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November 2013
Mission 2014: Stop Diabetes @ Work

Carolinas HealthCare System, which cares for more than 100,000 people with diabetes, is leveraging its expertise and extensive database to develop innovative ways of managing and preventing the widespread chronic condition beyond the doctor’s office.


The medical costs for a person with diabetes are 2.3 times higher than for those without the illness, and a 2012 study estimated that diabetes costs the U.S. economy another $69 billion in lost productivity. A person with diabetes is more likely to be unemployed and those with jobs miss two or three more days a year on average than a worker without the condition. Engaging individuals at the community and employee levels can help detect precursors for disease and disrupt unhealthy routines that lead to chronic illness.


Clinicians can identify who is at risk for diabetes, including those with prediabetes, and interventions, such as weight loss, nutrition and exercise, can prevent the onset of type 2 diabetes. Much of the vital education and intervention can happen at the workplace.


“We recognize of course that most people spend much of their time at their place of employment,” says Dr. Charles Rich, medical director for Corporate Health and Wellness at Carolinas HealthCare System and a practicing internist for 30 years who has worked extensively with diabetics.


“That environment, that location, the culture there and the employer’s understanding and commitment to helping people understand issues important to their health is very important to improving the health of the community.”


Almost 26 million adults and children—8.3 percent of the U.S. population—have been diagnosed with diabetes, and almost 2 million cases are added each year. An estimated 7 million are undiagnosed, and 79 million live with prediabetes.


“The importance of this disease to the health of our population, the health and wellness of the people we love and work with, is colossal,” Rich says. “It’s something that needs focused attention. It’s one of our major cost drivers. It’s a major cause of human suffering.”


With its diabetic population base one of the largest in the country, Carolinas HealthCare System is positioned to find new solutions, he says.


“We are laser-focused on this disease,” Rich says. “What can we do to impact this disease for our individual patients and for the population in general? Very importantly, we’ve created and maintain a very robust registry of our diabetics over a number of years. We have the metrics, we have the information on the population we serve.


“All of our clinicians provide very detailed information about their population and how they’re performing and how the system is performing around important measures to control that disease. It’s a very data-rich environment. We understand who we’re caring for.”


Big Data Yields Personal Solutions


Dr. Michael Dulin, chief clinical officer for analytics and outcomes research for Carolinas HealthCare System and a family medicine physician, says data analytics work can leverage information to improve outcomes for patients with chronic diseases such as diabetes.


“I think it really is the foundation for us transforming the health care delivery system so we can improve the outcomes of patients, specifically patients with chronic diseases,” he says, adding that the doctor’s visit is just part of the solution. “Health care is influenced by much broader contexts of the patient experience—home, work, community.


“Big Data allows us to think about all those different factors that impact a patient’s health. Are they getting exercise? Are they eating the right foods? Do they have access to resources?”


The data is so extensive that proactive interventions can be tailored to an individual. For example, it can reveal that a particular individual with prediabetes who lives near a greenway could join a local walking club in order to get more exercise.


Diabetes is unevenly distributed. Compared to non-Hispanic whites, the risk of diagnosed diabetes is 1.2 times higher among Asian Americans, 1.7 times higher among Hispanics, and 1.8 times higher among non-Hispanic blacks.


“Understanding individual risk and scores, having access to medical care, and taking small steps toward healthier living can mitigate the progress of diabetes,” Rich says.


Keeping Business Healthy


Carolinas HealthCare System has long focused on the workplace as an opportunity to boost wellness understanding and practice.


“We engage with many employers and have for decades,” Rich says. “We have a variety of services we can provide to them—including population assessment, current health assessment, identification of people at risk, and worksite-based consulting and programs. We work with them on establishing logical and good incentive programs to help motivate their employees to understand and seek appropriate attention for their disease.”


Employers’ interest, driven by rising health care costs, has accelerated in recent years. Today, 1 in 10 health care dollars is spent treating diabetes and its complications; 1 in 5 health care dollars is spent caring for people with diabetes.


“Employers are at different stages of understanding this, just like patients,” Rich says. “We’re there to help work with employers in any way. Many of these employers are very interested and committed to help provide financing for the health care of their employees. My perception is there’s more of a genuine than a simple bottom line motivation to have a healthy workforce.


“I think employers are smarter. It’s a more competitive world. Part of that is taking care of your employees and having a healthier workforce. If you take good care of your folks, you have engagement and commitment. Self-insured employers especially have a commitment to employees’ good health.”


Carolinas HealthCare System has its own workplace health initiative—LiveWELL—where physicians and other employees practice what they preach.


“We’re really trying to change our culture inside the health care system so we can be examples to our patients,” says Dulin, who has seen meeting snacks shift from cookies and candy to apples and popcorn. I feel like it’s been a very successful program to engage with people in the workplace to change behaviors.”


In the past few months, Carolinas HealthCare System has developed its ability to partner with employers and conduct data analysis to help improve the health of employees and hold costs down. Simple online surveys or data mining can identify at-risk people based on such factors as body mass index, glucose levels and family history.


“There’s an understanding that there’s a need out there. I think employers are looking for a different approach. I think it’s pretty cool to think about partnering directly between a health care provider and an employer,” says Dulin.


Solutions, for example, could include embedding a mid-level health care provider at the worksite so employees can be seen without scheduling an appointment and going to a doctor’s office.


“It’s about using the data to tailor the interventions so they are applicable to that individual,” Dulin says. “We actually have done it in the research area as a result of some pilot studies,” says Dulin, referring to a neighborhood exercise group that started more than two years ago is still operating.


“I think it’s those kinds of things we need to launch on a broader scale. We’ve done the piloting. We’ve started to think about it. All the foundational work is in place and the pilots have been going on for over a year and a half.”


Carolinas HealthCare System has already conducted a large predictive analytics project with asthma sufferers and plans to conduct a similar study for people with diabetes.


“Diabetes is our emphasis for 2014,” Dulin says. “I think it’s a very exciting time. I think we’re just at the beginning of the next wave of looking at how we deliver health care across the community. We’ve made investments, and we’re now launching the next wave on top of those investments. I would imagine 2014 is going to be a pretty exciting year for us.”


“We’re mission-driven,” Rich says. “That’s why we’re so keenly interested in helping employers. We realize at the end of the day that we’re about the health of our community, the population we serve, and the employer space is so vital.”

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