Peterson Institute finds that diabetes programs improve quality but raise costs

March 29, 2024

The Peterson Health Technology Institute, a new nonprofit dedicated to evaluation of digital health interventions, just published its first report, a review of peer-reviewed medical literature on digital diabetes vendors currently selling to employer sponsored health plans.

They found that behavior and lifestyle modification programs had a modest impact on Hemoglobin A1C (HbA1C,) an indication of long-term blood sugar control, and increased costs on average by $484 per patient per year. The researchers were more positive about the clinical impact of a nutritional ketosis program, which showed clinically meaningful decrease in HbA1C. They also found that remote patient monitoring had only a small impact on HbA1C and increased costs by an average of $2002 per commercial patient per year.

Vendors and an industry trade group complained that the study used a simulation model based on clinical trials to predict cost savings, while industry-sponsored observational studies often show more substantial savings by comparing participants in the program with members who do not participate. However, these industry studies often fail to account for ‘selection bias,’ where those that participate in the program are healthier and more motivated. Therefore, industry-sponsored observational studies tend to overstate savings.

Implications for employers:

• The clinical improvements from some of these interventions, HbA1C decreases of 0.2-0.6%, are of at least some clinical benefit.

• Vendor programs that delight employees and improve health can be provide value to a company even if they do not decrease the cost of medical claims. 

• Employers should not count on huge cost savings from these programs, and any decreases in costs might happen much later. 

• Vendor contracts should include robust performance guarantees.  Program performance should be monitored carefully.

• Employers should look critically at vendor savings claims, which can be based on flawed methodology. Any contractual ROI guarantees should include detailed instructions for calculations of savings.

• This evaluation suggests that employers seeking to establish a diabetes program should give nutritional ketosis a careful look. Many members, though, have difficulty complying with a very low carbohydrate diet. 

• Good diet and exercise are very important for health, but programs promoting lifestyle behavior change are often less effective than we would hope. The Peterson findings on digital diabetes vendors likely bear some relevance to digital programs for obesity care.
  

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Monday: Employer implications of Medicare’s coverage for obesity drugs for those at high risk for heart disease