Sustainable ways to lower healthcare claims in Diabetes: Shift from traditional approach to a Digital way of managing Diabetes.
Introduction: India is experiencing a rapid increase in diabetes.(1) Alarmingly, 80% of patients have poor glycemic control (HbA1c >7%) increasing the risk of severe complications.(2) It is essential to have a multifaceted approach to diabetes management, considering its clinical, economic, and second and third-order implications on society and the country.
Impact on the Indian Economy from a Health Insurance Perspective
India is facing a substantial economic burden of diabetes management, with patients spending an average of up to 10% of their annual income on treatment. Severe complications requiring hospitalization can escalate costs to 21% of annual income. India's annual spending on diabetes treatment is Rs. 1.5 lakh crore, growing by 30% per annum, which is 4.7 times the central health allocation. (3)
This financial strain is intensified in the insurance industry, where unmanaged diabetes results in increasing premiums and decreased policy approvals for the larger diabetes population. This affects the topline of the insurer as well as leaving a large segment of people un-insured and financially vulnerable. With persistency and aging cohorts, most of the health insurers have 25-30% of their policyholder pool struggling with diabetes. Typically, diabetes cohort drives higher hospitalization rates and claims due to direct and indirect causes. This is a ticking time bomb every year for an insurer. In this scenario, examining sustainable methods to reduce healthcare claims using the best available solutions is essential. Conventional approaches might emphasize prompt medical treatments, whereas a long-term sustainable approach will make the person with diabetes sufficient in managing diabetes by leveraging the healthcare resources such as doctors and health coaches as well as technology.
Digital (New age) Approach to Managing Diabetes:
In this critical situation where diabetes has become a pandemic, we must move beyond the traditional approach to treating diabetes and seek solutions that provide real-time support and guidance. Digital therapeutics offer an effective and sustainable way forward. A digital approach to managing diabetes leverages innovative technologies like mobile apps, wearable devices, and continuous glucose monitors (CGMs) to provide real-time data, personalized insights, and tailored plans. This approach empowers patients by tracking glucose levels, adjusting lifestyle choices, and receiving personalized feedback. Digital tools foster patient engagement, encourage adherence to treatment plans, improve clinical outcomes and provide early detection of complications.
In developed countries like the USA, digital therapeutics (DTx) are being increasingly adopted to improve glycemic control and reduce hospitalisations for diabetes patients. The FDA has introduced streamlined approval processes, such as the Pre-Certification Pilot, to foster innovation in DTx. Additionally, insurance companies are beginning to reimburse evidence-based digital solutions, recognising their potential to lower healthcare costs while enhancing patient outcomes. (4,5) This global perspective underscores the potential for similar adoption in other countries to achieve better health outcomes and economic efficiency in diabetes management.
Investing in a multidimensional approach to reduce future Diabetes burden:
While evaluating diabetes solutions, we are drawn by instinct towards traditional budget impact models that offer a narrow lens of financial assessment for only 1-2 years. We propose a comprehensive approach known as Cost-Consequence Analysis, which goes further by evaluating the long-term health outcomes of diabetes treatments, such as preventing complications like Cardiovascular Disease, Kidney Diseases, or Retinopathy but also considers elements like patient empowerment, Personalised lifestyle modifications, and Community support.
We can best illustrate this with a case study. Imagine an insurer processing 800,000 claims every year. By heuristics, 25% of these will have diabetes as the direct or indirect contributor for hospitalization. A targeted digital lifestyle management program provides this high-risk group with an intensive lifestyle management program to optimize blood sugar control, stop progression and reduce claims in the next 1-5 years.
The following table outlines key drivers of diabetes-related claims and the possible reduction in the incidence of these events once policyholders are onboarded to the lifestyle management program. This data is based on various clinical trials across the globe which had interventions that reduced HbA1c in people with Diabetes.
Condition | Avg claim amount (INR) | Risk Reduction in 5 Years |
Diabetic Retinopathy & Cataract (6) | 50,000 | 30% |
Myocardial Infarction (7) | 200,000 | 20% |
Stroke (8) | 250,000 | 25% |
Kidney Disease (9) | 100,000 | 30% |
Infections (per year reduction) (10,11) | 100,000 | 12% |
Foot Infections (12) | 100,000 | 40% |
Hospitalizations & Mortality (13,14) | 110,000 | 30% |
Based on this, we expect the following claims reduction with high program completion (100%) and low program completion (50%):
Claims Count Reduction | In 5 years |
High | 11000 |
Average | 8,800 |
Low | 6,000 |
2.5 - 4.2% reduction in overall healthcare claims for type 2 diabetes policyholders.(15)
Based on the above claims’ reduction, potential savings with high program completion (100%) and low Program Completion (50%) would be as follows:
Potential INR 65-115 crore annual savings on diabetes-related expenditures for insurers in the 5-year time horizon. (4)
Program Completion | Savings in 5 Years (INR) |
High | 150 Crore |
Average | 115 crore |
Low | 76 Crore |
This table clearly shows the clinical and economic benefits of a digital approach to manage Diabetes for an insurer. Fitterfly has presented several studies across health conferences in India and abroad and we are now taking this approach live with 3 top insurers. Our latest publication in a reputed peer reviewed journal, JMIR Diabetes reported a 1.2% reduction in HbA1c among the study population. (16)
Conclusion
Digital health solutions like Fitterfly are essential for shifting healthcare from a reactive to a preventive model, improving long-term health outcomes while minimising future medical costs. This approach transcends traditional, one-size-fits-all treatments by addressing individual needs as well as nurturing a healthcare ecosystem that empowers individuals and communities alike. Investing in such comprehensive models allows us to reimagine healthcare as a strategic investment.
Authors | Designation |
|---|---|
Chief Medical Officer, Fitterfly Healthtech | |
CEO & Co-Founder, Fitterfly Healthtech |
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Joshi, S., Verma, R., Lathia, T., Selvan, C., Tanna, S., Saraf, A., Tiwaskar, M., Modi, A., Kalra, S., K, V., Chitale, M., Malde, F., Abdul Khader, M., & Singal, A. K. (2023). Fitterfly Diabetes CGM Digital Therapeutics Program for Glycemic Control and Weight Management in People With Type 2 Diabetes Mellitus: Real-world Effectiveness Evaluation. JMIR diabetes, 8, e43292. https://doi.org/10.2196/43292
Internal Data analysis, Fitterfly.
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