Cleveland Clinic Senior Director of Patient Experience Stephanie Bayer

Population Health

Social Needs Impact on Diabetes Management

New research published in JAMA Network Open found that health-related social needs (HRSNs) have a major impact on both quality and utilization outcomes for people with type 2 diabetes.

Using self-reported data from a national sample of 21,528 Medicare Advantage beneficiaries with T2D, researchers found that the majority (56.9%) reported at least one HRSN, and that each one significantly affected outcomes.

Here’s a look at the odds ratio impact of HRSNs on diabetes medication adherence (proportion of days covered over 80%), statin adherence (PDC over 80%), and having controlled HbA_1c. Not too surprising to see that financial strain had the largest negative impact on HbA_1c control.

• Food insecurity – Diabetes (0.93), Statin (1.02), HbA_1c (1.02)
• Financial strain – Diabetes (0.91), Statin (0.91), HbA_1c (0.83)
• Loneliness – Diabetes (0.85), Statin (0.79), HbA_1c (0.96)
• Unreliable transport – Diabetes (0.80), Statin (0.80), HbA_1c (0.94)
• Housing insecurity – Diabetes (0.78), Statin (0.96), HbA_1c (0.92)

Each of the five HRSNs also influenced hospital utilization, and it was interesting that food insecurity was identified as the factor with the largest impact on acute care usage. Here are the changes in utilization per 1,000 MA enrollees for avoidable hospitalizations, ED visits, inpatient encounters, and 30-day readmissions.

• Food insecurity – Hospitalization (17.1), ED Visit (84.6), IE (30.4), Readmission (8.2)
• Financial strain – Hospitalization (4.6), ED Visit (40), IE (6.8), Readmission (2.3)
• Loneliness – Hospitalization (3.9), ED Visit (173), IE (-6.3), Readmission (-4.5)
• Unreliable transport – Hospitalization (13.5), ED Visit (244.6), IE (41.8), Readmission (1)
• Housing insecurity – Hospitalization (6.3), ED Visit (55.4), IE (16.1), Readmission (10.2)

The Takeaway

Type 2 diabetes affects more than a quarter of people above age 65 while costing the US health system over $200B each year, and this study underscores the significant role that HRSNs play in managing the disease. Much of the existing work around HRSNs relies on area-level social needs measures because patient-level data is hard to come by, but these findings suggest that collecting patient data is worth the effort to move the needle in diabetes care.

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The Wire

• Verizon Sunsets BlueJeans: Verizon is pulling the plug on its BlueJeans video conferencing software suite, which it acquired during the early days of the pandemic for $400M. Healthcare was a core pillar of Verizon’s BlueJeans ambitions – we even sat down with BlueJeans founder Krish Ramakrishnan in one of our early Q&As – but a cutthroat competitive environment and a general usage slowdown since the peak of the pandemic pushed Verizon to sunset the service by the end of the month.

• Consumer Privacy Misconceptions: A Harris Poll survey of 2,000 consumers found that 58% don’t consider where their personal health information is shared when they use digital health apps, and only 27% said that privacy was a factor when looking for care online. That’s actually not too surprising after seeing that 81% of consumers incorrectly assumed this data was HIPAA protected, when in reality HIPAA makes no mention of protected health information stored on digital health apps or by organizations that aren’t “covered health entities.” 

• Marathon Acquires Cerner WHS: Marathon Health acquired Cerner Workforce Health Solutions to help grow its VBC population health management footprint in 15 states. The acquisition includes Cerner WHS’s 21 employer clients, 35 health centers, and 300k members, with Marathon specifically calling out Cerner’s occupational health and onsite pharmacy capabilities as key areas that it will be looking to build upon.

• Hospitals Among Most Dangerous Workplaces: About 3 in 4 nonfatal workplace violence injuries now involve workers in healthcare and social work, making hospitals and clinics the most dangerous workplaces in the US. Healthcare workers suffer more nonfatal injuries from workplace assaults than any other field – including law enforcement – and backlash against pandemic public health measures hasn’t helped the situation. Healthcare saw 10.4 injuries from workplace violence per 10k workers in 2018, up 62% from 2011.

• United Cuts Prior Auth Requirements: United Healthcare is moving forward with plans to drop prior authorization requirements for a number of popular procedures, including imaging services and genetic tests. Starting September 1, United will begin the phase out across a “vast majority” of its plans, with the removals representing 20% of its overall prior auth volume. There’s recently been a bright spotlight on the administrative burden that prior auths place on overworked clinicians, prompting Cigna and Aetna to announce similar rollbacks.

• Consumers Turn to Telehealth for GLP-1s: A Trilliant Health analysis found that among the 3.6M people with a new GLP-1 prescription in 2022, only 53% also had a medical visit claim within three days. That suggests that 1.7M Americans likely went the OOP route with a D2C telehealth company instead of going through a doctor to get their prescription, an important number to keep an eye on given the medication’s side effects and massive impact on weight.

• Are Doctors Overpaid? A recent NBER study raised some pointed questions about whether US physician salaries are contributing to rising healthcare costs. Researchers found that the average physician brought home $350k in 2017 (25% higher than previous estimates), and estimated that physician salaries make up about 9% of total healthcare costs. Our sister pub The Imaging Wire put it plainly in last week’s deep dive, saying that physicians should be the target of last resort in “a medical system that’s rife with overutilization, administrative costs, and duplicated effort.”

• Digital Maternal Care Reimagined: A great blog post from e-Lovu cofounder Santosh Pandipati, MD peels back the many problems causing the US to rank the worst among high income nations in maternal mortality despite spending $126B annually on pregnancy care. Dr. Pandipati points to an outdated care model, poor reimbursement structures, and a wide range of health inequities as contributing factors, then offers a series of possible solutions to help turn things around.

• Community Health Center Stats: New data from the National Association of Community Health Centers unveiled that 31.5M people currently receive care from one of the nation’s 15,000 community health centers, roughly 9% of the population. The NACHC confirmed that these health centers and FQHCs play a vital role for underserved groups: One in five patients at these locations lack health coverage, 61% are covered by public plans like Medicaid or CHIP, 41% are rural residents, and 90% are low income.

• Daybreak Health Series B: Daybreak Health closed a $13M Series B round (total funding now $25M) to continue expanding its school-based mental health services to new states. Daybreak’s strategy is to combine school district funding with payor reimbursement (both private plans and Medicaid) to ensure every student has access to care, and the startup has already partnered with 60 public school districts since launching its teletherapy services in 2019.

• CVD Technology Gap: A new Yale study (n=16k, 2017-2020) found that 42% of U.S. adults who have or are at risk of developing cardiovascular disease use their smart devices to monitor their health. Although that’s less than the overall population (46%), people with the highest CVD risks are least likely to use health apps. Older and poorer individuals, men, and cigarette smokers were all less likely to use smart devices for health monitoring, prompting the authors to warn that this “technology gap” could worsen health disparities.

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