March 13, 2024

by Michael R. Wickline | Arkansas Democrat-Gazette

A consultant on Wednesday 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.

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 outcomes measures for mental health and other comorbidities under the recommendations of the Segal Group, a consultant to the Bureau of Legislative Research.

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

Dr. Sadhna Paralkar of the Segal Group recommended the state’s Employee Benefits Division issue a request for proposals 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 guarantee, she said in a report to the Legislative Council’s Employee Benefits Division Oversight Subcommittee.

Paralkar said it’s 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 return on investment from the diabetes management program should be measured periodically, she said.

Sen. Alan Clark, R-Lonsdale, questioned whether these type of wellness programs dealing with diabetes work for everybody. In response, Paralkar said the programs definitely work if somebody is motivated enough to lose weight.

“We just need to hammer the message home with communication of how this is going to impact your life in the future and get that person motivated,” she said. “When they are motivated enough, it does work with all of these interventions and sometimes these drugs … [put them] on the right track so you get that initial boost and you just have to maintain that lifetime.”

“But not doing anything is not an option either, so we have to help the members achieve the boost when they need it,” Paralkar said.

Sen. Linda Chesterfield, D-Little Rock, said “at some point in time if we are able to harness better health, then we should look forward to lower costs.

“I am not sure it’s going to happen unless this committee or some other legislative committee is working to make sure that that happens” she said. “I think this is one of the more important conversations … that we are having in the Legislature and one of the more positive ones.”

But Sen. Gary Stubblefield, R-Branch, said if a person skips these drugs and has enough willpower to eat healthy and exercise that the person can bypass using these drugs.

The Legislative Council’s Employee Benefits Division Oversight Subcommittee on Wednesday didn’t take action on the consultant’s recommendations because the recommendations for the diabetes management plan will be part of a larger wellness program recommended by the consultant that will be considered for the state’s public school and state employee health insurance plans, said subcommittee Co-Chairman Rep. Aaron Pilkington, R-Knoxville.

“I don’t think we’ll probably take action until … July,” he said about the subcommittee taking action on the consultant’s recommendations.

Act 113 of 2022, sponsored by Rep. Jeff Wardlaw, R-Texarkana, requires the subcommittee to file a report by July 1, 2024, summarizing the results of a study of general diabetes management programs to evaluate the viability and sustainability of a general diabetes management program for the state’s health insurance plans for public school and state employees.

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. Last fall, he said “we have 14,501 of members diagnosed with diabetes.” The plans cover more than 150,000 people.

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 over the past three years, the Segal Group said in its report to the subcommittee.

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.

Paralkae said 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 health care deprived areas 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.

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