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July 20, 2012 at 10:11 AM
Imagine that you could start a health insurance company that enrolled only healthy people. Would you ignore your members until they got sick and then pay whatever expenses they incurred? Or would it be worth the cost to help keep them healthy as long as possible?
In the real world, where health plans insure people with chronic illnesses, they offer disease management services to help hold down costs. Even though services like telephonic counseling are expensive, they can help reduce hospitalizations.
But what if a plan could help people avoid using those services in the first place by helping them stay healthier?
The Avalanche Model
Chronic illness can be compared to an avalanche. Although both often seem to appear out of the blue, they are almost always preceded by warning signs. On a ski slope, expert skiers can often spot conditions that are likely to trigger an avalanche. Likewise, there are certain preconditions that can predispose individuals to chronic diseases.
Avalanches have three parts. The starting zone is the area that, though it may look stable, conceals dangerous conditions that can trigger a shift in the snow mass. This is analogous to the population with asymptomatic preconditions like prehypertension and prediabetes.
Section two, the avalanche track, is the path the avalanche takes down the mountainside. It can be compared to the accumulation of risk factors, such as inactivity and insulin resistance, that finally reaches a tipping point and results in chronic disease, such as diabetes. The avalanche model helps demonstrate a critical but often overlooked detail: once the accumulation of risks moves past the tipping point, health conditions become much more difficult and costly to treat.
The third section, the run-out zone, is where the avalanche comes to a stop. It is comparable to end-stage disease, the inevitable result for those who don’t succumb to acute illness or trauma. By intervening in the disease process early on, however, we may be able to delay or reduce the duration of disability from chronic disease. This is known as the compression of morbidity, a concept introduced by James Fries, MD, more than thirty years ago. Dr. Fries showed that, with the human lifespan approaching its maximum, people with healthier lifestyles will have shorter periods of disability because they will develop chronic disease closer to the time of death.
Why Pay Attention to People Who Aren’t Sick?
The statistics on diabetes are grim. Over 25 million adults in the U.S. have diabetes and in 2010, about 1.9 million adults were newly diagnosed. Diabetes is the seventh leading cause of death and is a major cause of heart disease and stroke. Estimated direct medical costs for diabetes in 2007 were $116 billion and indirect costs were $58 billion. Direct medical costs for people with diabetes were 2.3 times higher than for those without diabetes. The American Diabetes Association (ADA) states: “One in five health care dollars is spent caring for people with diabetes.”
But even people with prediabetes incur higher costs than those with normal blood sugar. The Centers for Disease Control and Prevention has estimated that in 2005-2008, 35 percent of Americans aged 20 and over—79 million – had prediabetes. ADA estimates that prediabetes accounts for $25 billion in health care costs annually. What’s a health plan to do? Providing telephonic counseling to everyone with prediabetes would be prohibitively expensive. Should health plans simply ignore the impending avalanche?
