevention of diabetes would be the development of a team-based, managed care approach to diabetes treatment that provides patient-centered care integration including collaborative communication and comprehensive examinations from primary care and specialists to manage or

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UNIT 5 INDIVIDUAL PROJECT 7 prevent symptoms from diabetes and coexisting conditions (APHA, 2021). The implementation of this care coordination model nationwide could drastically increase patient education and awareness of not only diabetes but the multitude of related conditions it could cause. Another strategy for increased awareness, education, and prevention of diabetes would be centered on healthcare system payers and providers shifting financial incentives from volume-based to value- based. An example of the necessity for more value-based provider incentives is detailed by Chehal et al. (2022) in their study of the fragmentation of the American healthcare system; under fee-for-service and pay-for-performance incentive programs, primary care providers can be penalized for diabetes patients that have complex medical and social needs, while surgeons that perform amputations resulting from uncontrolled diabetes are rewarded. With a standard of more value-based healthcare system, primary care providers will have the time and incentive to properly screen and educate patients on their conditions before the worst case scenarios occur.

UNIT 5 INDIVIDUAL PROJECT 8 References American Public Health Association (2021, October 26). A Call to Improve Patient and Public Health Outcomes of Diabetes through an Enhanced Integrated Care Approach . Apha.org. https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy- Statements/Policy-Database/2022/01/07/Call-to-Improve-Patient-and-Public-Health- Outcomes-of-Diabetes Bernell, S., & Howard, S. W. (2016). Use Your Words Carefully: What Is a Chronic Disease?. Frontiers in Public Health , 4 , 159. https://doi.org/10.3389/fpubh.2016.00159 Burge, M. R., & Schade, D. S. (2014). Diabetes and the Affordable Care Act. Diabetes Technology & Therapeutics , 16 (7), 399–413. https://doi.org/10.1089/dia.2014.0171 Centers for Disease Control and Prevention (2023, November 29). National Diabetes Statistics Report Estimates of Diabetes and Its Burden in the United States . Cdc.gov. https://www.cdc.gov/diabetes/data/statistics-report/index.html Chehal, P. K., Selvin, E., DeVoe, J. E., Mangione, C. M., & Ali, M. K. (2022). Diabetes And The Fragmented State Of US Health Care And Policy. Health Affairs, 41 (7), 939-946. https://doi.org/10.1377/hlthaff.2022.00299 Michigan Health and Human Services (n.d.). Diabetes Prevention and Control Program . Michigan.gov. Retrieved December 17, 2023, from https://www.michigan.gov/mdhhs/keep-mi-healthy/chronicdiseases/diabetes National Diabetes Prevention Program (2023, August 1). About the National DPP . Cdc.gov. https://www.cdc.gov/diabetes/prevention/about.htm

UNIT 5 INDIVIDUAL PROJECT 9 Rosputni, C., Short, E., Rahim-Sepulveda, M., Howe, C. L., da Silva, V., Alvarez, K., & Hingle, M. D. (2019). Diabetes Prevention Programs in Rural North America: a Systematic Scoping Review. Current Diabetes Reports, 19 (7), 1-9. https://doi.org/10.1007/s11892- 019-1160-3 Sayed, B. A., et al. (2023, January 24). Insulin Affordability and the Inflation Reduction Act: Medicare Beneficiary Savings by State and Demographics. Assistant Secretary for Planning and Evaluation Office of Health Policy , (Issue Brief No. HP-2023-02). https://aspe.hhs.gov/sites/default/files/documents/bd5568fa0e8a59c2225b2e0b93d5ae5b/ aspe-insulin-affordibility-datapoint.pdf

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