Type 2 diabetes, behavioral health and health care spending.
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Dear John,

An estimated 37.3 million Americans have type 2 diabetes-an increase
of more than 40 percent from a decade ago.

Most of the July 2022 issue of Health Affairs is devoted to an invited
group of articles discussing how we can prevent and improve care and
outcomes for type 2 diabetes. Additional articles in the issue focus on
behavioral health and health care spending and prices.

Read The Issue

Type 2 Diabetes

In their overview article, Puneet Kaur Chehal and coauthors find that
progress in diabetes prevention and treatment in the US has stalled
.
They argue that fragmentation in insurance coverage, payment, and
delivery have all contributed to poor diabetes outcomes.

They conclude: "Reducing persistent individual-and population-level
diabetes burdens and inequities will require a more coordinated approach
that affords greater concentration on high-value services, alignment of
incentives, and continuity of information and services."

"Care management is a set of activities designed to assist patients and
their support systems in managing their diabetes and related social
problems," explain Thomas Bodenheimer and Rachel Willard-Grace.

Despite a strong base of evidence supporting care management
,
the authors note significant barriers to its wider use in primary care,
particularly because of the "lack of an adequate, diverse, trained care
manager workforce; regulations limiting scope of practice for care
managers and constraining the services they provide; and misalignment of
payment policies with patients' needs."

Arguing that the proliferation of quality measures has not improved the
health of people with diabetes, David Jiang and coauthors propose the
adoption of new measures

and the modernization of existing ones.

They argue for the alignment of these measures with six domains of
quality, as defined two decades ago by the Institute of Medicine, and
the use of a subset of the new measures for public reporting and
payment.

Leonard Egede and coauthors conduct a systematic review of studies

of nonmedical interventions designed to reduce risk and improve clinical
outcomes for type 2 diabetes.

They find that "interventions with targeted, multicomponent designs that
combine both medical and nonmedical approaches" can improve outcomes and
that "targeting social risk factors concurrently with medical
interventions has the potential to reduce and prevent the burden of
diagnosed type 2 diabetes."

Maria Alva and coauthors analyze national survey

data and determine that
13.5 percent of the population has prediabetes, representing a
4.8-percentage-point increase between 2010 and 2020.

Despite these trends, the authors find that "only 5 percent of patients
diagnosed with prediabetes were referred by a health care professional
to a diabetes prevention program."

They suggest increasing payments for prevention, improving data
integration and patient follow-up, and expanding access to preventive
interventions.

Sabrina Wang and coauthors analyze various Alternative Payment Models
for diabetes care
.

They report promising results but conclude that "the fragmented US
health care system, with its myriad payers and payment models, is
structurally at odds with the need for care continuity for chronic
conditions such as diabetes."

Articles by Hamlet Gasoyan and colleagues, Joshua Weinstein and
colleagues, and Baylee Bakkila and colleagues also highlight aspects of
diabetes care
.

Read More

Behavioral Health

Jane Zhu and coauthors find that 58.2 percent of providers listed in
Oregon's coordinated care organization

network directories saw four or fewer Medicaid patients in 2018.

Referring to these as "phantom" providers, the authors conclude,
"Although phantom networks may satisfy network adequacy requirements on
paper, they may contribute to delays and disruptions in care and place
cumulative barriers on patients' ability to obtain mental health care
in a timely manner."

In accompanying Perspectives, Howard Goldman notes that "phantom
networks undermine the intent of policies
,
such as mental health insurance parity, that were designed to improve
mental health coverage," and Brett Dolotina and Jack Turban focus on the
burden of phantom networks

on children and adolescents with severe mental disorders.

Read More

Spending And Prices

Analyzing changes in disease burden

and spending on treatment from 1996
to 2016, Marcia Weaver and coauthors determine that the US overall spent
$114,339 per disability-adjusted life-year averted and conclude that
"much of the growth in health care spending over time has purchased
health improvements."

Morgan Henderson and Morgane Mouslim investigate cash prices for
emergency department (ED) facility fees.

They determine that relative to nonprofit hospitals, for-profit status
is associated with 80.4-93.1 percent higher average ED facility fees
for self-pay patients across all levels of visit acuity. Larger
hospitals also have higher prices.

Read More

Acknowledgments

Health Affairs thanks Mohammed Ali of Emory University

for serving as adviser for the diabetes theme articles. We also thank
Eli Lilly and Company for their financial
support for those articles.

Order The Issue

Join Health Affairs Unlimited to access our current and past issues
.

In case you missed it, we have launched Health Affairs Insider
,
a membership offering exclusive access to content beyond the journal.

Health Affairs Insider is a membership community that includes exclusive
news from Health Affairs, entry to our growing portfolio of virtual
events, and curated email newsletters on priority health policy topics.

Join Insider

Attend These Events

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This month, Health Affairs will host events
featuring Jonathan H.
Adler, Katie Keith, Sara Rosenbaum, Morgan A. Henderson, Morgane C.
Mouslim, and more.

Access to our virtual Lunch and Learn, Professional Development, and
Journal Club events will be limited to Health Affairs Insider and
Unlimited

members only.

Theme issue briefings, which are held alongside the launch of a monthly
issue on a dedicated topic, and Policy Spotlights will continue to be
free for all to attend.

July events include an Insider Lunch and Learn on July 8 discussing the
current term and decisions made by the US Supreme Court
.

On July 14, we'll host the next Professional Development event in our
Summer Session series, "Capturing The
Forefront
."

Health Affairs Deputy Editor Rob Lott and Forefront Editor Chris Fleming
will cover the evolution of Forefront, the types of content that attract
the most attention, and strategies for making submissions accessible to
a non-expert audience.

We'll also host a Theme Issue Briefing that's open to all on July 19:
"Type 2 Diabetes: Policies to Improve
Prevention,
Care and Outcomes
."

Finally, the next Journal Club event
on
July 20 features authors of a new study examining how ED facility fees
for self-pay patients (cash prices) vary according to hospital and
regional characteristics.

To become an Insider and attend all virtual events, visit our membership
page
.

View Full Event Schedule

Listen to This Podcast

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This month we'll feature a number of guests on A Health Podyssey
including Juan Andino, Marcia Weaver, Jane Zhu and more.

On a recent episode, we invited Sherry Glied to discuss the role of high
deductible health plans
in
creating health market efficiencies.

Listen

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About Health Affairs

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, and Health Affairs Sunday
Update .  

Project HOPE is a global health and
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