According to the American Diabetes Association, 27% of people with diabetes don’t even know they have it. Diabetes is a disease of elevated blood sugar levels. Elevated blood sugar is bad because it essentially ‘gums up’ the blood vessels and leads to (1) heart attacks, (2) strokes, (3) blindness, (4) kidney failure and (5) burning numbness. However, before these terrible end results occur, the blood vessels are ‘rotting on the inside’ usually without any signs or symptoms for years. As a result, many people with diabetes have ‘silent’ progression of their illness until it is too late and they have one of the devastating results numbers 1 – 5 above.
All of these facts are not new and well-known.
However, what does all this mean to the employee benefits professional? The impact of diabetes on an employee population’s health and claims cost often presents itself as catastrophic claims that do not necessarily fall under the diabetes ICD-9 category. Therefore, the true impact of diabetes is often undercounted in an employee population. To more effectively measure diabetes, it would be more appropriate to look at all claims costs related to (1) coronary artery disease, (2) cerebrovascular accidents (CVAs or ‘strokes), (3) retinopathy (eye damage), (4) nephropathy (kidney damage), and (5) neuropathy (nerve damage) and assume that 50% – 75% of all of those claims costs are caused by underlying diabetes. Once this mathematical exercise is performed, the personal and financial impact of diabetes is usually much greater than originally thought.
Diabetes ICD-9 codes are not always captured by provider billing departments when they are coding claims for the above diseases, so even if an ICD-9 code for diabetes is not there, the disease could still be present.
Employee benefits professionals have become much better at putting in biometric screening programs to identify those people with undiagnosed diabetes and the next step is to connect these people to healthcare providers to effectively treat the condition.