After my physical every year (wink wink), I become a nervous wreck waiting for my doctor to phone with the lab results. After all, there are a host of things that you never want to hear your doctor say. One of my biggest fears? "You have diabetes."
It's not unprecedented in my family. My Dad developed type 2 diabetes in his early 60s. His sister became diabetic in her 50s. My cousin, on my Dad's side, of course, also had late-onset symptoms. History isn't necessarily on my side.
There are a host of other risk factors, I know, but in advance of writing this column, I took a quick risk test on the American Diabetes Association website and — I sure hope no one at BCBS of Illinois is reading this — and I scored relatively high. (Truth be told, I exaggerated a couple of answers understanding that it would probably skew the results. Still, the bright red warning sign was a bit startling.)
If I ever do receive that fateful call from my doctor, I won't be alone. As Geri Aston reports in a new bimonthly series (page 34), the diabetes epidemic threatens to overwhelm the U.S. health care system. Roughly 26 million Americans have the disease, which is responsible for $116 billion in direct medical costs annually and $58 billion in indirect costs. Estimates suggest that nearly half of all Americans will be diabetic by 2020.
In the article, the ADA's LaShawn A. McIver notes, hospitals and health systems will be on the front lines — even more so than now. She points out that the Affordable Care Act removes many barriers that had prevented diabetics from getting coverage and thus access to care. Additionally, the migration toward a more integrated delivery system means hospitals will have to be more connected to primary and post-acute care.
Some progessive health systems are out in front, setting up disease-management programs targeted at diabetics. UMass, for instance, harnassed the power of its EHR. Through MyCareTeam, patients can regularly transmit vital signs to their care team. Patients and clinicians can see data in an organized manner and spot patterns. Since the data are integrated into the EHR, it triggers alerts.
For as innovative as systems like UMass are, there's still an enormous opportunity for the nation to attack diabetes from a population health standpoint. In 2011, researchers from the University of California, San Francisco; San Francisco General Hospital and Trauma Center; and the state Department of Public Health found that the vast majority of treatment guidelines are geared toward managing diabetes in individuals, not planning care for populations.
"In order to improve diabetes for populations, rather than individuals, we need to know how to maximize health and quality of life with the limited resources available," lead researcher Urmimala Sarkar, M.D., assistant professor at UCSF, said when the study was published.
That won't be easy. As our cover story (page 26) denotes, there's a pretty significant talent gap in health care when it comes to providing population-level intelligence. Given the size of this epidemic though, it seems that diabetes is the best place to start honing those skills and targeting solutions.
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