November 17, 2024

by Michael R. Wickline | Arkansas Democrat-Gazette

An Arkansas Legislative Council subcommittee has recommended that the state’s health insurance plans for public school and state employees implement a diabetes management program that includes mental health and other comorbidity monitoring and treatment integrated within the diabetic treatment module.

The diabetes management program also would include claims integration to help identify high-risk individuals for pro-active outreach, control over GLP-1 drug costs and performance guarantees that address proactive outreach process measures in addition to outcome measures for mental health and other comorbidities under the recommendations of the Legislative Council’s Employee Benefits Division Oversight Subcommittee.

The subcommittee approved a report on its recommendations on Thursday.

GLP-1 drugs are medications used to manage diabetes that were found to have a side effect of weight loss, according to Grant Wallace, director of the state’s Employee Benefits Division.

GLP-1 drugs either have FDA approval to treat diabetes such as Monjuaro and Ozempic, or FDA approval to treat obesity such as Zepbound and Wegovy, he said in March.

The Legislative Council Employee Benefits Division Oversight Subcommittee’s recommendations include that the state’s Employee Benefits Division issue a request for proposal to seek a competitive bid for the diabetes management program.

The division should compare vendor fees and consider whether the vendor offers credits or allowances to offset its costs, and negotiate competitive vendor contracts that include performance guarantees, according to the subcommittee’s recommendations.

It is important to manage the rollout of the diabetes management program and member engagement communications because the learning curve can be steep as participants adjust to the new user experience, the subcommittee said in its three-page written report.

In addition, the return on investment from the diabetes management program should be measured periodically, according to the subcommittee.

The state’s Employee Benefits Division “does not have a specific management plan currently for our members who are diagnosed with diabetes beyond what is accomplished through case management with BCBS (Blue Cross Blue Shield) and the traditional treatment options of diet and medication,” according to Wallace.

“We do offer bariatric surgeries for qualified members managing diabetes along with other comorbidities,” he said in March. Last fall, he said “we have 14,501 of members diagnosed with diabetes.”

The state’s health insurance plans for public school and state employees cover more than 150,000 people.

Act 113 of 2022 — sponsored by Rep. Jeff Wardlaw, R-Texarkana — created the Legislative Council Employee Benefits Division Oversight Subcommittee and included a requirement that the subcommittee study general diabetes management programs to evaluate the viability and sustainability of a general diabetes management program for the state’s insurance health plans for public school and state employees.

In 2022, the Legislative Council’s Executive Subcommittee authorized the Bureau of Legislative Research to contract with the consultant the Segal Group to provide actuarial and consulting services, including assisting the Employee Benefits Division Oversight Subcommittee with the study mandated by Act 113 of 2022.

In March, the Segal Group recommended the state’s public school and state employee health insurance plans implement a diabetes management program that includes mental health and other comorbidity monitoring and treatment integrated with the diabetic treatment module.

In calendar year 2022, the state’s public school and state employee health insurance plans had 6,839 active and non-Medicare retirees who were considered obese diabetics — up from 5,471 in calendar year 2020 and 6,670 in calendar year 2021 — as the prevalence of obesity within the diabetic population has increased during the past three years, the Segal Group said in its report to the subcommittee in March.

In calendar year 2022, 74.5% of diabetics also were classified as obese and 4.6% had at least one medical nutrition therapy during the same period, the consultant said.

In March, Sadhna Paralkar of the Segal Group told lawmakers that the prevalence and costs of diabetes are high in the state’s health insurance plans for public school and state employees and need to be addressed.

Comorbidities of diabetes present a higher burden of illness such as hypertension, hyperlipidemia, cardiovascular disease and obesity, she said. Mental health as a comorbidity remains very high as well, she said.

The costs of newer diabetes medications such as GLP-1s are very high and need to be managed, Paralkar said.

In addition, members of the health insurance plans living in areas deprived of health care need more help in diabetes management in terms of health education, coaching, access and affordability than anybody else, she said.

Fifty-eight percent of the diabetics in the plans reside in moderately disadvantaged areas of the state, but the most disadvantaged areas have the highest diabetes prevalence for the plans at 10.4%, Paralkar said.

The breakdown of key utilization metrics showed that high-cost treatment settings such as hospital inpatient and emergency rooms is the highest for the most disadvantaged members, while the low-cost treatment settings such as urgent care and telehealth are the lowest for the most disadvantaged members, she said.

Preventive visits also were the lowest for the most disadvantaged group, Paralkar said.

Read full article HERE.