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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.
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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.
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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.
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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.
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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.
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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.
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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.
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About Health Affairs
Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking
content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.
Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.
Copyright © Project HOPE: The People-to-People Health Foundation, Inc.
Health Affairs, 1220 19th Street, NW, Suite 800, Washington, DC 20036, United States
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