American Indian and Alaska Native Programs,

University of Colorado Denver

Costs Associated with Diabetes Treatment and the

Diabetes Prevention Demonstration Project

Joan O’Connell, PhD

Special Diabetes Program for IndiansDemonstration Projects

Preliminary Findings !!!!

PresentationPreliminary Findings

I. Costs of Treating Diabetes within the IHS

II. Providing Prevention Programs - Description of Program Staff

III. Participating in Prevention Programs - Costs incurred by Participants

IV. Discuss Next Steps

I. Costs of Treating Diabetes within the IHS

Methods

Population: Phoenix Indian Medical CenterService Unit Population

Data: RPMS

Year: October 2004 – September 2005

Phoenix Indian Medical Center Service Unit Diabetes Status by Age Group

10.6% of adults in this study were classified as having diabetes.

Age Number Row Number Row Total group of adults percent of adults percent Number

18-34 664 3.5% 18,195 96.5% 18,85935-44 799 12.1% 5,803 87.9% 6,60245-54 881 23.6% 2,856 76.4% 3,73755-64 624 35.8% 1,117 64.2% 1,74165-74 308 40.5% 452 59.5% 76075+ 110 31.2% 243 68.8% 353

Total 3,386 10.6% 28,666 89.4% 32,052

Diabetes no Diabetes

Inpatient Utilization

The 10.6% of adults with diabetes accounted for nearly ½ of non-OB hospital inpatient utilization.

Number Percent

All adults 7955

All adults, excluding OB 6472

Adults with diabetes 3109 48.0%

Adults without diabetes 3363 52.0%

Inpatient service utilization data include data for IHS facilities and contracted health services.

Hospital Inpatient Days

Outpatient Utilization

Adjusting for age differences, outpatient utilization for adults with diabetes was approximately 2-3 times higher than utilization among adults without diabetes.

Clinic visits

Emergency

Other outpatient

Outpatient Visits

Outpatient utilization data include data for IHS facilities and contracted health services.

Diabetes no Diabetes

Mean numberper person

Mean numberper person

1.8

12.4

0.9

3.9

Ratio Diabetes /no Diabetes

2.0

3.2

Determining a Unit Cost for Treatment

We used the Cost Center Report for the average unit cost inclusive of professional, facility, ancillary, and pharmaceutical services.

● 1 hospital inpatient day = $1,963

● 1 outpatient visit = $325

The methodology was developed by OMB.

Costs for Inpatient Services

Inpatient costs per person per year were approximately 4 times higher (ratio=3.9) for adults with diabetes as compared to adults without diabetes.

Unadjusted utilization rates

Adjusted utilization rates*

Diabetes no Diabetes Ratio

Costs Costs Diabetes / per person per person no Diabetes

$1,935 $316 6.1

$1,935 $493 3.9

* Utilization rates were adjusted for differences in the age distribution of the two populations.

Type of Utilization Rate

Costs for Outpatient Services

Outpatient costs per person per year were 3 times higher for adults with diabetes as compared to adults without diabetes.

Unadjusted utilization rates

Adjusted utilization rates * 3.0

$5,068

$5,068

$1,327

$1,711

per person per person no Diabetes

3.8

Rationo Diabetes

Costs

Diabetes

Diabetes / Costs

* Utilization rates were adjusted for differences in the age distribution of the two populations.

Type of Utilization Rate

Total Health Costs

Total health costs (inpatient plus outpatient) per person per year for adults with diabetes were 3 times higher than expenditures for adults without diabetes.

Unadjusted utilization rates

Adjusted utilization rates*

Diabetes no Diabetes Ratio

Costs Costs Diabetes / per person per person no Diabetes

* Utilization rates were adjusted for differences in the age distribution of the two populations.

Type of Utilization Rate

$7,003 $1,643 4.3

$7,003 $2,205 3.2

Total Costs among Persons with Diabetes by Cardiovascular Disease Status

Total health expenditures per person per year for persons with diabetes and CVD were 2 times higher than expenditures for persons with diabetes but not CVD.

Diabetes with Diabetes without CVD CVD Ratio

with CVD /

per person per person without CVD

Unadjusted utilization rates $12,693 $5,917 2.1

Adjusted utilization rates* $12,693 $6,049 2.1

Costs

* Utilization rates were adjusted for differences in the age distribution of the two populations.

Type of Utilization RateCosts

We will next examine cost differences for other comorbidities.

Percent of

all adults Dollars Percent

Persons with diabetes 10.6% $23,713,428 33.5%

Persons without diabetes 89.4% $47,087,931 66.5%

Total 100.0% $70,801,359 100.0%

Total Costs

Total Costs

Adults with diabetes accounted for one third of costs for all adults in this population in a one year period.

Diabetes is costly within the IHS.

Known health expenditures for an adult with diabetes within the IHS were $7,003/year in FY2005 or three times that of adults without diabetes.

1 of every 3 IHS Dollars spent on adult health care is needed for people with diabetes.

More information is needed on diabetes treatment in other geographic areas.

I. Costs of Treating Diabetes within the IHS - Conclusions

II. Providing Prevention ProgramsDescription of Program Staff

Methods

Population: CGP Personnel

Data: Provider Annual Survey

Year: 2006

Types of Project Staff*II. Program Costs

* We used an algorithm to assign a primary role to all staff. Educators include lifestyle coaches. Other includes recruiters.

Frequency Percent

Project Management & Educator 8 3.0

Project Management 41 15.2

Educator 109 40.4

Data Coordinator 18 6.7

PCP 61 22.6

Other 33 12.2Total 270 100.0

Project Staff: Number of RolesII. Program Costs

Frequency Percent

One role 168 62.2

Two roles 96 35.6

More than two 6 2.2

Total 270 100.0

Project Staff: Length of Time Worked for the Program

II. Program Costs

Frequency Percent

Less than one year 98 39.7

1~2 year 101 40.9

Great than two year 48 19.4

Total 247 100.0

Project Staff* Educational Background

II. Program Costs

* Primary role

Project Mngr & Educat

Project Mngr

Educa- tor

Data Coord PCP Other

High school 0.0% 0.0% 1.8% 5.9% 0.0% 6.5%

1+ years vocat school 0.0% 0.0% 0.9% 5.9% 0.0% 12.9%

1-3 years college 25.0% 10.3% 27.5% 29.4% 0.0% 32.3%

4 years of college 12.5% 38.5% 31.2% 17.7% 3.3% 19.4%

Graduate/Professional 62.5% 51.3% 37.6% 41.2% 96.7% 29.0%

Number of persons 8 39 109 17 61 31

II. Program Costs Project Staff*Hours Staff Work on all Projects/Positions

* Primary role

Percent of Staff who work part and full time by primary project role

Hours per week

Project Mngr & Educat

Project Mngr

Educa- tor

Data Coord PCP Other

< 4 hrs 0.0 0.0 4.6 0.0 1.6 4.8

4 - 8 hrs 0.0 0.0 0.9 0.0 0.0 0.0

16 hrs 0.0 0.0 0.9 0.0 1.6 0.0

24 hrs 0.0 0.0 3.7 11.1 6.6 0.0

32 hrs 0.0 2.4 5.6 0.0 14.8 9.5

40+ hrs 100.0 97.6 84.3 88.9 75.4 66.7

II. Program Costs Project Staff*: Hours Staff Work on Diabetes Program

* Primary role

Percent of Staff who work part and full time by primary project role

Hours per week

Project Mngr & Educat

Project Mngr

Educa- tor

Data Coord PCP Other

<= 4 hrs 12.5 12.5 28.0 5.9 82.5 50.0

8 hrs 0.0 12.5 11.2 5.9 8.8 9.4

16 hrs 12.5 10.0 7.5 0.0 5.3 3.1

24 hrs 0.0 17.5 6.5 41.2 0.0 0.0

32 hrs 25.0 2.5 2.8 0.0 0.0 6.3

40+ hrs 50.0 45.0 43.9 47.1 3.5 31.3

Mean Hours

Project Mngr & Educat

Project Mngr

Educa- tor

Data Coord PCP Other

Planning 5.8 5.6 4.5 2.4 1.4 2.3

Staff Training 1.4 1.1 1.7 0.9 0.3 3.0

Recruit/Screen 4.0 3.2 5.4 3.4 2.0 4.7

Consent/Enrollment 2.1 0.9 1.3 1.4 0.4 1.0

Baseline Activities 4.5 1.4 1.9 2.5 1.0 5.3

Intensive Activities 5.6 2.4 5.4 1.5 0.4 3.6

Data 1.6 2.2 2.0 13.4 0.5 3.2

Program Admin 7.0 11.0 1.3 1.7 0.5 3.2

Total 32.0 27.9 22.8 27.0 6.4 19.8

II. Program Costs Project Staff*: Hours Staff Work on Diabetes Program

Average Number of Hours Worked on Project Activities

II. Providing Prevention ProgramsConclusions

Program implementation requires different types of staff and coordination with health professionals not on salary with the program.

There are issues with staff retention.

Not all staff work full time on the program.

There is a need to understand costs associated with program personnel, staff training, recruitment and retention of participants, and other activities.

III. Participating in Prevention ProgramsCosts incurred by Participants

Methods

Population: CGP Personnel

Data: Participant Annual Survey

Year: 2006

During the last year, you may have changed the type of food you eat.

III. Participant Costs

Frequency Percent

Increased a lot 109 15.5

Increased some 349 49.7

Stayed about the same 195 27.8

Decreased some 42 6.0

Decreased a lot 7 1.0

Total 702 100.0

Has the cost of the foods you eat…

Frequency Percent

Increased a lot 46 6.7

Increased some 227 33.0

Stayed about the same 392 57.1

Decreased some 15 2.2

Decreased a lot 7 1.0

Total 687 100.0

Have the costs of clothing, exercise shoes, and other things you need for exercising …

During the last year, you may have changed the amount of physical activity you do.

III. Participant Costs

How many minutes does it usually take you to travel to your lifestyle coaching visit?

III. Participant Costs

12% travel30+ minutes

Mean: 14.4Std Dev: 13.6

Frequency Percent

Less than 15 mins 473 69.8

Between 15-29 mins 124 18.3

Between 30-44 mins 49 7.2

Between 45-59 mins 20 3.0

Between 60-74 mins 9 1.3

More than 75 mins 3 0.4

Total 678 100.0

Frequency Percent

Less than 15 mins 100.0 15.6

Between 15-29 mins 271.0 42.3

Between 30-44 mins 133.0 20.8

Between 45-59 mins 75.0 11.7

Between 60-74 mins 52.0 8.1

More than 75 mins 9.0 1.4

Total 640.0 100.0

Time for a Lifestyle Coaching Visit

III. Participant Costs

Mean: 30.8 Std Dev: 18.1

Total Time for a Lifestyle Coaching Visit( travel*2 + wait + visit )

III. Participant Costs

Mean: 67.4 Std Dev: 35.8

Frequency Percent

Less than one hour 367.0 58.2

1~1.5 hours 164.0 26.0

1.5~2.0 hours 46.0 7.3

2.0~2.5 hours 33.0 5.2

2.5~3.0 hours 15.0 2.4

Great than 3 hours 6.0 1.0

Total 631.0 100.0

IV. Next Steps

Goal: Study program costs to provide information to plan for and support program sustainability

Population: Grantee Volunteers

Focus: II. Costs of Providing the Program III. Costs Incurred by Participants

We plan to replicate I. Phoenix Treatment Cost Study in all 12 IHS Regions. That will be a separate effort from this component of the DP study.

IV. Next Steps

Data: 1. IHS Program Final Reports & Continuation

Applications 2. Information from grantees, DDTP, CC staff

on program activities and costs

3. Information from grantee staff on the costs your

participants incur

Years: Program Years 1-6 (6 years!!!!)

Start Analysis: Program Year 5 (after Sept 2008)

IV. Next Steps

Grantee Responsibilities:

1. Respond to calls and emails about program activities 2. Attend breakout sessions during DP Meetings

Grantee Benefits:

1. You will have information on your program costs that may be compared to costs of other programs.

2. There will be data about program costs that may be used to plan for future program activities.