The results suggest employers can make a different in health costs through a 2-step process: using testing to identify those at risk, and following up with evidence-based programs of lifestyle change and support.
A study presented Monday at the American Diabetes Association (ADA) Scientific Sessions found that one-third of those who initially screened positive for prediabetes or diabetes were able to bring their blood sugar down to normal levels after taking part in a workforce-based intervention.
The study by Quest Diagnostics, which involved a collaboration with the digital health provider Omada Health, shows promise for employer-based wellness programs that involve a 2-step process: screening for those at risk, and then offering an evidence-based program of lifestyle change and support for those whose health risks are revealed during screening.
At ADA, researchers presented results from 3 years’ worth of deidentified laboratory and biometric data for at-risk employees, as well as spouses or partners, who took part in the workforce-based program. After taking part in the intervention, 32% of those whose screening results showed they had prediabetes or diabetes were able to achieve normal blood glucose levels. Prediabetes was defined as having fasting glucose (FG) of 100-125 mg/dL or glycated hemoglobin (A1C) of 5.7% to 6.4%; while diabetes was defined as FG ≥ 126 mg/dL or A1C ≥ 6.5%.
After screening, 107 at-risk individuals in the study took part in the 16-week digital Diabetes Prevention Program (DPP) offered by Omada Health, which recently received full recognition status from CDC. Besides offering DPP to those with prediabetes, Omada Health announced last week that it will now offer digital programs for those with type 2 diabetes (T2D) or hypertension.
Besides helping one-third of participants return to normal blood glucose levels, the Omada program also:
Health costs fall to employers
Employers are the largest providers of health coverage in the United States, insuring 153 million people; despite changes in benefit design over the last decade, most still pay for the bulk of their workers’ care. Chronic conditions like diabetes and heart disease are top drivers of health insurance costs. Quest researchers cited a 2017 analysis by Willis Towers Watson that found employee health benefit costs rose 24% between 2001 and 2015 and are projected to rise as high as 6.5% in 2018.
Increasingly, employers are looking to disrupt healthcare delivery to lower costs—perhaps the most celebrated example is the collaboration of Jamie Dimon of JPMorganChase, Warren Buffett of Berkshire Hathaway, and Jeff Bezos of Amazon, who have tapped Harvard’s Atul Gawande, MD, MPH, to start an as-yet unnamed nonprofit to come up with new delivery solutions.
“Many employers are eager to implement employee wellness programs that drive better health and cost outcomes, but are unsure of how best to achieve these goals. This study demonstrates a viable 2-step solution—identifying people at higher risk using objective lab and biometric measures and then supporting their access to programs to modify behaviors and thereby reduce those risks,” said Quest Diagnostics’ Scientfic Director Charles E. Birse, PhD, who led the study.
Expanded offerings at Omada Health
Adam Brickman, spokesman for Omada Health, explained that the company’s expanded offerings beyond DPP allow employers and health plan customers to vastly expand the populations they can serve through Omada’s convenient digital format. The programs are personalized, Brickman said, so that a person who has prediabetes and hypertension will have a program that reflects that; a person who has T2D and hypertension will have a different program.
In a statement, Omada Health said it customizes programs based on a person’s clinical profile, demographics, self-identified barriers to success, actions once the program begins, and a person’s use of a connected glucometer and blood pressure cuff.
For example, couples who do the Omada program together but have different diagnoses—perhaps both have prediabetes but only one has hypertension—may end up eating many of the same foods, but they will have customized programs for their individual needs, Brickman explained in an interview.
“Omada delivers evidence-based behavior change by combining digitally-enabled coaching and clinical fidelity with sophisticated data science,” said Carolyn Bradner Jasik, MD, the company’s vice president of Medical Affairs, in a statement. “We will now bring that expertise to the challenging areas of medication adherence and remote monitoring through an extensible, flexible platform that treats the whole person—not just a single piece of their diagnosis.”
Birse BE, Lagier RJ, Chew P, Jasik CB, Madero EN. Reduction of diabetes and cardiovascular risk in a workforce through biometric screening and digital behavioral counseling. Diabetes. 2018;67(suppl 1). doi: 10.2337/db18-62-LB.