Patients spend about $17 billion annually treating potentially avoidable complications of diabetes, according to researchers at the Health Care Incentives Improvement Institute.
Identifying the causes, and preventing the development of these complications are powerful opportunities to improve care and lower costs in the healthcare system, particularly considering the prevalence of diabetes in the United States: in 2012, 9.3 percent, or 29.1 million Americans had diabetes, and an estimated 1 out of 3 people are expected to develop the disease in their lifetime, the analysis showed.
The researchers evaluated administrative claims data for nearly 10,000 adults with diabetes who had commercial insurance, and close to 7,000 who had Medicaid coverage. They processed the claims data through analytics software that separated costs of "typical" care from costs associated with potentially avoidable complications.
These complications, they say, are events that negatively affect patients, and may be controllable by the clinicians delivering care to the patients. In a diabetic population, potentially avoidable complications can range from a skin infection to acute pancreatitis or even amputations.
And the HCI3 analysis found that such complications are costly and common in both Medicaid and private insurance members.
"When healthcare leaders can zero in on where unnecessary costs are coming from, and identify which are caused by potentially avoidable complications, they're in a great position to start making changes that are going to be better for patients' physical and financial health," said François de Brantes in a statement. De Brantes is coauthor of the study and executive director of HCI3.
Data showed the majority of diabetes patients experience at least one potentially avoidable complication, costing an average of $1,043 per year for patients with private insurance and $1,869 for those with Medicaid. Such costs represent almost 23 percent of diabetes care costs among the commercially insured population and 28 percent under Medicaid, the institute found.
Extrapolating the data to the national population of adults with diabetes, the researchers identified $6.5 billion dollars annually in care for potentially avoidable complications suffered by patients with private insurance, and $10.3 billion for those with Medicaid, for a total of $16.8 billion.
Measuring potentially avoidable care costs is just one step toward improving quality and affordability of care, said de Brantes -- but it's a crucial one.
"Without the spotlight on problem areas, there's no progress," he said. "Data insights make it possible to alter payment models so they reward excellence, or to modify some clinical practices."