Results from next-d: Can a disease specific health plan reduce incident diabetes development among a national sample of working-age adults with pre-diabetes?

Moin T, Li J, Duru OK, Ettner S, Turk N, Chan C, Keckhafer A, Luchs R, Ho S, Mangione C. Results from next-d: Can a disease specific health plan reduce incident diabetes development among a national sample of working-age adults with pre-diabetes? Paper presented at: AcademyHealth Annual Research Meeting; 2015 Dec 14; Washington, DC.

Related HSR&D Project(s)

• SDP 12-549 – VA Diabetes Prevention: Enhanced Implementation Evaluation

Background: Prediabetes affects one third of adults in the United States and can significantly impact health outcomes and costs for large segments of the population who progress to diabetes. Population-wide approaches to diabetes prevention may include innovative health insurance benefit designs targeting working-age adults with prediabetes. Thus, our objective was to determine whether the Diabetes Health Plan (DHP), the first disease specific health plan designed with incentives to improve care for persons with prediabetes and diabetes, lowers rates of incident diabetes among adults with prediabetes. Methods: Our analysis included data from a large, national private insurer offering health plans to public and private employers between 2009-2013. In this natural experiment, propensity score matching was conducted at the employer-level to find comparable control employer groups, and an adjusted logistic regression model at the individual-level was used to test the association between DHP employer group status and incident diabetes diagnosis during the 3-years of follow-up after baseline. We examined eligibility and claims data from continuously covered employees and dependents insured over a 4-year study window. Our primary outcome was incident diabetes over 3 years of follow-up after baseline. Findings: Our analysis included data from 11,965 continuously enrolled adults with prediabetes (N = 1,538 from 9 employers offering the DHP; N = 10,427 from 105 control employers offering standard plans). DHP employees and covered dependents with prediabetes had a 7.6% lower absolute predicted probability of incident diabetes compared to individuals from employer groups offering standard benefit plans (29% predicted probability of incident diabetes for DHP vs. 37% for controls, p < .001). Implications for DandI Research: Our findings indicate that health insurance benefit designs that specifically increase prediabetes awareness and provide incentives and/or reduce barriers to recommended care for persons with prediabetes may be a viable means of preventing or delaying incident diabetes for working-age adults. To our knowledge, this is one of the first studies to examine the impact of health insurance benefit design on outcomes for patients with prediabetes and an area of needed future study.