Major Cost Drivers in T2D Management

John A. Johnson, MD, MBA: What we’ve seen in the managed care community is [that] the management of diabetes and the costs associated with it is [based on] managing the complications of their disease, whether it’s the hospitalizations, the ER (emergency room) utilization, or the readmissions associated with diabetes. It is one of the leading conditions for hospital admissions and readmissions, so, if we can partner with our members and with the providers to manage diabetics more appropriately in the outpatient setting, we can avoid readmissions and hospitalizations. I think it’s [about] creating that safety network where there’s sort of a continuum.

What happens in the managed [care] space, which is what we do well at WellCare, is the management of patients during the transition [from one care setting to another]. So, when they go from the inpatient to outpatient [setting], [we look at] what services you have connected them to ensure that you prevent a readmission. And then, likewise, when they’re with their primary care physician, [we consider] how you can partner with the provider to prevent the hospitalization in the first place. So, the costs are definitely associated with the hospitalizations, the readmissions, and the ER utilization.

What we’d like to see with better management, of course, is that the first course [should be] lifestyle medication—so, weight loss, physical activity, and diet control. When that fails, then medication is appropriate and should be partnered or coupled, with lifestyle modification to get an enhanced effect. So, again, you will see some modest increased cost associated with therapy, but that’s not such a bad thing when, downstream, you’re avoiding managing the complications.