Clinically Speaking: Cardiodiabesity 101

More than half of U.S. adults suffer from cardiovascular disease, diabetes or obesity and a growing number experience all three. Plan sponsors can take action to address this increasingly complex challenge.

Cardiodiabesity health care challenges

The prevalence of cardiodiabesity is growing, with patients at greater risk for poor health outcomes, including premature disability and death. Between 1999 and 2020, the rate of adult obesity in the United States climbed from 30.5% to 41.9%. By 2030, it’s estimated to be 50% or more. Obesity also affects 19.7% of U.S. children. Similarly, the prevalence of diabetes has increased steadily, affecting 37.3 million people in 2019. And, although the heart disease death rate had declined for nearly a decade leading up to 2020, it surged in the wake of the COVID-19 pandemic.

Ultimately these conditions drive one another. Patients with obesity are more likely to develop diabetes and cardiovascular disease. In fact, 30% to 50% of all new diabetes diagnoses are linked to obesity. Almost 85% of patients with diabetes have either hypertension or high cholesterol, which are primary contributors to heart disease and stroke – the #1 and #5 leading causes of death in the U.S.

Cardiodiabesity cost challenges

As the incidence of cardiodiabesity continues to rise, the cost pressures on the health care system intensify. Obesity costs the system roughly $173 billion a year. The price tag for heart disease and stroke is roughly $219 billion. And diabetes costs an estimated $327 billion, including both health system expenses and lost productivity.

Doctor’s visits, hospital stays, and the cost of prescription medications – particularly expensive weight-loss drugs known as GLP-1s – contribute to higher trend. Employers must also contend with missed workdays and other bottom-line burdens.

The good news is both premature death and disability from cardiodiabesity are possible to overcome. Treating the conditions early and holistically can ultimately improve care and clinical outcomes for patients and reduce costs.

Taking action on cardiodiabesity

Managing cardiodiabesity has many facets, so plan sponsors are wise to focus on data-driven solutions designed for comorbid conditions. Using medical data and insights to ensure appropriate usage, and encouraging lifestyle changes through plan design can vastly improve member outcomes and decrease client spend.

Here are some questions for payers to consider for their cardiodiabesity strategy:

  • Does your plan currently have weight loss coverage? Do you want to cover it?
  • Do you want to implement more aggressive utilization management for GLP-1s?
  • Are you solely focused on weight loss or looking for an integrated solution that addresses each comorbidity?
  • How important are clinical outcome guarantees?

Overall, plan sponsors should look for features such as plan-specific clinical and financial insights, integrated vendor partnerships that support interventions to close gaps in care, utilization management to decrease pharmacy spend, and finally, guarantees around reducing wasteful spending and improving clinical outcomes.

What is the cost of inaction? First is the direct cost of caring for the huge volume of patients who are, or will be, included in the cardiodiabesity category, especially those who are improperly managing their health. Second is the indirect impact of productivity losses, which are estimated to range from 13 to 27 billion dollars nationally. Third is the expense of a tidal wave of new drugs for these conditions coming to market.

Implementing a solution today can help improve health outcomes and stabilize expenses in the long term. If members can maintain their well-being, better health and healthier spending will follow.

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EncircleRxSM: Cardiodiabesity
Evernorth’s EncircleRx is a data-driven solution portfolio that helps plan sponsors reduce costs and enhance outcomes. The EncircleRx: Cardiodiabesity solution gives clients optionality and predictability in managing cardiodiabesity – obesity, diabetes and cardiovascular disease with the first-ever GLP-1 financial guarantee from a PBM.