Today, more than half of all Medicare Advantage (MA) beneficiaries have access to over-the-counter (OTC) health benefits. MA plans have a unique opportunity to offer supplemental benefits to plan members living with chronic illnesses from diabetes to heart disease and more, by tailoring them to an enrollee’s specific needs and conditions.
Approximately 80% of older adults have at least one chronic disease. The National Diabetes Statistics Report 2020 states that there are 14.3 million seniors age 65 and older living with diabetes specifically, one of the leading chronic conditions affecting Americans today. Plans that tailor OTC programs towards members with diabetes, make it easier for members to access specific products for their condition, and can realize savings and a healthier membership.
Long-term complications of diabetes evolve slowly over time. The longer a person has diabetes–and the less controlled a person’s blood sugar–the higher the risk of disabling or even life-threatening complications.
Poorly managed diabetes of any type can lead to heart disease, stroke, kidney disease, high blood pressure, eye damage, and foot problems. Poor management results in worse health outcomes for patients and negative financial consequences. In the general population, diabetics incur an average of $16,752 per year in medical expenditures, of which $9,601 is attributed to diabetes. On average, medical expenditures are approximately 2.3 times higher for those diagnosed with diabetes than they would be in its absence.
The median cost of care for patients with poorly managed diabetes surpassed patients with
controlled diabetes by nearly 43% in the 65-to 75-year-old age group,
rising almost to a 50% gap for individuals age 85 and up.
(“Costs of Managing Patients with Diabetes in a Large Health Maintenance Organization in Israel: A Retrospective Cohort Study,” by Avi Porath, Naama Fund and Yamin Maor)
The National Council on Aging website states “in a 2007 Centers for Disease Control and Prevention program for people at high risk of developing diabetes, lifestyle intervention reduced risk by 71% among those aged 60+.” In a time when the majority of MA plan members believe their plans aren’t doing enough to help them manage their conditions, investing in supplemental benefits designed for members with chronic illnesses has the potential to lead to many positive results not only for health plans, but for those beneficiaries.
Patients with chronic illnesses, like diabetes, may be more apt to select MA plans that are more focused on their chronic conditions. Navigating the world of healthcare can be complicated and overwhelming for persons of any age. Simplifying the process by promoting MA OTC benefit programs targeted towards diabetics will make sorting through enrollment options easier and lead beneficiaries to your plan.
A tailored OTC benefit program for diabetes can include such beneficial items as diabetic skin relief cream to keep the skin moisturized and help to reduce cracks, Neosporin® on existing cuts to reduce the chance of infection, compression stockings to aid with lower extremity circulation, and Diabetic Tussin DM, a sugar free cough syrup.
Social determinants of health play a central role in the development and progression of type 2 diabetes,10 in the senior population.
The OTC benefit can be designed to address SDOH and chronic conditions like diabetes, which affects all social, economic, and ethnic backgrounds. A diabetic-focused supplemental benefit program can address the following SDOH factors:
Community infrastructure: When barriers to community infrastructure such as reliable transportation, neighborhood safety and access to healthy food exist, it makes it more difficult for diabetics to manage their condition. For example, a senior with type 2 diabetes living in a remote rural area with limited access to transportation may need to travel outside of the local community to visit healthcare providers or purchase nutritious food.
Benefits programs offering specialized access to OTC products and related services to diabetic plan members can help mitigate limitations such as travel.
Economic standing & education: Research shows a direct relationship between socioeconomic status and health outcomes. An article by Hui Zheng and Linda K. George reported that education level, employment, and family income affect socioeconomic status that in turn affects health. Research shows that individuals with less education and lower income are 2 to 4 times more likely to develop diabetes than those with more opportunities. Additional studies show that people with higher levels of education are more likely to take part in preventative healthcare such as healthy eating and physical activity, which is key to managing some types of diabetes.
A comprehensive supplemental benefits program can address issues of socioeconomic status and health outcomes by offering educational outreach via phone or online, providing members with additional support in the utilization of their benefit and the products and services themselves.
Access to medical care: Access to medical care may be an issue based on socioeconomic status, where people live, race / ethnicity, and culture. Inner cities and remote rural regions, for example, tend to lack both primary and specialty healthcare providers, thus reducing access to healthcare for those with diabetes and other chronic conditions.
Low-income members realize significant relief with access to a supplemental OTC benefit, particularly a strategically built and disease targeted program. AARP proclaims that an OTC benefit can bring savings of at least 40% on OTC medicines and products.
Customizing MA OTC benefits toward diabetic beneficiaries is critical to surviving in such a competitive market. It is not enough to offer the bare minimum to your members. Leveraging these benefits is crucial to not only improve the immediate health outcomes of your high-risk members, but also improve the plan and its ability to meet the holistic needs of its members.