Payers | Hygieia

Advanced Diabetes – One of Your Highest Cost Segments

7 million Americans use insulin to treat their
type 2 diabetes.

Over 50% of the costs of care for diabetes are spent on Rx.

The average insulin user has a total annual cost of care >$25,000.

For every 100,000 Medicare members or 200,000 Commercial members, a health plan spends
$100 million / year on diabetes.

2-3% of commercial populations and 4-5% of Medicare recipients use insulin to treat their
type 2 diabetes.


Members Are Not Reaching Treatment Goals

More than two-thirds of insulin users have an A1C above their target range, and over one third have an A1C above 9.0%.

With an A1C of 9.0 or above, your members have approximately a 50% greater chance of experiencing a heart attack (MI), heart failure, and stroke, further increasing the cost of their care. According to Express Scripts, diabetes prescriptions are #2 in pharmacy costs to Medicare beneficiaries and Commercial members.

Understanding the journey that members with type 2 diabetes go through can help significantly alter this picture.


Type 2 diabetes is a progressive condition where over time, the body makes less and less insulin. At the same time, treatment becomes more and more expensive as additional high-cost drugs are introduced to control glucose levels. Clinical guidelines for the treatment of diabetes are driven by the member’s hemoglobin A1C. When it’s above goal additional medications will be prescribed.





Why Aren’t We Getting Better Results?

Insulin has been around almost 100 years, yet given that over two-thirds of patients using insulin have on A1C over 7%, prescribing insulin effectively is hard.

Too little time

Effective insulin therapy requires that insulin doses be titrated at least 1-2 times per week. It is not reasonable to expect providers to see their patients 100 times per year, and patients are not able to make the changes to optimize results themselves without professional guidance.

The insulin level prescribed to most patients is ultimately ineffective.

Too much complexity

Similarly, there are >45 types of insulin a provider can prescribe with costs ranging up to more than 10-fold. In addition, there are 6 other drug categories that could be used to treat patients with advanced type 2 diabetes.

The result: >$14B in insulin costs per year. Additionally, many patients cannot afford their insulin, resulting in additional costs of care.


Hygieia’s Solution

Our focus for your population of insulin users with type 2 diabetes is to improve the A1C of each person by assisting with insulin prescribing and dose guidance before each injection, along with the optimization of other diabetes medications.

Hygieia’s d-Nav® Insulin Management Program was developed over the past 10 years based on extensive research with over 3,000 patient-years of experience.

The service has been well studied, with results published in leading peer-reviewed publications such as The Lancet.



The d-Nav® Program has shown to:

  • Help nearly 90% of patients to improve their A1C within three months.
  • Significantly reduce the frequency of mild and severe hypoglycemia.
  • Increase patient’s satisfaction.
  • Eliminate thousands of dollars in pharmacy costs per participant per year.

We provide a high-touch center of excellence approach that includes on-going virtual visits or face-to-face in our community-based clinics, regular A1C testing and home delivery of testing supplies, daily insulin guidance and frequent virtual support.


Expected Results

In addition to significant improvement in a member’s A1C, you can expect greatly improved member satisfaction as well as a significant reduction in the cost of pharmacy and diabetes supplies.

Reduction in Cost of Care

According to the Standard of Care in Diabetes, pharmacy use is driven by A1C levels. When a patient fails to reach their A1C goal additional medications will be used. However, if treatment goals are reached, those additional medications may not be needed. Optimizing a member’s A1C often eliminates the need for additional anti-diabetes medications.

An economic impact study in 2018 projected direct savings from implementing the d-Nav® Program at $11,991 per member over two years. First year pharmacy reduction was estimated at $2,916 per member per year. An average of $910 per member is eliminated each year because the d-Nav® Program provided members with their diabetes supplies at no extra cost. Additional savings was due to a reduction in member related medical utilization projected to be $2,503 in year one, totaling $4,193 over two years.

Note: does not include consideration of Hygieia fees. Source: Hygieia internal analysis – Economic Impact Model built using Hygieia clinical results and published estimates of medical costs by A1c level from Bansal, et al., Impact of Reducing Glycated Hemoglobin on Healthcare Costs Among a Population with Uncontrolled Diabetes, Applied Health Econ Health Policy, 2018.

Improved member satisfaction and quality ratings

Based on the results of a client survey, the members using the d-Nav® Program have reported higher treatment satisfaction.  This increase in member satisfaction, along with an improvement in diabetes metrics specific to A1C testing and the percentage of diabetes patients under 9.0%, can help you improve or maintain your STAR / HEDIS quality ratings.

Changes in treatment satisfaction within 3 months
HbA1c for d-Nav Insulin Program Management Users
                           d-Nav® Program clinical outcomes since 2013












To talk to a Hygieia Representative, or to schedule a demonstration of the d-Nav® Insulin Management Program, please call 734-743-2838 or contact us using the button below.