North Carolina Diabetes Advisory Council Moves to Expand Access to Key Diabetes Services

North Carolina Diabetes Advisory Council Moves to Expand Access to Key Diabetes Services

By Krista White (JD ’16)

North Carolina has the 13th highest diabetes prevalence in the United States, and if current trends continue, diabetes is on track to cost the state $17 billion by 2025. Together with committed advocates from every sector in North Carolina, the Center for Health Law and Policy Innovation (CHLPI) at Harvard Law School hopes to reverse the diabetes epidemic. To that end, CHLPI released a report in May 2014 entitled The Diabetes Epidemic in North Carolina: Policies for Moving Forward. The report was part of the Providing Access to Healthy Solutions (PATHS) project, funded by Bristol Myers Squibb Foundation. The recommendations in the report included increasing access to needed services for people with diabetes, including the Diabetes Prevention Program (DPP) and diabetes self-management education (DSME).

Responding to recommendations from CHLPI and concerns from decision makers throughout the state, the NC Diabetes Advisory Council (DAC) convened on October 3rd, 2014 to form DPP and DSME workgroups. These groups were tasked with drafting and implementing Action Plans to improve access to both the DPP and DSME in the state. I was fortunate to be able to attend the DAC meeting in Raleigh, North Carolina, along with CHLPI clinical instructor Sarah Downer and fellow clinical student Anup Myneni. Hosted at the NC Division of Public Health (DPH), the meeting convened a wide range of stakeholders in the diabetes community. Attendees hailed from all parts of the state, from groups including universities, hospitals, community organizations, health care organizations, and nonprofits.

Workgroups were presented with draft Action Plans developed by the Diabetes Advisory Council and the Community and Clinical Connections for Prevention and Health (CCCPH) branch of DPH. Workgroup members then refined the objectives of each Action Plan and discussed how to move forward in making key changes to the Plans and taking the first steps toward implementation.

For example, the DPP workgroup discussed the four main objectives of the DPP Action Plan. The first objective is to promote awareness of prediabetes among people at high risk for type 2 diabetes. Many North Carolinians do not know they have prediabetes, and knowledge of their condition would alert them to the changes in diet and physical activity necessary to minimize risk of developing diabetes. The second objective is to increase referrals to CDC-recognized lifestyle change programs for the prevention of type 2 diabetes. The workgroup envisions easier and more commonplace referrals to the DPP by healthcare providers. The third objective is to increase and expand reimbursement for CDC-recognized lifestyle change programs for type 2 diabetes prevention. Stakeholders are pushing for the DPP to be covered by the State Health Plan, Medicaid, and private insurance. The fourth and final objective is to expand access to CDC-recognized lifestyle change programs. This could include offering the DPP at worksites, offering employees incentives for participating in the DPP, and embedding DPPs into primary care facilities.

The energy and enthusiasm in the room for progress in meeting these goals was overwhelming. Several of the workgroup members run DPPs at YMCAs across the state, and they were enthusiastic about the prospect of expanding access and reimbursement for the lifestyle change program. The group also expressed a desire to invite other stakeholders into the dialogue, including insurers.

In coming together to develop these Action Plans, the state is sending a clear message to decision-makers both in North Carolina and nationally that expanding access to these key diabetes services is a vital step in addressing the type 2 diabetes epidemic, and that support for investing resources in realizing these Action Plans is strong and widespread. Both workgroups will meet several times over the near year to finalize and implement the Action Plans.

I believe North Carolina is lucky to have such fierce public health advocates among its population – advocates dedicated not just to policy-making, but to action. Public health is a multifaceted endeavor, and stemming the diabetes epidemic will depend on organizations like the NC DAC that work to bring stakeholders together.

The Economic Burden of Diabetes in the U.S.

By Kristie Gurley (JD ’15)

A recent study conducted by the IHS Life Sciences economic consulting group highlighted the staggering economic impact of diabetes in the United States: in 2012, we spent $244 billion to treat the disease. This number is even higher when we account for loss of productivity from those with diabetes, which brings the total up to $322 billion.

Reporting on the study, NPR highlighted the increasing number of people across the nation who have diabetes or will soon develop diabetes: “About 29 million people have been diagnosed with diabetes, according to the Centers for Disease Control and Prevention; 8 million of them haven’t yet been diagnosed. Another 86 million, or 37 percent of adults, have prediabetes.” This is an astonishing number of Americans, and it bears repeating: more than half of all adults in the United States either have diabetes or will soon have diabetes without intervention.

The number of affected individuals appears stark in the context of the individual economic burden of diabetes, which averages at $10,970 per year. Because of incidence disparities, the cost will vary across states:

West Virginia had the highest rate of people diagnosed with diabetes, at 10 percent. Alabama, Arkansas, Delaware, Florida, Kentucky, Louisiana and Mississippi all posted rates over 8 percent. Alaska had the lowest diabetes rates in 2012, at 4.2 percent, followed by Utah, Colorado, Montana and Vermont, all under 5 percent.

We can hope that the report on the economic burden of diabetes spurs intervention at both the state and federal levels. As a student in the Harvard Center for Health Law & Policy Initiative (CHLPI) clinic this semester, I have been working on federal policy interventions in particular. We are currently drafting recommendations for actions the federal government may take to curb the rise of type 2 diabetes in the United States. Our recommendations were echoed by NPR, as we advocate the adoption of cost-saving preventative interventions and treatment methodologies. Our recommendations will also call for federal assistance in life-style interventions, such as improved access to healthy food and delivering medically-tailored meals, as well as increased coverage of services such as the Diabetes Prevention Program under Medicare and Essential Health Benefits.

The IHS Life Sciences report makes the economic case for interventions in the prevalence of type 2 diabetes. We can hope that federal policymakers will act quickly to curb the rise of the disease in the United States, or we will face an increased economic burden in the years to come. As NPR put it, “We better get cracking.”

NJ Diabetes Awareness Day

by Kristie Gurley (JD ’15)

On Thursday, November 13, New Jersey celebrated Diabetes Awareness Day with events at the New Jersey State House. The day began with speakers highlighting the importance of government measures to address the diabetes epidemic in New Jersey. Melita Jordan, Director of Chronic Disease Prevention and Control Services of the New Jersey Department of Health, presented a proclamation from Governor Chris Christie declaring November 2014 as Diabetes Awareness Month. Similarly, Senate President Stephen Sweeney and General Assembly Speaker Vincent Prieto presented a Joint Legislative Resolution recognizing November as National Diabetes Month. These events were followed by a networking and information event, where participating organizations set up tables throughout the State House hallways. The day concluded with a formal presentation of the Joint Legislative Resolution.

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As a continuing student in the Food Law & Policy Clinic, I was excited to see this event in relation to CHLPI’s previous work in New Jersey. In the spring semester, I had travelled down to help launch CHLPI’s Providing Access to Healthy Solutions (PATHS) report, which evaluated the type 2 diabetes landscape in New Jersey and made comprehensive recommendations for policy action. The 200-page report was intended to serve as a resource for diabetes advocates, and we hoped it would be the starting point of additional state action.

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At the Diabetes Awareness Day events, it was clear that the PATHS report had made an impact. The report was favorably remembered by many of the participants, and the recommendations even seemed to form the foundation of Melita Jordan’s remarks on needed policy actions. Allison Condra, the clinical fellow I travelled with who co-authored the New Jersey PATHS report, was sought-after by other attendees who wanted to discuss the report and share their subsequent state and advocacy efforts. As a student in the clinic, I even received several questions not only about the New Jersey report, but also our current efforts for the federal policy recommendations.

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As exciting as the day was, however, I left with some concerns. Following the morning’s speaker event, I had a conversation with a community health worker who told me what it was like on the ground. “All this stuff is well and good,” I remember her telling me, “but it’s not the problem. I’m dealing with people who can’t even pay for their test strips—awareness is not really the problem.” To me, the community health worker was pointing out a fundamental flaw in the Governor’s proclamation and the Senate and General Assembly resolution: awareness can only go so far in curbing the rise of diabetes. Environmental factors—including access to healthy food and ability to pay for needed medical services—seem to have a much more direct impact on the ability to prevent and treat diabetes. We can hope that raising awareness on Diabetes Awareness Day could serve not only to help individual New Jerseyans learn about symptoms of the disease and prevention techniques, but also to convince policy-makers to take action. It is the government action, rather than individual action, that will have the biggest impact on fighting the type 2 diabetes epidemic within the state.

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the Center for Health Law & Policy Innovation or Harvard Law School. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.