Designing plans to manage comorbid conditions

As more Americans cope with chronic conditions, health plans should focus on helping them manage not only individual conditions, but also complex comorbid conditions.

In the United States today, six in 10 adults have at least one chronic condition, and four in 10 have two or more chronic conditions. Comorbidities have become widespread.

Prominent among them is cardiodiabesity, the triple diagnosis of cardiovascular disease, diabetes, and obesity. On their own, these individual conditions drive costs and threaten patients’ health. Combined, they lead to greater expenses and worse health outcomes, which can include premature disability and death.

Health plans should address the combined effects and related nature of these conditions.

Cardiodiabesity on the rise

Having one of these individual conditions can lead to developing another, and ultimately to developing cardiodiabesity. With all three conditions on rise, cardiodiabesity is shaping up to become an epidemic with devastating consequences.

• The rate of obesity among U.S. adults reached 41.9% in 2020, up from 30.5% in 1999. People with obesity are at greater risk for developing type 2 diabetes and heart disease.
• About 11.3% of the U.S. population has diabetes. The rate of adult diabetes climbed steadily over the last two decades. Diabetes can lead to heart disease and stroke.
• One person dies every 33 seconds from cardiovascular disease in the United States. After a decade of decline, the cardiovascular disease death rate rose again after the onset of COVID-19.

Lifting the administrative burden for clients

With chronic conditions becoming more common, health plans should provide simple, tailored solutions to address comorbidities. By creating a more cohesive benefit, they can spare clients from wading through the many point solutions available.

A health plan that takes an analytical, data-driven approach to these complex conditions can offer greater efficiency for clients and reduce their number of administrative steps. What’s more, it can help control expenses.

Reducing costs

Cardiovascular disease, diabetes, and obesity are complex, costly to manage conditions. Consider the financial burden of each on the U.S. health system, including doctor visits, hospital stays, and prescription medications.

• Obesity costs about $173 billion a year.
• Diabetes costs about $327 billion a year, including lost productivity.
• Heart disease and stroke cost about $219 billion a year.

More recently, people have been using glucagon-like peptide 1 (GLP-1) agonists, a class of diabetes medications, to lose weight. This trend has created supply shortages and disrupted plan forecasts and budgets, while many patients with diabetes already struggle to afford medications.

Better health outcomes through health plan design

Individuals and health plan providers will continue to bear the burden of chronic conditions, but the right benefit can be the key to solving the complexities of cardiodiabesity. It should draw on plan-data to do the following:

• Identify opportunities for interventions
• Close gaps in care
• Better manage pharmacy spend through appropriate utilization management

All of this depends on the health plan’s design. It should have a holistic view of patients’ health, including any cardiodiabesity conditions they have. Based on this information, it should anticipate care needs while also keeping the patient engaged.

Using data-driven insights, a health plan can encourage lifestyle changes and support treatment to improve health outcomes and reduce expenses.