Most of the tests you mention above are wasteful for your typical Medicare Advantage enrollee. There's a ton of low hanging fruit for a start-up like Clover to make a meaningful impact. Trying to change human behavior through diet or exercise is incredibly difficult, especially for those from disadvantaged communities or of lower socioeconomic status. Kudos to Clover to trying to make a marginal impact on that front; most insurance plans wouldn't do anything.
A good point to discuss. Perhaps I'm overly optimistic about people in general, but how do we know, a priori to a data-centric healthcare model applied to a patient, about their participation? These tests are only wasteful in the context of the current care model, which stipulates that once you have Type 2, there is a lockstep progression of increasingly invasive and expensive medication and interventions, graduation to insulin injection, and culminating in early death from complications? In the face of that kind of prognosis, it is not at all surprising that any additional tests are considered futile by both medical practitioners and patients alike. But if the patient was offered via data-centric care a clearer window to their condition, amplified proactive participation in care management with negative feedback loops tamping down undesirable fluctuations, and in the case of Type 2 or metabolic syndrome the clear goal of reversion (though not a cure) and drastically improved eventual outcomes, why do we assume that even elderly patients on Medicare Advantage would not statistically respond well as a whole population? I dunno, this isn't my domain expertise, so I'm honestly asking these questions; if there is the equivalent of behavioral economics studying patient behavior, then perhaps that field has the answers I'm seeking.
> There's an entire cottage industry devoted to solving this problem for insurers.
I'd like nothing more than to see these efforts succeed, look forward to following the progress.
You might want to take care here -- to be honest I don't know all the things we do in home visits for diabetes assessment (though I am working a few desks over from the person building the next version of our diabetes assessment, so I could find out but then I'm unsure whether I can publicly detail the whole thing), but I'm pretty sure no matter how many things there are, an article like this one isn't going to go into enough deep medical detail to satisfy you :)
The business model of a US health insurer in this situation frankly sucks, however. If Clover successfully manages a reversion outcome with aggressive short-term techniques for a chronic condition, then nothing prevents the patient from switching away to a cheaper insurer afterwards. Clover puts in all the hard work, and another insurer reaps the actuarial benefits. That has to be fixed, because all the big killers of patients, insurer profits and medical budgets in the developed nations are the biological analogs of Advanced Persistent Threats, and not amenable to fixes developed for acute situations (which as a civilization we're really good at addressing).
That's a big "if" for a Medicare Advantage insurer, since we can't enroll someone unless they're eligible for Medicare. Although it's possible to become Medicare-eligible prior to age 65, it's much less common, and some of the ways it happens make someone ineligible to enroll in a Medicare Advantage plan (for example, someone with end-stage renal disease is Medicare-eligible regardless of age, but unless already enrolled in one cannot join a Medicare Advantage plan -- they must opt for traditional Medicare instead).
So by the time a typical diabetic becomes eligible for a Medicare Advantage plan, the intense regimes you're talking about don't (as far as I know) offer any realistic chance of reverting. Which means most of the effort instead goes into proper management techniques to prevent progression and complications.
Are there any papers / data-sets that demonstrate this? If so, could you share here or at my email (see profile)? Would be greatly appreciated it. It's been my hunch this is true, but haven't seen the evidence for it.
Let's take the Type 2 diabetes example given in the article.
No mention is made of putting a Continuous Glucose Monitor on the 83-year old patient, to graphically show in real time the impact white rice has upon her blood sugar.
No mention is made of five additional antibodies tests to identify Latent Autoimmune Diabetes in Adults (LADA), which looks a lot like Type 2 in its early stages, but likely needs to be treated as Type 1 as early as feasible according to some very recent research.
No mention is made of regular tracking of her HbA1c, fructosamine (gives a 14-day instead of ~115 day window into long-term blood sugar management), and 1,5-anhydroglucitol (indicates time spent with hyperglycemia).
Not to speak of doing those three areas on a regular, monthly/quarterly basis. It is very rare in the US to do all of that even on an annual basis; at best, the common practice is HbA1c once a year. While metabolic syndrome leading to diabetes is a huge drain on US insurers, aggressive data-led syndrome reversion is de facto not recognized by either the mainstream medical field nor insurance industry.
There is lots more data they could gather than what I mentioned here, but all they did instead was suggest "try to eat brown instead of white rice". She should try not eat rice (and other carb-heavy food) at all for a month, and see if that improves her blood sugar numbers. While the fitness community has already empirically identified that diet is 90% of success unless you are a genetic anomaly, the food, medical and insurance industries still push the idea upon patients they need to go out and exercise more, and only tinker around the edges of their diets (unless you are fasting/caloric-restricting, going very low-carb, going vegetarian, going raw food, etc., most Americans idea of a diet change by adding a couple salads a week, picking "low fat" packaged food and so on is just tinkering).
This doesn't even get into monitoring controlled changes in habits, measuring the impact upon the data, and using those results to guide further changes. Nor have we even touched upon the lack of incentives in the US for companies seeking to "disrupt" medicine through holistic, integrated process changes instead of "product" like pharma or medical devices: if company X can provably intake Y number of customers with say, metabolic syndrome or even Type 2 diabetes, and achieve a reversion rate of Z% with negligible (<5%) backsliding 5+ years out from date of reversion, monetizing that proprietary process is limited to either being a provider (in which case you're squeezed by the insurance companies with take-it-or-leave-it negotiations) or an insurer (in which case you're too spread out covering other ailments to really capitalize upon the proprietary knowledge). I suspect the lack of incentive structures is similar in nations with national health plans.