When the Blue Cross Blue Shield Association analyzed over 200 conditions for its BCBS Health Index, diabetes had the third highest impact nationally on quality of life and was the third highest driver of per member per year costs for the commercially insured population. According to a study by the Healthcare Incentives Improvement Institute (HCI3), the annual avoidable costs associated with diabetes complications and services is over $16 billion.

The NextHealth platform tackles this growing problem with big data, advanced analytics and effective consumer engagement.


BCBS diabetes costs
Source: Blue Cross Blue Shield

Other findings include:

  • The prevalence of diabetes is growing among various age groups, including adults between the ages of 18 to 34 and 45 to 54.
  • The national average cost to treat diabetes is $137 per member per year (PMPY), with significant regional differences and higher costs in the Southeast and Central South regions of the US.
BCBS diabetes impact
Source: Blue Cross Blue Shield

Payers are focusing on ways to help their members manage their chronic conditions to live healthier lives and to reduce unnecessary costs to the health care system. To ensure these innovative strategies are successful in lowering costs and improving outcomes, organizations need claims analytics and other data-driven reports to make informed, clinical decisions and many struggle to understand how to leverage analytics to tackle the key challenges:

  • What programs work best to ensure members already diagnosed with diabetes comply with preventive testing to improve health outcomes and reduce costs?
  • How can prediabetic members be identified early and enrolled in preventive programs?

The NextHealth platform tackles this growing problem with big data, advanced analytics and effective consumer engagement. The NextHealth prescriptive analytics engine predicts members who are likely to become diagnosed with diabetes and who are likely to change behavior. The NextHealth consumer engagement engine tests which diabetes program is effective to ensure members get the care they need to manage their condition. Whether payers are focused on identifying populations to target, understanding which program works best for whom, or looking for opportunities to improve their HEDIS measures, the NextHealth platform can address the cost and quality of care parts of the equation.


Contributed by Thomas Tran, Engagement Manager, NextHealth Technologies

NextHealth’s platform scales to address multiple use cases.