The Missing Piece of Your Diabetes Strategy

Are you managing a problem or solving it?

Health plans have anywhere from 3-5 diabetes management programs. But if asked, their medical directors will tell you they are falling short of expectations. 

“Health plans today all have some mechanism for diabetes management. But they’re really not doing enough.” says Tony Masso, former CEO of Consortium Health Plans. 

“They’re basically measuring blood glucose levels. They’re prescribing more and more meds. It’s not unusual for a person with type 2 diabetes to be on 3 to 4 medications at the same time, overweight, and only occasionally contacted by their primary care physician, usually on a monthly basis.” Masso says.

Tony Masso and Don Berwick

Don Berwick, former administrator for Center for Medicare & Medicaid Services, highlights the pitfalls of conventional care for type 2 diabetes, saying “It tends to be interventional, drug-oriented. It tends to be episodic. We don’t think about relationship management. We think about visit management. That’s how healthcare is built and that’s how it’s paid for. It doesn’t really work that well with chronic illness of any type. And it doesn’t work to help people make the changes in their lives that really will get upstream and stop the effects and the causes of diabetes.”

Most programs are only successful in monitoring A1c levels. They don’t actually treat the root cause of the disease. And as diabetes prevalence and the associated costs continue to rise1, it’s clear that traditional management programs aren’t making any meaningful impact. 

The high cost of ineffective diabetes management programs

Limiting your strategy to programs that only manage diabetes is a risky and expensive proposition. Diabetes drugs are a top 3 Rx cost driver in the U.S2. Care for people with diagnosed diabetes accounts for 25% of total healthcare dollars spent in the U.S., according to the American Diabetes Association3. And diabetes prevalence is doubling every decade, according to the CDC4

As the disease progresses, it has been shown that glucose-lowering medication usage, health care costs, and complications all rise. At 9 years, less than 25% of patients are able to control their blood glucose level with only one medication5, and 10-15 years after the diagnosis of type 2 diabetes, more than 50% of patients will require insulin6.

Steve Martin, former CEO of Blue Cross & Blue Shield of Nebraska

Steve Martin, former CEO of Blue Cross & Blue Shield of Nebraska, highlights how mission-critical it is for health plans to address diabetes. “For the last 30 years, health plan leaders needed to have type 2 diabetes on their radar because it’s been growing every year…The average patient living with type 2 diabetes is going to cost a health plan about $10k a year.” 

If left unchecked, the cost of diabetes care and drugs can threaten a health plan’s bottom line. 

A solution that’s bending the trend 

For a long time, type 2 diabetes was accepted as a chronic and progressive condition, but a new whitepaper based on decades of research shows that it can be reversed, offering significant quality of life improvements for patients and meaningful Rx and medical cost savings for the insurer7

Diabetes reversal is now clinically defined, and completely different from diabetes management. Reversal saves health plans $425 a month per engaged member with diabetes in gross claims savings - more than 5x typical diabetes management solutions8. And while most health plans already offer diabetes prevention and management solutions, they are adding Virta’s diabetes reversal treatment as an additional, impactful option for their members. 

What are the key differences between diabetes reversal and management programs?

Virta’s diabetes reversal:

  • Goal is to return patients to sub-diabetic A1c levels and eliminate all diabetes-specific medications other than metformin, without surgery or other drugs
  • Reduces type 2 diabetes Rx costs, estimated medical costs, and side effects  

Diabetes management:

  • Goal is to keep A1c levels in check by adjusting the amount of insulin or other diabetes medication taken; does not reverse the root cause of the disease 
  • Does not reduce type 2 diabetes Rx costs, medical costs, or side effects and sometimes this even comes with an increase in medications

Virta’s reversal treatment is a low risk, high reward solution to reverse diabetes 

Virta makes diabetes reversal possible through personalized nutritional therapy and a fully virtual, provider-led medical group. 

Health coaches work with patients to make personalized nutritional changes that aim to reduce their blood sugar and dependence on diabetes medications. Patients monitor their blood sugar on a daily basis, and as their numbers come down, Virta’s medical providers safely deprescribe their medications. 

In their first week, many patients on insulin have their dosage cut in half. At 10 weeks, many patients are off the majority of their diabetes-specific drugs, like insulin, with the exception of metformin9. They save money, feel better, lose weight and say goodbye to the costly complications of diabetes as they take their lives back. 

Virta can safely and sustainably reverse type 2 diabetes without surgery or medication because of  continuous remote monitoring – something a primary care physician doesn’t have the bandwidth to do. It’s a low risk, high reward investment that works, no matter what the patient’s walk of life.

Banner|Aetna's CEO, Tom Grote, recently told Becker's that "the smartest thing I've done in the past year is set up a partnership with Virta Health...So far, our members have had incredible success and we have seen strong program enrollment."

Dr. Khuram Arif, Chief Medical Officer from Western Health Advantage, recently shared why he decided to offer Virta’s diabetes reversal treatment to members and how it’s changing lives. “It's unheard of that patients can actually discontinue or stop their diabetes medications. Virta saves our patient's copays, gives their quality of life back, and most importantly, gives them hope that diabetes is not a life sentence.”

Reversal is a necessary pillar of your diabetes strategy 

Dr. Arif isn’t the only health plan leader paying attention. Humana, Blue Cross NC, Capital Blue Cross and Centene are just some of the 30+ health plans that have added Virta’s diabetes reversal treatment to their disease management strategy, affirming the major industry shift away from management alone. “The tide is turning towards disease reversal as the primary goal for type 2 diabetes treatment,” says Sami Inkinen, CEO and co-founder of Virta.  

In 2021 the American Diabetes Association, the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK released a consensus report that defined diabetes reversal for the first time. While reversal or remission is not stated as the goal in this report, it does show increased momentum and recognition of non-invasive diabetes treatments.  

Reversal not only improves healthcare costs for the members that participate, but improves the efficiency of existing programs as well. While it’s a smart business decision for the health plan, it can be life changing for members, just ask Chris.

Chris, Virta patient
“Virta’s outcomes are unmatched. Health Plan leaders should pay attention.”
Steve Martin, former CEO, Blue Cross & Blue Shield of Nebraska 

Leading health plans are partnering with Virta because diabetes prevention programs, management solutions, wellness platforms, and even renegotiating medication rates with PBMs (Pharmacy Benefit Managers) aren’t doing enough to improve outcomes and reduce costs.

Mark Smith, MD, Clinical Professor of Medicine, UCSF, Former President and CEO, California HealthCare Foundation

Mark Smith, MD, Clinical Professor of Medicine, UCSF, Former President and CEO, California HealthCare Foundation highlights why health plans view Virta as a critical solution for members “If you’re a health plan and you’re thinking about what you’re currently paying for medication, for monitoring, for physician visits, for all the sorts of paraphernalia that goes along with diabetic treatment—anything that can reduce the burden of diabetes currently in the population, that’s currently being treated, is a big plus.” 

In Virta’s clinical trial, 60% of patients who completed one year of treatment reversed their diabetes. At two years, most of the results were sustained or improved. 83% of patients who reversed diabetes in year one sustained reversal through the end of year two10.

Virta’s Definition of Diabetes Reversal: Glycemic control below the diabetes diagnostic threshold (HbA1c<6.5%) without use of diabetes-specific medications (except metformin)

Why health plans partner with Virta for diabetes reversal

The top reasons health plans add Virta’s diabetes reversal treatment to their strategy is:

  • Hard savings: delivers total cost of care savings of $425 per engaged patient, per month8
  • Evidence based: 60% of patients who completed one year of treatment reversed their diabetes in our clinical trial11 
  • 100% fees at risk in year 1:* only Virta offers this unique pricing model connected to clinical and financial outcome metrics that are unmatched in the market 
  • Easy button: easy contracting, easy implementation, easy launch
  • Pays for itself: as proven in claims-based, externally-validated methodology8
  • Straightforward pricing: Only pay for engaged and participating members
  • High quality care: Frequent monitoring from Virta’s provider-led medical group
  • Member choice: give members a way to get off diabetes Rx safely and sustainably 
  • Supports health equity: telehealth model and personalized coaching is inclusive and can work for anyone from truck drivers to teachers and nurses to office workers

It’s time to deliver a new message to your members

Virta is different from diabetes prevention or diabetes management. We reverse chronic disease—not just manage or slow diabetes progression. In our clinical trial, 60% of patients who completed one year of treatment reversed their diabetes11

A lifetime of increased medications, weight gain, worsening blood sugar, threat of catastrophic outcomes, and overall decline in quality of life should no longer be considered the norm with type 2 diabetes. 

With Virta’s clinically validated treatment and care delivery model, your members have another option to treat their disease and even achieve reversal and remission of their diagnosis.

A partnership with Virta lets you deliver a new message to your membership—Diabetes is no longer a disease you have to live with for the rest of your life!

Ready to start reversing diabetes for your population?

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Citations and Footnotes

* Year 1 PPPM fees

  1. Centers for Disease Control and Prevention. National Diabetes Statistics Report website. Accessed July 2022].
  2. Simeon I. Taylor; The High Cost of Diabetes Drugs: Disparate Impact on the Most Vulnerable Patients. Diabetes Care 1 October 2020; 43 (10): 2330–2332., S. Diabetes Care 2020;43(10):2330–2332
  3. American Diabetes Association; Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care 1 May 2018; 41 (5): 917–928.
  4. CDC. Long Term Trends in Diabetes. April 2017; Rowley, WR et al, Diabetes 2030: Insights from Yesterday, Today, and Future Trends. Population Health Management. 2017 Feb 1; 20(1): 6-12.
  5. Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. J Am Med Assoc 1999 Jun 02;281(21):2005-2012.
  6. Nathan DM. Clinical practice. Initial management of glycemia in type 2 diabetes mellitus. N Engl J Med 2002 Oct 24;347(17):1342-1349. 
  7. Virta Health, The Reality of Reversal: Inside the Revolution In Type 2 Diabetes Treatment, July 2022 (Virta).
  8. Virta Health, Analysis of Type 2 Diabetes Reversal Cost Savings, Sept 2021 (Virta).
  9. McKenzie AL, Hallberg SJ, Creighton BC, et al. A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. JMIR Diabetes. 2017; 2(1):e5.
  10. Athinarayanan SJ, Adams RN, Hallberg SJ, et al. Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-year Non-randomized Clinical Trial. Frontiers in Endocrinology. 2019; 10:348. doi: 10.3389/fendo.2019.00348 (Result of a post hoc analysis)
  11. Hallberg SJ et al. Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Therapy. 2018;9(2):583-612.
  12. Hallberg SJ et al. Diabetes Ther. 2018; 9(2): 583-612. Outcomes among one year completers (83% retention in Virta Treatment; 90% retention in Standard Care). Rx refers to the net change in diabetes-specific prescription volume at one year (which excludes metformin) compared to baseline and multiple insulins prescribed to a patient were counted as one rx. 
  13. Bollyky JB et al. JMIR Diabetes. 2019; 4, e14799 (Outcomes among one year completers (44% retention in Livongo). 
  14. Bollyky JB et al. J Diabetes Res. 2018; 3961730. (Outcomes at 12 weeks for Livongo + scale group).
  15. Diabetes-related prescription utilization according to five-client, two-year DiD analysis (slide 34). Livongo presentation at EBPA 2018.