Innovation & Inclusion: Essential Tools to Improve ...

Innovation amp Inclusion Essential Tools to Improve Diabetes Care and Cost ManagementHRcomAugust 17 2021

INTRODUCTIONS

GEORGE HUNTLEYCEO Diabetes Leadership Council

AARON TURNER-PHIFERDirector Health Policy JDRF

2

OBJECTIVES

UNDERSTAND how diabetes impacts health plan risk and costs and disproportionate impact in communities of color

HEAR about innovative and individualized approaches to diabetes management and prevention

LEARN from employee benefit experts who aligned incentives for their employees insurance companies and pharmacy benefit managers

TAKE AWAY key health plan design features and concrete steps your organization can take

3

AGENDA

THE STATE OF DIABETES CARE amp COVERAGE

MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS

HR PERSPECTIVES PLAN DESIGNS TO MANAGE DIABETES-RELATED RISK amp COSTS

QampA

4

THE STATE OF DIABETES CARE amp COVERAGE

1 IN 8 ADULTS

34 million Americans

HAVE DIABETES1

SPENDING

HEALTH DOLLARS2

TOP 4

LARGE EMPLOYERS3

Health plan cost driver

IN 2020

1IN 4

IN 2017

1 Centers for Disease Control and Prevention httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf2 American Diabetes Association httpsdoiorg102337dci18-00073 Society for Human Resource Management Managing Health Care Costs toolkit 2020

5

DIABETES IS CHRONIC amp PROGRESSIVE

Kidney Failure

There is no cure but individualized diabetes management plans can helpPREVENT OR DELAYserious complications

Approximately 1 in 3 aged 40 years or older1

Diabetic Retinopathy

2 to 4 times more likely to die2

Heart Disease

44 of new cases1

60 of non-traumatic amputations1

Lower-limb amputation

1 Centers for Disease Control and Prevention httpswwwcdcgovdiabetespdfsdata2014-report-estimates-of-diabetes-and-its-burden-in-the-united-statespdf2 American Heart Association httpwwwheartorgHEARTORGConditionsMoreDiabetesWhyDiabetesMattersCardiovascular-Disease-

Diabetes_UCM_313865_ArticlejspW1un89JKhPa

6

DIABETES amp COVID GLOBAL PANDEMICS

75

117

125

126

149

Native AmericanAlaskan NativeAsian IndianHispanicNon-Hispanic BlackNon-Hispanic White

5-10 TYPE 1Autoimmune

Canrsquot produce insulin

90-95 TYPE 2AutoimmuneMetabolic

Insulin deficient or resistant

DISPROPORTIONATE IMPACT ON COMMUNITIES OF COLOR2

PERCENTAGE OF DIAGNOSED DIABETES

IN US ADULTS BY RACEETHNICITY

People with diabetes are at higher risk for severe complications from COVID-191

1 Gregory JM Slaughter JC Duffus SH et al COVID-19 severity is tripled in the diabetes community a prospective analysis of the pandemicrsquos impact in type 1 and type 2 diabetes Diabetes Care 2021 Feb 44(2) 526-532 httpsdoiorg102337dc20-2260

2 Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf

7

ROOM FOR IMPROVEMENT

Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf

8

16 MILLION ER visits per year

78 MILLION inpatient hospital stays

per year

~50reached A1C goal

19met A1C blood

pressure cholesterol and non-smoking goals

89overweight or obese

CDC 2020 National Diabetes Statistics Report

THE STATE OF DIABETES CARE amp COVERAGE

JOHN E ANDERSON MDFrist Clinic Nashville TN

DLC Medical Advisor

DONNA B RYAN RN RD MPH CDE FAADE

Ascension Health Pensacola FLDLC Board Member

9

DIABETES IS NOTONE-SIZE-FITS ALL

24 7 365SELF-MANAGEMENT

++

42 FACTORS affect blood glucose

The 42 Factors graphic is used with permission from The diaTribe Foundation To learn more go to diaTribeorg42FactorsExplained

10

TECHNOLOGY IS PERSONAL

GLUCOSE MONITORING INSULIN ADMINISTRATION

11

90

96

82

8790

7880

88

73

79

83

7470

75

80

85

90

95

100

lt13 13-lt26 ge26

Mea

n H

bA1c

AGE

Injection only Pump only Injection + CGM Pump + CGM

IMPROVE GLYCEMIC MANAGEMENT

Foster NC Beck RW Miller KM et al State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018 Diabetes Technol Ther 201921(2)66-72 doi 101089dia20180384

Continuous glucose monitoring technology improves glycemic levels regardless of the insulin

delivery method

12

bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor

bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month

POLL QUESTION13

bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor

POLL QUESTION - ANSWER14

$424month net savingsCost reductions were driven

by reduced inpatient hospital costs

INFORMED DIABETES DECISIONS

AGENDA

THE STATE OF DIABETES CARE amp COVERAGE

MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS

HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS

QampA

16

INSULIN IN THE NEWS

NET prices

Competitionbull Brandsbull Biosimilarsbull Authorized generics

LIST prices

$85NET

$334LIST

1 IN 4Patients report

cost-related rationing

17

FOLLOW THE REBATES

$-

$50

$100

$150

$200

$250

$300

$350

$400

2012 2013 2014 2015 2016 2017 2018 2019 2020

LIST PRICE NET PRICE +141

-53

1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf

2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846

3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https

People with diabetes are overcharged for lifesaving

insulin when exposed to list price instead of net or a flat copay

INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2

BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT

RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH

First dollar preventive coverage consistent with IRS guidance on HDHP-

HSAs

Low predictable

copays

Net cost bull Coinsurance

based on netbull Full rebate

pass-through

Full ldquoretailrdquobull No preventive

coveragebull Coinsurance

based on list pricebull No rebate pass-

through

$25MONTH

$360MONTH

$1200MONTH

19

bull Does your organization offer at least 1 plan with full rebate pass through to plan members

bull Yesbull Nobull Not sure

POLL QUESTION20

MANAGE PBMs LIKE A VENDOR

Most

27Some

32

Very Little

18Dont Know

23

How much do large employers receivefrom PBM-negotiated rebates1

Many employers donrsquot know who benefits from rebates discounts and fees related to their plan

THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls

bullPerverse incentivesbullLower trust in the plan

1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019

21

PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive

LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year

REBATE PASS THROUGHEliminate list price exposure and reverse insurance

TREATMENT CHOICESuited to patient needs and clinical complexity

KEY PLAN DESIGN FEATURES

1234

22

bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management

bull Yesbull Nobull Not sure

POLL QUESTION23

RATIONINGbull 34 of families with employer-provided insurance ration

medical care (compared to 33 of uninsured)1

bull 1 in 4 people with diabetes report cost-related insulin rationing2

COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat

complications vs management3

bull 2x spending on prescriptions to treat diabetes complications vs management3

STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery

versus less expensive and less invasive options4

bull 80-98 of dieters regain their lost weight5

PENNY WISE amp POUND FOOLISH PLAN DESIGN

1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health

httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S

PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS

KAREN BRUSTBusiness Administrators amp Consultants Columbus OH

Vice President

LORI SWEENEYInsperity

Senior HR Specialist

25

PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive

LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year

REBATE PASS THROUGHEliminate list price exposure and reverse insurance

TREATMENT CHOICESuited to patient needs and clinical complexity

KEY PLAN DESIGN FEATURES

1234

26

Continuity of care rather than annual

medication changes

Rapid adjudication for diabetes-related

claims

Diabetes care and education as needed rather than capped

Avoid copay accumulators and

maximizers for products with no

generic alternative

Eliminate or minimize spread on generics

Insurance literacy and plan selection

guidance for employees

BONUS FEATURES27

Examine your current plans

bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go

Analyze data for diabetes direct

plan costs

bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment

bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc

Examine any available data on

indirect costs

bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls

obtaining supplies office visits vs telehealth

Model plan design options

bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)

TAKE AWAY STEPS28

AGENDA

THE STATE OF DIABETES CARE amp COVERAGE

MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS

HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS

QampA

29

THANK YOUDownload this slide deck at HRcom

Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative

Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey

Questions bull Contact us at - employersdiabetesleadershiporg