Health Plan Weekly

In a series of articles in the July issue of the health policy journal Health Affairs, researchers evaluated diabetes care in the United States through several lenses, including care management, prevention, interventions, health equity, quality measures and value-based payment design. Several of them also spoke at a July 19 policy briefing in which a key message was that the fragmented U.S. health system is contributing to a plateau in improving diabetes care — and value-based diabetes payment programs may be causing still more fragmentation.  

Despite remarkable advances in clinical understanding and treatments for diabetes, the U.S. has stagnated over the past decade in preventing and managing the condition, said Mohammed Ali, a professor in the Hubert Department of Global Health at Emory University. Ali served as the theme advisor for Health Affairs’ diabetes-focused issue and also was a co-author of the issue’s overview article, “Diabetes And The Fragmented State Of US Health Care And Policy.” 

More purchasers than ever are offering virtual primary care to their members and may be on the verge of launching “virtual-first” plans, according to recent surveys by benefits consultants and brokers. However, health care experts tell AIS Health, a division of MMIT, that there’s an important distinction between the availability of such options to members and actual uptake — and point out purchasers aren’t yet convinced that virtual offerings will reduce costs or improve the member experience. 

Recent benefit surveys show increasing interest from employer purchasers in the availability of virtual primary care — which places a member with a telehealth primary care provider inside a traditional health benefit — and virtual-first plans, which are benefit designs that require members to use some sort of telehealth option (usually a telehealth PCP) as their primary point of contact with the health care system.  

Health insurers, states and the federal government are beginning to take more seriously health inequities, according to experts who spoke with AIS Health, a division of MMIT, as the issue becomes a hot topic due to the health and financial costs caused by disparities in health care access and outcomes. 

Health inequities related to race, socioeconomic status and sex/gender account for $320 billion in annual health care spending for five high-cost diseases, according to a Deloitte report released on June 22. Deloitte actuaries project that could increase to $1 trillion by 2040 and lead to an average $2,000 increase in health spending per person in the U.S. if those issues are not addressed. The researchers examined the costs of health inequities related to the treatment — or lack thereof — of breast cancer, diabetes, colorectal cancer, asthma and coronary heart disease.