Treat­ing di­a­bet­ics costly to Med­i­caid

Study finds deal­ing with the con­di­tion dou­bles ex­penses

Baltimore Sun - - FRONT PAGE - By An­drea K. McDaniels and Mered­ith Cohn

Peo­ple with di­a­betes cost the state’s Med­i­caid pro­gram twice as much as those with­out the chronic con­di­tion, a study com­mis­sioned by the so­ci­ety that rep­re­sents Mary­land’s doc­tors has found.

Med­i­caid spent an av­er­age of $24,387 on each pa­tient with di­a­betes in 2014, com­pared with $10,880 for some­one with­out the dis­ease, ac­cord­ing to the study com­mis­sioned by MedChi and con­ducted by the Hill­top In­sti­tute at the Univer­sity of Mary­land, Bal­ti­more County and re­leased Thurs­day. There were sim­i­lar find­ings among en­rollees in 2013, ac­cord­ing to the study of adults ages 35 to 64.

Such spend­ing adds up to hun­dreds of mil­lions of dol­lars an­nu­ally. HealthChoice, which man­ages care for the bulk of the state’s Med­i­caid pa­tients, spent more than $471 mil­lion treat­ing peo­ple with di­a­betes in 2014 for hos­pi­tal­iza­tions, doc­tor vis­its and pre­scrip­tions, and more than $312 mil­lion in 2013.

Di­a­betes oc­curs in peo­ple who do not pro­duce enough in­sulin or do not process it cor­rectly, caus­ing an in­crease in blood su­gar. It af­fects 29 mil­lion Amer­i­cans and more than 610,000 Mary­lan­ders, or about10 per­cent of the state pop­u­la­tion.

The cost of car­ing for di­a­betes pa­tients builds up over time be­cause the dis­ease of­ten causes costly com­pli­ca­tions, such as kid­ney fail­ure and gan­grene lead­ing to am­pu­ta­tions. HealthChoice en­rollees with di­a­betes were more than twice as likely to be ad­mit­ted to a hos­pi­tal as those with­out the dis­ease.

MedChi said the re­search is the first look at the cost of car­ing for di­a­bet­ics on Med­i­caid in Mary­land, and ad­vo­cates say it could pro­vide fuel for pol­icy and leg­isla­tive changes at the state and lo­cal lev­els.

“Th­ese num­bers re­ally show the bur­den in Mary­land,” said Dr. Richard Bruno, a MedChi trustee and a board mem­ber of the ad­vo­cacy group Su­gar Free Kids Mary­land.

“We­have some sug­ges­tions to make a dent.”

Since obe­sity is a big risk fac­tor in the most com­mon form of di­a­betes, Bruno said, pub­lic ed­u­ca­tion about diet and ex­er­cise is cru­cial. The re­port sug­gests reme­dies for pol­i­cy­mak­ers and law­mak­ers that in­clude adding di­a­betes screen­ings, de­vel­op­ing walk­a­ble com­mu­ni­ties, and mak­ing fresh fruits and veg­eta­bles more ac­ces­si­ble in poor neigh­bor­hoods.

The re­port also rec­om­mends some more con­tro­ver­sial mea­sures, such as taxes on sug­ary drinks, re­quir­ing warn­ing la­bels about those drinks in re­tail out­lets, and “healthy vend­ing” laws that re­quire most foods and drinks sold on gov­ern­ment prop­erty to be lower-calo­rie.

A bill re­quir­ing that 75 per­cent of the op­tions in vend­ing ma­chines on state prop­erty meet a set of di­etary guide­lines failed in the Gen­eral Assem­bly this year, though spon­sors said they plan to rein­tro­duce the mea­sure. Howard County and Bal­ti­more City al­ready have such laws.

An ef­fort also stalled in Bal­ti­more City to re­quire busi­nesses that sell or ad­ver­tise su­gar-sweet­ened so­das, en­ergy drinks, sports drinks, juices, cof­fees and teas to post signs warn­ing con­sumers that they con­trib­ute to tooth de­cay, obe­sity and di­a­betes.

City Coun­cil­man Nick Mosby said he was moved to in­tro­duce the bill by the num­ber of obese chil­dren in Bal­ti­more who could face a life­time of bat­tling re­lated dis­eases. He said he was dis­ap­pointed that the mea­sure has not got­ten a vote.

“In Bal­ti­more, we’re go­ing to be the leader in pol­icy re­forms and progress on things like this, or, un­for­tu­nately, we’ll con­tinue to see the im­pacts,” he said. “We’ve al­ready al­lowed the im­pacts on the city for far too long.”

While Mosby said the warn­ing la­bels did not re­strict choice among con­sumers and only pro­vided in­for­ma­tion, rep­re­sen­ta­tives of the bev­er­age in­dus­try ar­gue that con­sumers are al­ready get­ting enough in­for­ma­tion to make pur­chas­ing de­ci­sions.

Ellen Valentino, a lob­by­ist for the Mary­land-Delaware-D.C. Bev­er­age As­so­ci­a­tion, op­posed Mosby’s bill and said the in­dus­try is al­ready of­fer­ing more choices with fewer calo­ries and pro­vid­ing calo­rie counts on the prod­ucts. “We know gov­ern­ment in ev­ery gro­cery cart is not a real so­lu­tion,” she said. “Real so­lu­tions are pro­vid­ing con­sumers choice, smaller por­tion sizes, lower calo­rie op­tions and in­for­ma­tion on pack­ag­ing.”

Pol­i­cy­mak­ers say they con­tinue to work on other pre­ven­tive pro­grams to re­duce obe­sity and the rate of di­a­betes — and the costs.

The Mary­land Depart­ment of Health and Men­tal Hy­giene, which ad­min­is­ters the Med­i­caid pro­gram for the fed­eral gov­ern­ment, said in a state­ment that the agency is par­tic­i­pat­ing in a na­tional di­a­betes pre­ven­tion pro­gram.

The state health depart­ment an­nounced this sum­mer that it had cho­sen four man­aged-care or­ga­ni­za­tions un­der HealthChoice — Ameri­group, Jai Med­i­cal Sys­tems, MedS­tar Fam­ily Choice and Pri­or­ity Part­ners — to help im­ple­ment di­a­betes pre­ven­tion pro­grams for Med­i­caid pa­tients as part of a two-year pilot study by the fed­eral gov­ern­ment.

Mary­land is one of two states that were awarded fund­ing as part of the Na­tional Di­a­betes Pre­ven­tion Pro­gram, which is fo­cused on keep­ing low-in­come res­i­dents from de­vel­op­ing di­a­betes

“The depart­ment wel­comes the study and shares the con­cern about the im­pact of di­a­betes,” the state­ment said. “For this rea­son, the Depart­ment of Health and Men­tal Hy­giene, this sum­mer, se­lected the man­aged care or­ga­ni­za­tions that will par­tic­i­pate in a demon­stra­tion project to show ways to of­fer the Na­tional Di­a­betes Pre­ven­tion Pro­gram to Med­i­caid re­cip­i­ents.”

But with­out more in­ter­ven­tion, oth­ers fear that di­a­betes pa­tients will con­tinue to drive up spend­ing. The MedChi study al­ready found that more than a quar­ter of Med­i­caid’s 2014 spend­ing of $1.77 bil­lion on pa­tients ages 35 to 64 was for di­a­bet­ics, though they made up only 14 per­cent of en­rollees.

“The bur­den on our pa­tients, their fam­i­lies and state tax­pay­ers will con­tinue to in­ten­sify, putting strain on Med­i­caid fund­ing, en­roll­ment, and per­haps even the qual­ity of care pro­vided,” said MedChi’s pres­i­dent, Dr. Stephen J. Rock­ower.

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