NJ Legislators Set Sights on Fighting Diabetes

Andrew Kitchenman | January 11, 2013 | Health Care
Bill would review current programs with eye on devising more effective battle plan

Dr. Samuel S. Grossman, New Jersey advocacy chairman for the American Diabetes Association.
Diabetes, one of the biggest contributors to rising healthcare costs in New Jersey and the nation, is the target of a new bill introduced by state lawmakers.

The bill, S-2288 and A-3432, would require the state Department of Health to produce an action plan for combating diabetes in the state, including a review of the financial impact of the disease and the effectiveness of existing programs.

Assemblyman Herb Conaway Jr. (D-Burlington), a bill sponsor and a physician, said he wants to take action both because of the impact diabetes has on patients as well as the costs of the chronic disease, which causes severe complications if left untreated.

“The state has an important interest in the programs in trying to reduce the costs of diabetes for its employees,” Conaway said, adding that state action may benefit the private sector. “The kinds of things the state may choose to do or highlight may have a good application outside of state government.”

New Jersey had 1 million residents with diabetes in 2010, or 11.2 percent of the population, a number that is expected to rise to 1.5 million, or 15.6 percent, by 2025, according to the Institute for Alternative Futures, a Virginia-based nonprofit .

Dr. Samuel Grossman, advocacy chairman for the state’s American Diabetes Association chapter, said diabetes is “like an iceberg,” with many undiagnosed cases.

“It’s an expensive disease and it’s a disease that affects many patients,” said Grossman, whose organization supports the bill.

Grossman noted that the bill would require a report every two years on the progress the state is making in deal with the disease.

“It’s like a report card and I believe that a report card would help many providers and many patients improve the quality of healthcare in New Jersey, especially for diabetes,” Grossman said, adding that programs found to be effective in the reports could be implemented across the state.

“We don’t have the data,” Grossman said. “This is why it’s so important to have this monitoring information.”

Global diabetes-focused pharmaceutical company Novo Nordisk, whose U.S. headquarters is in Plainsboro, also is advocating for the bill.

Novo Nordisk state government affairs director Tom Boyer said the most important goal of the legislation is to “break down the silos” that exist dividing state government departments. By requiring state Medicaid and public health efforts to be coordinated, new information about the disease can be analyzed, Boyer said.

“No one has conducted the kind of soup to nuts assessment as to how much we’re spending, how effective the interventions are and what kind of return we’re getting on our investment,” Boyer said, noting a recent increase in diabetes costs. “If we don’t collectively conduct an assessment of what’s working today, how can we possibly know what’s going to work tomorrow and the greatest opportunity for the state to achieve savings in its Medicaid program and improve the lives of its citizens?”

Boyer pointed to gestational diabetes – which affects some pregnant women and leads to a higher risk of delivery complications and costs – as an area with particularly high potential for effective state policies.

“In an ideal world we would have done this work 10 or 15 years ago, but we’re not in the ideal world; we have to deal with the crisis that’s at our doorstep,” Boyer said. “We really need to come up with strategies and interventions that are available today that reduce the cost of that care in an appropriate way.”

Boyer said the bill opens the possibility of the state gathering the “best and brightest minds” on diabetes policy and treatment to formulate measures that would be most effective.

The bill can put the state in a position where it “can dictate the terms by which it will engage diabetes, rather than having diabetes dictate the terms that it will engage the state. It’s that simple,” Boyer said.

He pointed to the IAF report Diabetes 2025, which projected that the medical and indirect societal cost of diabetes to New Jersey will rise from $9.3 billion in 2010 to $14.5 billion in 2025. He noted that the most prominent state program addressing the program, which is funded by the federal Centers for Disease Control, provides $350,000 to the state.

“The state of New Jersey today is combating a $9.3 billion problem with a $350,000 grant,” Boyer said.

State Department of Health spokesman Dan Emmer said the state has additional funding streams other than the CDC grant that allow the state to leverage additional grants that allow the state “to take a global approach to combating diabetes and other chronic conditions. This strategy allows those who are impacted to live to their optimum health.”

State officials declined to comment on the bill, but said the state is already working to reduce the disease’s impact. It currently has several programs seeking to address diabetes as well as other chronic diseases, according to Melita Jordan, senior executive service director for the Department of Health’s chronic disease prevention and control unit.

The state is using evidence-based policies to promote a healthy lifestyle for residents who have diabetes or are at risk for it, including a worksite wellness program, Jordan said. This helps give people more control over their health and reduces hospitalizations, she said. She noted that the CDC grant, which funded a diabetes self-management program in southern New Jersey more than a year ago, has been expanded to northern New Jersey.

The bill is backed by other organizations that focus on the disease. Bonnie Starr, program manager for the Diabetes Foundation, said the bill could complement her organization’s focus on providing emergency medication to low-income residents with diabetes.

Conaway agreed with Boyer than gestational diabetes is a potential subject for new state policies. He added that providing comprehensive services for state employees with diabetes is another area, including the potential for providing diabetes supplies for free, in line with the federal Affordable Care Act’s focus on promoting free preventative screenings.

“How can the government as the employer help employees take better care of their health?” Conaway asked, adding that encouraging exercise or other programs could be started by the state and then expand into the private sector.

Sen. Robert Gordon (D-Bergen), the Senate sponsor, said he has been interested in reducing diabetes since he worked as a hospital consultant prior to joining the Legislature.

“I think the state needs to develop public policies that try to address the epidemic,” he said. “If you look at the major cost drivers in the public sector today it’s healthcare costs, health insurance, and the major cost driver of rising insurance rates is chronic diseases,” primarily diabetes.

If the state can drive down the cost of treating diabetes, it will ultimately reduce the burden on taxpayers who finance government health programs, Gordon said.

The last statewide report on diabetes dates back to 2005 and 2006. Novo Nordisk’s Ken Inchausti said a new look at diabetes is necessary, considering the changing demographics of the state – minority populations are more likely to have diabetes – and the importance of diabetes in healthcare spending. One quarter of Medicare spending and 10 percent of national healthcare spending is on diabetes.

“Diabetes is starting to overwhelm healthcare systems,” Inchausti said.

The Senate version of the bill is scheduled for a hearing in the Senate Health, Human Services and Senior Citizens Committee meeting on Monday. The Assembly version has been referred to the Assembly Health and Senior Services Committee.