Despite recent therapeutic advancements, diabetes remains among the most common and costly chronic diseases across America. In addition to the higher medical costs, reduced productivity, premature mortality, and the unseen costs emanating from reduced quality of life are additional costs of the chronic disease. Currently, diabetes affects approximately 31 million Americans, of which about another 8 million are undiagnosed. On matters prevalence, with approximately 90% of the cases being type 2, it is significantly predominant over type 1 (Centers for Disease Control and Prevention, 2017). Such prevalence is magnified when one considers that approximately 34 million Americans are prediabetic, quite a significant amount. Generally, up to 70 % of such cases develop into type 2 diabetes in normal life course. Therefore, not only is the prevalence of diabetes anticipated to double within the decade, but with current trends the prevalence might be about 100 million citizens by 2050 (Centers for Disease Control and Prevention, 2017).
While the disease affects a significant section of the population, its prevalence among ethnic groups is a function of the susceptibility variance among such sets. For example, Americans of South Asian descent are more than 3 times likely to develop the disease than their Caucasian counterparts. Also, both African American and Hispanic sections are approximately 2 times as likely. According to the National Diabetes Statistics Report, a periodic publication of the Centers for Disease Control and Prevention, approximately 320,000 youth not older than 21 years have been diagnosed for diabetes as of 2015 (Centers for Disease Control and Prevention, 2017). Notably, the growing prevalence of obesity is associated with a similar predominance of diabetes among the young. This also explains why this group presents majority of new type 2 cases.
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Diabetes is among the top ten leading causes of death in the United States (Office of Disease Prevention and Health Promotion, 2018). On top of that, it is associated with high hospitalization rates and treatments for either kidney or cardiovascular diseases (Mechanick & Kushner, 2016). Here, average expenses for diabetes are about 2.4 times higher when compared with those without diabetes. Diabetes related costs are both direct and indirect. Starting with the latter, disability, loss of work and premature deaths is some of the significant indirect expenses. On the other hand, hospitalizations, visits with healthcare providers and medications are examples of direct diabetic costs. Recorded estimates for 2012 was approximately USD 250 billion with about two thirds of the amount going to direct expenses alone (Mechanick & Kushner, 2016). Likewise, in 2017 the estimated reported costs on diagnosed diabetes was about USD 327 billion. Again, approximately two thirds accounted for direct expenses while the other third was for indirect costs. The notable increase in costs associated with diabetes is due to the growing prevalence of diabetes and the increased cost of diabetic care on the individual (Office of Disease Prevention and Health Promotion, 2018).
Alarmingly, the highest growth in both prevalence and cost was among Americans aged 65 and over, this translates to increased cost pressures on Medicare (Office of Disease Prevention and Health Promotion, 2018). Equally noteworthy is that such costs will inevitably increase along with the prevalence due to the equally inevitable aging of the population (Mechanick & Kushner, 2016). Basically, diabetes- both diagnosed and undiagnosed variants- place significant financial burdens on the American society. In addition to the quantifiable costs there is pain, suffering and a reduction in quality of life among affected citizens.
According to the American Diabetes Association (2016), “The ACA provides numerous health insurance protections for people with, and at risk for, diabetes and has greatly improved access to adequate and affordable health insurance.” Prior to the ACA, Americans with diabetes had trouble when applying for individual health covers for the disease was categorized as a preexisting condition. Alternatively, the plans availed were prohibitive in terms of costs, further curtailing access to adequate insurance policies (Ladd & Altshuler & Medical Library Association, 2013). Nowadays, provisions of the ACA make the management of chronic illnesses like diabetes an essential health benefit. Furthermore, such provisions mandate insurance companies to accept applications for preexisting conditions while paying uniform premiums with other policy holders. Critically, those with higher susceptibility to diabetes can access, without charge, recommended preventive care which features cholesterol screening; diabetes screenings for both pregnant women and adults with high blood pressure; obesity screening and weight loss counselling and depression screening (Ladd & Altshuler & Medical Library Association, 2013).
The ACA allows diabetic patients, arguably, an inexhaustible insurance coverage, good prescription coverage, and access to insurance plans with low out-of-pocket expenses. The former allows patients to have diabetes related complication surgeries without insurance providers imposing limitations on the amount of coverage received. The latter addresses the higher costs of diabetes management which requires frequent and continuing tests, doctors’ visits, and the purchase of diagnostics (Ladd & Altshuler & Medical Library Association, 2013). Such expenses increase the likelihood of paying higher than average copays and coinsurance. However, the ACA allows diabetic patients a selection of policies with lower deductibles and copays. Likewise, good prescription coverage favors diabetics especially those with cardiovascular complications that need monthly prescriptions (Ladd & Altshuler & Medical Library Association, 2013).
ACA allows patients the flexibility of selecting preferred doctors and facilities. People living with diabetes regularly access doctors and specialists who are fluent in their medical histories and therefore would prefer, if they can avoid it, not to switch doctors or specialists. Theoretically, this can allow such patients to access insurance policies that allow them to maintain existing doctors or specialists (Office of Disease Prevention and Health Promotion, 2018). Similarly, ACA health plans offer preferred health service providers which charge less. Again, in theory diabetics can, by checking with both the insurance providers and the local health providers, access health plans that include local health plans for their convenience. Generally, the ACA has sought to increase access of health insurance plans among Americans living with diabetes (Office of Disease Prevention and Health Promotion, 2018). Moreover, the law has mandated free screening services for diabetes and diabetes related complications.
ACA provisions affect all Americans, including clinical practice personnel and it has significant influence health service providers as well. Previously, the American healthcare system was characterized by professionals working in silos (Ladd & Altshuler & Medical Library Association, 2013). Not only did this model create communication challenges, it is also associated with increased healthcare expenses, challenges in patient safety and loss of efficiency. However, the healthcare system has undergone policy restructuring under the ACA, whose provisions seek to encourage practitioners to dispense care as part of a team. This is achieved by rewarding practitioners delivering services as teams (Mechanick & Kushner, 2016). These changes are inspired by the law for it draws attention to improving quality of care for diabetic patients as well by the shortage of healthcare workforce. Again, the American population is aging, increasing the complexity of its health needs, hence necessitating changes to improve care, access and manages costs. Collectively, these are some of the factors that have led to the adoption of inter-professional teams in the healthcare delivery system.
A feature of the aging American population is the prevalence of complicated, multidimensional medical conditions like diabetes. Such conditions necessitate the involvement of multiple health professions (Kuiper, 2016). Moreover, considering that the risk of death is twice that of patients without diabetes along with its attendant significant costs- about USD 180 billion in 2012 alone- diabetes management is improved through an inter-professional team (Centers for Disease Control and Prevention, 2017). Similarly, the growing complexity in the healthcare system necessitated the adoption of an inter-professional approach. Moreover, the modern understanding of diabetes and other chronic illnesses highlights the superiority of inter-professional team care in the primary setting (Kuiper, 2016). Functional inter-professional teams anchored in patient centered care operate with better efficacy and offer improved health outcomes and diabetic care.
Collaborative inter-professional teams offer diabetic patients continuous, active, and supportive care through the course of the disease present a model for the prevention and management of chronic diseases (Mechanick & Kushner, 2016). Indeed, the Chronic Care Model (CCM), a framework for the effective management of chronic diseases like diabetes, underscores the importance of inter-professional care in its system design (National Institute of Diabetes and Digestive and Kidney Diseases, n.d). In the same way, the Patient Centered Medical Home model (PCMH) encourages inter-professional teamwork in the proactive approach to health promotion, chronic disease management and prevention.
Improved cost management, care and health are fixtures in the objectives of inter-professional team approaches (Kuiper, 2016). However, in addition to the conventional benefits, this approach improves the experience for the provider as it reduces burden and burnout as well. Well implemented diabetes inter-professional teams are essential not only to intensive clinical management but also to health promotion and disease prevention. Notably, communication plays a significant role in the success of such teams, this emphasizes the need for communication skills and infrastructure to achieve optimal execution of the inter-professional team objectives (Kuiper, 2016).
Therapeutic advances notwithstanding, prevalence of diabetes is set to continue growing. Such a development will increase cost pressures on the health care delivery system. Moreover, the American population is aging and continues to present the health care delivery system with increasingly complex and multidimensional medical conditions. This situation is exacerbated by the shortage in the health care workforce, a shortage that is also set to grow in tandem with the increasingly aging population and their complicated medical needs. Chronic diseases like diabetes are costly to manage and significantly increase the odds of premature death. Similarly, this disease has great direct and indirect costs in addition to reducing patients’ quality of life. However, inter-professional teams, when constructed properly and are fully functional, offer solutions that address intensive clinical management, disease promotion and prevention.
References
American Diabetic Association. (2016). American Diabetes Association Opposes Affordable Care Act Repeal Without Immediate Replacement. American Diabetic Association . Retrieved from http://www.diabetes.org/newsroom/press-releases/2016/american-diabetes-opposes-ACA-repeal.html . Retrieved on May 13, 2018
Centers for Disease Control and Prevention. (2017). National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States. Centers for Disease Control and Prevention. Retrieved from http://www.diabetes.org/assets/pdfs/basics/cdc-statistics-report-2017.pdf . Retrieved on May 13, 2018.
Kuiper, R. (2016). Clinical reasoning and care coordination in advanced practice nursing . New York: Springer.
Ladd, L., D. & Altshuler, A. & Medical Library Association. (2013). The Medical Library Association guide to finding out about diabetes: the best print and electronic resources . Chicago: Neal- Schuman.
Mechanick, J., I. & Kushner, R., F. (2016). Lifestyle Medicine: A manual for clinical practice . New York: Springer.
National Institute of Diabetes and Digestive and Kidney Diseases (n.d). Team-Based Care. U.S Department of Health and Human Services. Retrieved from https://www.niddk.nih.gov/health-information/communication-programs/ndep/health-professionals/practice-transformation-physicians-health-care-teams/team-based-care . Retrieved on May 13, 2018.
Office of Disease Prevention and Health Promotion. (2018). Healthy People 2020: Diabetes. U.S Department of Health and Human Services . Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes . Retrieved on May 13, 2018.
