Diabetes is one of the most common chronic diseases in the U.S. and employers have plenty of experience dealing with this costly health issue. But the COVID-19 pandemic has caused a reset on employee health in many ways, and management of diabetes could see an improvement as both employers and workers pay more attention to employee wellness and associated topics such as mental health.
The costs associated with diabetes are staggering: the CDC estimates total costs of diabetes in the U.S. to be $327 billion annually. This includes more than $3 billion in absenteeism and $27 billion for lost productivity. Medical costs are estimated at $237 billion annually, much of which is covered by employer-sponsored insurance plans.
In addition to the challenges of managing type 1 and type 2 diabetes, millions of Americans have prediabetes, and most of them don’t know it. The disease is associated with a number of co-morbidities, including heart disease, hypertension, and depression. In addition, gestational diabetes affects millions of women each year.
Cheryl Larson, president and CEO of Midwest Business Group on Health, noted that the CDC has designated diabetes as the most expensive chronic disease in the U.S., one that has a direct impact on workplace productivity. “It’s the biggest health care cost that employers face,” she said. “The condition can also lead to other complications such as heart disease and stroke, many of which are avoidable.”
Larson added that prediabetes is a problem that employers are increasingly concerned about—because of its link to the more serious condition of type 2 diabetes and its co-morbidities. Employers are trying a variety of strategies to address prediabetes, including the CDC’s National Diabetes Prevention Program, which she noted employers have had success with.
“The benefits strategies should include an integrated approach for diabetes that addresses the whole person and includes behavioral/mental health benefits, lifestyle and disease management programs, value-based benefit designs like reduced copays for high-value services and medications, and incentives to support people where they are at today,” Larson said.
Diabetes, weight management, and behavioral health
This integrated/whole-person approach to weight management has become increasingly visible in the last few years. And with diabetes being tied so closely to weight management, a number of companies have sprung up offering new tools and approaches for employers and their workers.
One of them is Wondr Health, which bills itself as a “behavioral change program that teaches clinically-proven weight management skills.”
Dana Labat, Ph.D., and a clinical psychologist with Wondr Health, describes the company as taking the whole-person approach. “Programs that are really focused on just losing weight don’t incorporate why people gain weight to begin with,” she said. “It’s important to take a holistic look. So, if we’re thinking about stress, if we’re thinking about anxiety, if we’re thinking about mindless eating, lack of physical activity and those kinds of behaviors—that’s where we see success not only in weight loss but improving the overall quality of life.”
The Wondr Health approach uses video lessons and interactive tools to help participants address issues around nutrition, physical activity, sleep, and stress management, all part of the whole-person approach to mental and physical wellbeing.
The chief medical officer of Wondr Health, Tim Church, M.D., said the COVID-19 pandemic has led to two other epidemics: a mental health epidemic and an epidemic of metabolic disease. “Prediabetes is skyrocketing; hypertension is skyrocketing,” he said. “HR and C-suites are having to deal with both mental health and weight management. You can’t address one without addressing the other.”
A different landscape on mental health
The stigma around discussing mental and behavioral health issues has long been a problem for weight management programs that take this holistic approach. With the COVID-19 pandemic, mental health has become a big topic—both in terms of the workplace and for a range of everyday issues. The Wondr Health team has come to see that for all the problems that came with the pandemic, there is now an opportunity.
“The conversations were gradually shifting,” Labat said of the pre-pandemic world. “But when the pandemic hit… that really created a pathway to discuss our mental well-being and emotional function.”
Church said the pandemic allowed Wondr Health to double down on its emphasis on mental and behavioral health. “Pre-COVID, you kind of had to be careful when you talked about mental health and weight loss; you didn’t want to freak people out,” he said. “Now, it’s front and center.”
One thing that wellness experts have long agreed on is that these programs are far more effective when they have buy-in from company leadership. Church said the widespread impact of COVID-19 has given executives and HR leaders considerably more insight into what issues workers may be dealing with.
“The HR suite and the C-suite were directly impacted, and that’s pretty motivating,” he said. “People are struggling: they’re struggling with caregiving, they’re struggling with their jobs, they’re struggling with schools, they’re struggling with mental health. This isn’t an abstract thing anymore.”
Labat added that the length of time that the pandemic has been with us has also played a role in the evolution of how people talk about mental health. “This was ongoing,” she said. “As a result of that, the conversations began to change, and media coverage began to change. So, it became more of a normalized topic to discuss.”
Other innovations follow the onset of COVID-19
Two other areas that have been in the spotlight during the COVID-19 pandemic are telemedicine and diversity, equity, and inclusion efforts (DEI). Both have had a significant impact on employee health care and expensive chronic care conditions such as diabetes and prediabetes.
Telemedicine has become a promising area for mental and behavioral health programs, Larson noted. “One of the first things our members did was pivot to make sure to make sure that people have access to telemedicine,” she said. “It’s really taken a long time for telehealth to be accepted, now were seeing a bigger uptick of its use on the behavioral and mental health side.”
However, she added, there are areas of concern with the changes to work that have come with the pandemic. She noted that employees may not eat as healthy if they are working from home—and that studies are showing a significant number of people gaining weight during the pandemic. “That’s why it’s even more important for employers to have virtual solutions to help employees, if they’re going to continue to work from home,” she said. In addition, employers must balance employee demand for digital or remote solutions with the needs of employees who may not have access to technology or may prefer other ways of interacting with health programs.
“Another area is identifying and addressing program gaps, especially for people who are under-represented or high-risk populations, like minority and low-wage workers,” Larson noted.
Several recent developments have shown that addressing those DEI-related coverage gaps can help employers get a better understanding of their health care costs, using data analytics.
As the pandemic continues to affect both health care delivery and prevention programs in the workplace, it’s likely that vendors and employers will continue to innovate in this area, according to Larson. “Employers are ready to do what is needed to make sure their covered populations have access to the best benefits during these difficult times,” she said.