A Case Study: Cost Futility Analysis

One very prevalent issue that has more than doubled since the 1980’s and is growing rapidly is diabetes. In fact, “diabetes prevalence is particularly high among people age sixty-five and older, and it doubled among Medicare beneficiaries between 1987 and 2008, rising from 11.3 percent to 22.6 percent” (Thorpe, 2012, p. 61). The ACA granted the Centers for Disease Control and Prevention

There is a great deal of literature and studies that have been done on the subject of Diabetes Mellitus (DM). According to Healthy People.gov, there is an estimated 23.6 million people in the United States living with diabetes and it is the 7th leading cause of death. It also lowers life expectancy by up to 15 years, increases the risk of heart disease, is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness (Office of Disease Prevention and Health Promotion, 2015). The goal set by Healthy People 2020 is to reduce the disease and economic burden created by Diabetes Mellitus (DM) and to improve the quality of life for persons at risk for or living with this disease. The types of studies I reviewed include clinical

The effectiveness of diabetes program that is offered in Sacramento County can be measured and converted into indicators and variables. Different hospitals in Sacramento County measure and convert the concept into indicators differently. Indicators may include the number of patients, changes in mortality, and changes in the nutritional status of the patients. The types of variables that researchers could look at maybe 1) the amount of patients that were serviced in a month to a year at the same facility, 2) the number of people that have diabetes and other illness per 1000 population, and 3) the changes in the weight of diabetic patients.

An aspect of Medicare and Medicaid that is important to look at is disease management because this affects budget and financial costs for both patient and government. Before we can look at the issue itself we need to be able to define what Disease Management is. According to Wikipedia.org (Wikipedia, 2008) disease management is “a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. It is the process of reducing healthcare costs and/or improving quality of life for individuals by preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care.” The Centers for Medicare and Medicaid (CMS) organized a study to determine if disease management programs helped reduce costs for long term care for chronic conditions. Approximately 300,000 Medicare participants took part in about 35 programs. The idea was to assist these Medicare patients with chronic illnesses such as COPD, severe heart conditions, cancer and other conditions between office visits to prevent hospitalizations. The goal was to reduce the costs that accumulate with hospital visits, help the patient to have a better quality of life and the program save money (American Journal Health Pharmacy, 2009). The program worked as follows: health care providers were supposed to work with patients in return for receiving a small fee from CMS. The

Did you know diabetes is the seventh leading cause of death in the United States? (Fukunaga, 2011). Many are unaware approximately 25.8 million American’s, 8.3% of the population suffer from diabetes. Type II Diabetes Mellitus (DM II) is by far the most prevalent and accounts for 90-95 percent of the 25.8 million diabetic patients. The long term complications of DM II make it a devastating disease. It is the leading cause of adult blindness, end-stage kidney disease, and non-traumatic lower limb amputation (Lewis, Dirksen, Heitkemper, & Bucher 2014, p. 1154). Not only is diabetes debilitating to patients but also the health and employment costs are substantial. According to Fukunaga (2011), “The estimated national cost of diabetes exceeds

need for increased understanding of the economic, and societal seriousness of diabetes and its complications, and of the escalating costs to individuals, families, workplaces, society and governments.

Type II Diabetes is a growing disease that according to Ley, Ardisson Korat, Qi, Tobias, Cuilin, Lu and ... Hu (2016) approximately 415 million adults are affected by this disease world wide and in the United States in 2015, $348 million dollars was spent on treatment for diabetes. Additionally, the growing number of people who are projected to develop type II diabetes is

The Centers for Disease Control and Prevention (CDC) DSME driver document describes four drivers for DSME. These drivers are Program availability, Payers and payment mechanisms, Referral policies and practices, and People with diabetes willing to go to DSME. Research indicates that if employed these drivers can increase access, reimbursement, and referral for DSME. These four drivers can be used concurrently to improve DSME

There are costs of diabetes that the community pays for, helping those with the condition. These costs can be direct - costs linked specifically to diabetes, indirect - not specifically associated with diabetes, or intangible - being costs which aren’t physical, such as emotional pain. In relation to diabetes, community costs are increasing as is the number of individuals who have diabetes. Direct costs for communities can include funding treatment costs, cost of prevention strategies, cost of pharmaceuticals and cost of diagnosis. The direct cost of funding the treatment of diabetes includes having to pay for hospitalisation service costs. Even though the community as a whole has to assist in paying for the hospitalization of individuals experiencing diabetes. The average cost of hospitilisation services for people who have diabetes is around 6.3 billion dollars, most of which is coming from communities worldwide. Educating and promoting the younger generations of diabetes and the importance of maintaining a healthy lifestyle to prevent the condition also costs the community. Promotional campaigns such as WDD and Measure Up costs the community to run each year, so that the prevalence of diabetes can be reduced. Other promotional techniques such as talks with local schools and programs such as Healthy Harold costs the community to educate the younger generation on the importance of decreasing the amount of people with diabetes so that the costs to individuals

Improving relationships between patient-provider will increase communication which is essential to improve outcomes and lower healthcare expenditures. According to the World Health Organization (WHO) there are about 350 million people suffering from diabetes mellitus (DM) and by 2030, diabetes will become the seventh leading cause of death worldwide with diabetes deaths expected to raise by 50% by the next 10years. (http:/ /www.who.int/features/factfiles/diabetes/en/index.html.) Cases of diagnosed diabetes cost the United States an estimated$245million in 2012. This cost is expected to rise with the increasing diagnoses. (Center for Disease and Control and prevention).

The metric that is underperforming to the most significant degree for the federal benchmarks is the percentage of patients receiving eye exams (Integris Health, 2017). However, the most widespread under improving benchmark that affects the most patients and healthcare professionals of the SRDC is the percentage of patients having a HbA1C higher than 9%. This affects all areas of the SRDC due to abnormal patient glucose levels affects all aspects of the diabetic patient’s health and healthcare (Chrvala, Sherr, & Lipman, 2016). Subsequently, the most significant opportunity to improve the health of the SRDC patients, the community’s health, the SRDC, and improve patient outcomes is to improve the HbA1C levels of the patients.

Type 2 diabetes is probably the most recognizable chronic condition that results from obesity and it is an interesting condition to study because it is linked directly to increased healthcare costs and a number of lifestyle choices (Canning, Eggleston, Lecates, Ross-Degnan, Soumerai, Trinacty, Wharam, Zhang, 2013). Insurers have claimed that it costs $10,000 per year extra to treat someone with diabetes. A study conducted by the Healthcare Cost Institute (which is backed by United Health Group, Humana, Aetna, and Kaiser Permanente) seemed to support that statement. The study found that it cost $15,000 to treat a diabetic compared to $4,305 to cover the expenses of a non-diabetic

Type 2 Diabetes is a is a growing medical problem in the United States. Consequently, it is necessary that healthcare providers

Currently in Iowa there are approximately 300,385 adults who are diagnosed with diabetes, while 75,000 individuals do not know that they have the disease, and an additional 810,000 adults have prediabetes (Burden of Diabetes, n.d., para. 2-4). However, in our rural community there are limited services available that provide preventative disease management and support. With the changes in reimbursement in health care it is imperative that we become innovative in our approach to caring for these individuals in a proactive manner. The current goals of health care is to provide quality care at the lowest cost possible (Milstein & Darling, 2010). The cost of providing a Diabetes Prevention Program to the individual is $450 per year, while

With the increasing costs of managing chronic disease states, health care facilities are being driven to create disease management –specific programs for diabetes to improve the health of these individuals, prevent disease complications such as heart disease, macular degeneration, chronic kidney disease that can lead to kidney failure and reduce the cost related to hospitalizations and emergency room visits. A review of the available literature has shown that significant reductions in the use of health care service and expenditures have resulted for many patients enrolled in disease management