More than 29 million people in the United States have diabetes, and another 86 million have pre-diabetes. Of those, 30 percent will develop type 2 diabetes within five years, adding to the $245 billion spent in diabetes-related medical costs and lost work and wages annually. It’s no surprise more employers are honing in on preventive care, and looking to companies like TrueLifeCare to help curb employee health costs.
Closing the Gap
Industry veteran Thomas Milam founded the Brentwood-based company in 2012 after watching a close friend die from diabetes-related complications. “I wanted to understand what it is and why it does what it does,” Milam said of the disease. “I wanted to know how it could be different going forward.”
After much research, Milam realized a missing component was the “gap in care,” or what happened between clinical encounters. Who was helping patients manage their diabetes on a day-to-day basis?
“Diabetes is unique to each individual, and 99.9 percent of the time it’s about behavior,” Milam said. “What we do is help bridge that gap to help people overcome ambivalence, gain an understanding of what’s in their best interest, and start taking baby steps to help them become compliant with evidence-based care.”
TrueLifeCare (TLC) provides a one-on-one mentoring relationship, where members have meaningful incentives to participate and stay engaged. That engagement means better glucose control, which ultimately leads to fewer micro and macro complications.
The Price Tag of Diabetes
A former CFO, Milam knew first-hand the rising benefit plan costs facing employers and out-of-pocket expenses paid by employees. He also knew that much of the increase was rooted in diabetes care and complications.
“You can’t get around inflation, but with diabetes there have been many studies to show a group of people who’ve become more engaged and work more productively to self manage the disease have fewer events,” Milam said.
After providing TLC with 12 months of claims data, employers are shown transparent diabetes costs for employees. On average, eight to 10 percent of employees in a typical benefit plan has diabetes but consumes 25 percent of healthcare plan dollars. Nationally, Americans without diabetes cost employers $4,300 annually, while those with diabetes spend nearly $15,000. Compounding the issue is the rising incidence of diabetes and the fact that 15 percent of diabetics will experience a significant health problem each year, followed by a separate 15 percent the following year. Patients with type 2 diabetes also live seven to 10 years less and experience a diminished quality of life related to co-morbidities.
A New Standard of Care
It doesn’t take long for employers to understand what Milam and his team discovered years ago. “What employers have been doing over the past 15 to 20 years is coming up short,” Milam said. “The single greatest driver of health plan costs is diabetes, and there’s no silver bullet. It’s become the new normal for costs to go up twice as much or more as inflation, and people don’t realize it’s diabetes that’s doing that. Something can be done about it, and what’s been done in the past isn’t enough.”
Milam said companies often have one wellness program but believes they need multiple options to help employees get engaged and improve self-care for chronic conditions. To that end, TLC works with companies across the United States to provide their Five Essential Touchstones of: 1) supporting evidence-based practices, 2) productive interactions with skilled professionals, 3) consistency and persistency of the productive interactions, 4) actively using key vitals readings, and 5) incentives.
TLC provides an integrative, personalized approach that includes ongoing assistance and diabetes testing supplies, while employees upload daily glucose readings to a secure cloud-based server. Conversations start changing during the first few months, as employees gain a better understanding of their diagnosis.
Employers soon see a drop in emergency utilization among the diabetic population. By the second year, behaviors have changed and hospitalizations have typically dropped by 30 percent, with emergency visits down by 22 percent. On average, 1,000 employees without diabetes will total 175-200 hospital days in a year, and 200 ER visits. By contrast, a company with 1,000 diabetic employees funds 850-1,000 hospital days and 450 ER visits annually.
Value to Employers
The company also brings value since they’re paid through redirection of spending for glucose testing supplies, which is money that was already being spent. TLC doesn’t provide clinical care but supports clinical standards to help individuals understand their diagnosis and take action to improve overall health. TLC currently has 10 employees including a clinical advisor and endocrinologist and has contracted with companies of 400 to 5,000 employees. They also help employers understand the scope of a diabetes diagnosis and how it affects all aspects of a person’s life.
“When you have diabetes, you still have everything going on in your life that everyone else does – relationships, finances and work, plus diabetes 24/7/365, and your life becomes very complex,” Milam said. “Trying to do it alone or with three or four clinical encounters in a year is just daunting, if not impossible. Given the proven outcome of the disease, why would you do that?” he questioned, adding help is at hand.
