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Patient on Scale


Disparities and Opportunities in Missouri's Commercially Insured Population

In 2019, the prevalence of people being treated for type 2 diabetes among commercially insured Missourians ages 18 to 64, as measured by MHI claims data was 5.2%. Although those with employer sponsored health care coverage fare better than the broader population when it comes to a chronic illness like diabetes, social factors as well as age were found to be associated with the prevalence and care management of type 2 diabetes, even among the commercially insured.


The study reveals that geography matters in targeting interventions at the local level. MHI found that type 2 diabetes prevalence among working adults varied by Missouri county, and that socio-demographic factors accompanied those differences.


MHI performed statistical analysis on several key areas of interest in diabetes management, using the Robert Graham Center’s Social Deprivation Index (SDI). The index is a composite measure that blends demographic characteristics including income, race, educational attainment, and access to transportation, in order to identify levels of social disadvantage at the county level.


One of the study’s findings reveals that commercially insured adults in Missouri who lived in counties with higher SDI values, in aggregate received fewer recommended diabetes screenings (Hemoglobin A1c, Kidney Function and Cholesterol) than did their neighboring counterparts who lived in areas with a lower SDI, even though both groups were commercially insured.


The report poses policy considerations and urges healthcare leaders to target interventions at the local level, while viewing health outcomes through a community lens. “Small changes, community by community, employer by employer, family by family, can add up to meaningful improvements in health outcomes across the state,” said Marla Langenhorst, Director Benefits, Ameren Corporation and recent past Chair, St. Louis Chapter of the American Diabetes Association.  


Key Findings

  1. Prevalence of people being treated for type 2 diabetes among commercially insured Missourians aged 18-64 was 5.2% in 2019.

  2. 70% of those with a regular source of primary care received three recommended diabetes screenings during the year.

  3. Adjusting for age and health risk, people with type 2 diabetes were about 2 times more likely to visit the emergency department and 2.7 times more likely to be hospitalized in comparison to people without diabetes.

  4. Medication adherence is an improvement opportunity. People with type 2 diabetes did not consistently refill blood pressure (32%), cholesterol (40%), and anti-diabetes medications (26%).

  5. The average annual cost of a person with Type 2 diabetes ($14,791) was over 2.5 times higher than those without diabetes ($5,568).

  6. This study’s statistical models show that social factors as well as age were associated with type 2 diabetes prevalence and care management.

  7. By understanding disease prevalence, gaps in care, and spending at a local level, resources can be targeted to areas with the greatest opportunities for improvement.

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