The American Diabetes Association's new CEO Kevin L. Hagan has a message for America's healthcare providers: Diabetes is an escalating crisis in our country and it is putting a serious burden on our healthcare system.
In 2010, the Centers for Disease Control and Prevention issued an estimate that 1 in 3 American adults could have diabetes by 2050 if current trends continue.
Mr. Hagan assumed his position with the ADA in February. Before then, he served as CEO of Feed the Children and as COO of Good360, a nonprofit organization that links nonprofits with corporate product donations.
Here we checked in with Mr. Hagan to see what his plans are to address these issues as he leads the ADA, what population health means to him and how it can help change the face of diabetes in the U.S.
Note: Responses have been edited lightly for length and style.
Question: What do you hope to accomplish as CEO of the American Diabetes Association?
Kevin L. Hagan: My big hope is that we can have an exponentially greater impact on our mission, which focuses on providing services and information to those living with diabetes and at risk for diabetes. One of the ways we hope to do that is through the creation of new programming, population health initiatives and other ways we can begin to affect patient outcomes within healthcare systems. Now, all of that needs to be funded too. I plan to look at the Association's assets and communicate with the American public in an effective manner to increase revenue generation and fundraising.
Q: How do you define population health?
KH: Everyone has different definitions and it is interesting there is not a consistent application. What it means to me, and how we are taking it here, is focusing our initiatives on our population — people with diabetes and predisposed to diabetes — and figuring out what interventions we can make to improve their health. We are beginning to go into health systems and ask them to identify or target ways to reduce negative outcomes for our patient population by analyzing data, taking that feedback and incorporating it into the system of care. Preliminarily we are having positive experiences and improved patient outcomes in those areas. We are very excited about the possibility of more of that work in the future. We really look to drive quantifiable changes in healthcare and collaborate with health systems and clinicians.
Q: What is your experience with diabetes and how that has influenced your plans for the American Diabetes Association?
KH: Diabetes ravages most of my immediate family — my mother, my father and my brother-in-law, who especially is beginning to have some of the horrible side effects in terms of eyesight — but my own experience is even more personal than that. I was diagnosed with prediabetes.
Quite honestly, I was overweight; I was on two blood pressure medications and my primary care physician read me the riot act. She told me I had to change my lifestyle or I wouldn't make it to 45, which shocked me. I saw what it did to my family and took that seriously. I have lost over 100 pounds at this point and am no longer in the blood glucose range for prediabetes.
My story has influenced my plans in that we need to turn our attention toward primary care providers and clinicians who deal with this disease everyday — especially type 2 diabetes. With type 2, the war against diabetes is at the front line in the primary care provider's office. We have to find a better way to embrace primary care providers and fight this disease by providing resources and elevating the conversation around type 2 diabetes and prediabetes to prevent as many cases as possible. At this time, we are unfortunately unable to prevent type 1 diabetes, but have funded research in this area, as well.
Q: What, if anything, do you think is currently working with how diabetes and chronic disease are managed in the U.S.?
KH: Diabetes treatment and care really has improved markedly over the past 20 years. The mission to improve the lives of people with diabetes is evidenced with some serious declines in diabetes-related complications. For example, in 20 years [1990-2010] there has been a 68 percent reduction in myocardial infarctions, a 53 percent reduction in strokes and a 51 percent reduction in amputations due to diabetes complications. Obviously those pieces are working, but the real challenge is prevalence, particularly of type 2 diabetes.
Nearly 30 million Americans are living with diabetes [types 1 and 2] today and 86 million have prediabetes. If present trends continue, by 2050, 1 in 3 adults will have diabetes, and that is unacceptable. Complications are on the decline, but prevalence is on the rise. That's where our focus and energy need to turn to — how to help people at risk fend off diabetes while continuing high standards for managing and treating diabetes.
Q: What, if anything, would you like to change about how diabetes and chronic diseases are managed in the U.S.?
KH: There are a few things I would point out. We need to put greater efforts toward prevention as a whole, considering the escalating trends in type 2 diabetes. The numbers are incomprehensible and we simply cannot afford what that future looks like.
Second, we need to better coordinate the care of people with diabetes. The best care for people with diabetes comes from a team. That includes primary care physicians, dietitians, behavioralists, specialists, and for those who are insulin dependent, an endocrinologist. Part of that care network is also the family. All those groups can play a huge role in behavioral and lifestyle change that improves health.
Third, for healthcare providers as a whole, we would like to see them more adequately reimbursed for preventive care. As an American populace currently more focused on treating rather than preventing, the biggest bang for our buck will be focusing on the preventive stage.
Q: Have population health initiatives led by healthcare organizations been effective in helping improve health outcomes for diabetics?
KH: At this point, there are a couple of options such as patient-centered medical homes and accountable care organizations. They are still in their infancy stages, but the preliminary data suggests they are having a positive impact on diabetes. Of course, longer-term, broad-based data is going to be necessary to see if these are ideal delivery systems for people with diabetes.
Q: Are there any actionable steps hospitals and health systems can take to help address the social determinants of health?
KH: One of the big issues we as an American society need to discuss is that diabetes actually represents a much larger problem. There are a lot of environmental issues that play into diabetes. Living environment matters — do we have access to sidewalks to walk, playgrounds and exercise equipment? What about the availability of the right food options and the cost of food? Some of the more impoverished areas of the country have the highest incidence rate of diabetes. People who live in food deserts lack access to food, and food policy plays a real role. While health systems do play a role, there are much broader environmental policies that can affect health.
Q: Is there anything else you think healthcare leaders need to know about diabetes or population health?
KH: They need to know that this is a big, real American problem. Diabetes is an escalating crisis and we cannot talk about it enough. We need to stop the shame and blame surrounding diabetes and begin having a real conversation about the cost. It is staggering. We have spent $245 billion on diabetes and that's just the cost we know for diagnosed diabetes — it doesn't even count all the other costs of prediabetes-related care. We need to talk seriously and work in a collaborative manner with public policy to inform Congress, local and state governments and corporate America that this is a true priority for the American people and their healthcare system. The cost of us doing nothing is growing day by day.
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