The Evernorth Research Institute’s latest cardiodiabesity report helps illustrate sites of care where preventive interventions can make the greatest financial impact.
Incorporating interventions proven to prevent and control cardiodiabesity conditions into care protocols is a key to slowing or stopping progression of disease, and a new report from the Evernorth Research Institute provides a hint of the potential cost savings that can result.
Cardiodiabesity encompasses cardiovascular disease, type 2 diabetes, and obesity, which are among the biggest health problems in the United States and carry a total cost estimated at $719 billion a year.1 Previous research by the Institute found that cardiodiabesity is a progressive disease, with a large majority of patients experiencing worsening health.
The new report explores the utilization and costs of health care services for patients experiencing the three stages of cardiodiabesity:
- Early stage, with risk factors but no diagnosis
- Active stage, following a diagnosis of type 2 diabetes, obesity, or cardiovascular disease or a combination
- Advanced stage, experiencing severe complications such as heart attacks, strokes, and heart failure
The report also highlights how the costs and the utilization of health care services change as patients progress to the next disease phase – increases which may be avoided when effective risk factor control measures are in place.
“This latest report helps us better understand how health care services are used and where the key cost drivers are,” said Urvashi Patel, Ph.D., vice president of the Evernorth Research Institute. “This helps guide our employer and health plan partners to place interventions where they can do the most good.”
“The interventions proven to prevent diabetes, obesity, and cardiovascular disease such as blood pressure control and smoking cessation are also proven to stop progression to severe complications like heart attacks and strokes,” said Dr. Calie Santana, senior medical principal at Evernorth. “We have multiple opportunities along each person’s journey to reduce harm and costs in all stages of cardiodiabesity, especially for those who have not yet experienced the harm of severe complications.”
This research is based on an analysis of over 3 million insured patients diagnosed in 2019 through 2021 with early stage or active cardiovascular disease, type 2 diabetes, and/or obesity. Here are three key findings from the new report:
1. Comorbidities contribute significantly to costs
The research found that care costs for patients with active cardiodiabesity increased when they had multiple cardiodiabesity conditions. Compared with patients diagnosed with one of those conditions, the average annual total cost of care per year was 53% higher for patients diagnosed with two conditions and 141% higher for patients diagnosed with all three.
Average total cost of care for active cardiodiabesity patients ($ per patient per year)
2. Costs rise with disease progression
Care costs grew as patients progressed from one disease phase of cardiodiabesity to the next. Average total annual costs for early stage patients (with risk factors) who progressed to active cardiodiabesity within one year increased by 155%, more than three times the average 42% cost increase for patients who did not progress. Among patients with active cardiodiabesity, average annual total cost of care rose 42% for patients who progressed to the advanced stage and remained flat for those who did not progress.
Average total cost of care ($ per patient per year)
3. Hospitalization and inappropriate emergency department visits drive up the cost of care
The highest increases in the cost of care for all phases of cardiodiabesity were from hospitalizations, which also accounted for the highest increase in utilization among care services.
“The rate of increase for hospital visits was five times greater for patients who progressed to the next phase of cardiodiabesity compared to those patients who didn’t, which is alarming,” Dr. Santana said. “This points both to the strong need for employing interventions proven to prevent progression and for adequately supporting those who have recently left the hospital and are at highest risk of being admitted again. Bolstering existing clinical networks with virtual care, guideline-based medication management, and remote monitoring is crucial to preventing these admissions.”
Emergency department visits represented the next highest increase of care services used by patients in all phases of cardiodiabesity. In particular, the increase of inappropriate emergency visits for health issues that were not an emergency, preventable, or treatable by a primary care physician was significantly higher among patients who had progressed to the next disease phase. Among all patients who progressed, emergency department visits cost an average of $373 to $477 per patient each year.
Rate of increase in inappropriate emergency department visits in one year
“This is an area employers and health plans can address now by facilitating access to the most appropriate level of care that the patient needs, which leads to cost savings for both the plans and the patients,” Dr. Santana said. “Although the increase of emergency department visits was lower for those who did not progress to the next phase of cardiodiabesity, these patients still had a significant percentage of preventable visits, so wrap-around access should target everyone across all phases.”
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1 CDC. “Chronic Disease Fact Sheet.” Last reviewed September 8, 2022. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/nutrition.htm. CDC. “Heart Disease and Heart Attack.” Last reviewed August 17, 2021. https://www.cdc.gov/policy/polaris/healthtopics/heartdisease/index.html. CDC. “Diabetes.” Last reviewed August 9, 2021. https://www.cdc.gov/policy/polaris/healthtopics/diabetes/index.html.