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 a 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 #1 in pharmacy costs to Medicare beneficiaries and a close #2 for 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.





Insulin using patients that have A1C above goal are prescribed expensive anti-diabetes drugs such as: 

SGLT-2 inhibitors

DPP-4 inhibitors

GLP-1 agonists


Without specially-designed intervention, it has proven hard to control costs.


Why Aren’t We Getting Better Results?

Insulin has been around almost 100 years, yet 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.

As a result, most patients are prescribed ineffective doses of insulin.

Too much complexity

Similarly, there are >30 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 Guidance Service was developed over the past 10 years based on extensive research with over 2,500 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® Service was shown to:

  • Help nearly 90% of members to improve A1C within a short three months.
  • Significantly reduce the frequency of mild and severe hypoglycemia.
  • Increase members 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 face-to-face visits in our community-based clinics, regular A1C testing and glucose test strips free of charge, 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 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.

Projected direct savings from implementing the d-Nav® Service are $11,991 per member over two years. First year pharmacy reduction is estimated at $2,916 per member per year. An average of $910 per member is eliminated each year because the d-Nav® Service provides members with their diabetes supplies at no extra cost. Additional savings due to a reduction in member related medical utilization is 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® Service 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.

Treatment Satisfied
Changes in treatment satisfaction within 3 months
d-Nav® Service clinical outcomes since 2013



To talk to a Hygieia Representative, or to schedule a demonstration of the d-Nav® Insulin Guidance Service, please call 734-369-9983 or contact us using the button below.