American Indian and Alaska Native Programs, University of Colorado Denver Costs Associated with Diabetes Treatment and the Healthy Heart Demonstration Project Joan O’Connell, PhD Special Diabetes Program for Indians Demonstration Projects Preliminary Findings !!!!

Presentation Preliminary 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 Center Service 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.

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

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

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.

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

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.

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. We will next examine cost differences for other comorbidities.

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 Programs Description 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. Other includes recruiters.

Project Staff: Number of Roles II. Program Costs

Project Staff: Length of Time Worked for the Program II. Program Costs

Project Staff* Educational Background II. Program Costs * Primary role

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

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

II. Program Costs Project Staff*: Hours Staff Work on Diabetes Program Average Number of Hours Worked on Project Activities

II. Providing Prevention Programs Conclusions Program implementation requires different types of staff and coordination with health professionals (e.g. PCPs) who are not hired by the program. In general, the staff are well educated. 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 Programs Costs 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

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 case management visit? III. Participant Costs 25% travel 30+ minutes Mean: 22.1 Std Dev: 19.7

Time during a Case Management Visit III. Participant Costs Mean: 36.9 Std Dev: 16.8

Time Spent for a Case Management Visit ( travel*2 + wait + visit ) III. Participant Costs Mean: 93.2 Std Dev: 48.0

IV. Next Steps Goal: Study program costs to provide information to build support for program sustainability Population: Grantee Volunteers Data: 1. IHS Final Reports & Continuation Applications 2. Information from grantees, DDTP, CGP 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