When People Corp. started looking into reducing its claims numbers related to chronic disease, it decided to tackle what Judith Plotkin, vice-president of health and wellness solutions, called “the Four Horsemen of the Apocalypse:” diabetes, obesity, heart disease and high blood pressure.
The four conditions are comorbidities not only with each other but other afflictions such as arthritis, respiratory illnesses, chronic obstructive pulmonary disease and mental-health challenges. “When we looked at how to focus a program, in terms of chronic-disease coaching, we realized we have to look at all of these as they interrelate to one another,” Plotkin said during Benefits Canada’s 2021 Chronic Disease at Work conference in late February.
The group-benefits provider decided to first focus on diabetes, because it had claims data it could measure to determine the impact of its programs, Plotkin said. Within Canada, 11 per cent of Canadian adults over the age of 20 live with diabetes. Looking at People Corp.’s claims, plan members with type-2 diabetes who aren’t on insulin spent about $1,500 on average in 2019, typically on anti-diabetic medications or other tools. Plan members with advanced diabetes tended to spend around $3,000 that year. In comparison, a healthy plan member spent approximately $300 on claims in 2019.
While anti-diabetic medication Metformin was the most common drug claim for plan members with diabetes, she noted People Corp. was starting to see more-expensive drug and device trends for diabetes. “So back to our estimate of between $1,500 and $3,000, those numbers are actually going up in more recent data. We know that by case this is quite an expensive illness. . . . It’s quite costly in terms of the health cost and in terms of the workplace burden.”
Expense is broader than just claims data, she said, as diabetes is often associated with comorbidities such as heart disease and potential amputations or blindness. As well, the disease has an income level and racialized component, often more prevalent in South Asian and Black communities and lower income groups. “It’s worthwhile to [point] that out when we’re looking at the cost and the cost in our communities.”
The company partnered with NDC-Nutrition at Work to on a nutrition- and health-coaching program for plan members. The platform includes an online assessment and has online tools such as a goals tracker, resource library, food and mood journals and live chats with a registered dietitian.
Plotkin said one of the first challenges the company needed to address was the potential stigma associated with using the service. To do that, People Corp. dug into its claims data to determine who was most likely to benefit from the program. The profile it developed was someone with type-2 diabetes, aged 45 or over and more likely to be male than female.
To encourage the uptake that could lead to behaviour change, People Corp. and NDC included a “robust” number of live sessions with diabetes educators in the program and the ability to have those chats by phone, rather than over video. “We realized that we’re trying to attract users who may not be the most tech savvy amongst a member population. . . . We looked at something that could be very engaging and something that could really speak to a wide variety of folks, [including] people who may have previously felt some stigma about reaching out.”
The program is meant to support plan members with lifestyle interventions, including nutrition counselling and encouraging physical activity and behaviour modification, all of which can decrease the risk of developing type-2 diabetes by up to 70 per cent.
Karine Levy, a registered dietician and clinical manager at NDC-Nutrition at Work, said nutrition coaching often results in increased consumption of fruit, vegetables and fibre and decreased intake of fat. The lifestyle interventions also improve blood pressure and cholesterol levels after about three months of work and decrease body weight by roughly three to six kilograms after at least a year.
The partners found that plan members who completed at least three or five of the coaching sessions reported having a better knowledge of healthy eating, felt more confident, experienced higher energy levels and saw improved weight management. “We’re seeing that this virtual coaching is helping members achieve positive eating behaviours and relationships with food and it’s also increasing adherence, which increases the quality of life,” Levy said.