Executive Summary

A Midwest health plan wanted to reach, engage, and empower more members living with diabetes through personalized virtual care. With Cecelia Health, the plan implemented a six (6)-month diabetes management solution that included clinical support and education from experienced Certified Diabetes Care & Education Specialists (CDCES). The Cecelia Health clinical team is specially trained to help individuals better understand how to selfmanage their condition. They build relationships that foster trust to address individual preferences as well as unique barriers to medication and care plan adherence, including social determinants of health.

Members enrolled in the Cecelia Health program realized lower medical per member per month (PMPM) costs compared to rising costs among those not enrolled as shown in Figure 1, and:

 38% reduced diabetes claims cost over six months compared to nonenrolled members, where diabetes was the primary diagnosis

 64% reduction in inpatient costs over six months compared to nonenrolled members

These impacts resulted in a 3.7x return on investment (ROI) for the plan

Background & Objectives

Cecelia Health is a virtual specialty medical practice providing holistic, chronic care management across a range of care and conditions. Cecelia Health’s clinicians empower members to understand their disease, remove barriers, and adhere to their medication and treatment plans

The plan partnered with Cecelia Health to expand and scale their existing diabetes management program in a cost-effective way, launching Cecelia Health’s virtual care platform in February 2022, including:

 Cecelia Health team of Certified Diabetes Care and Education Specialists (CDCES) providing dedicated care management support

 Member engagement over a six (6)-month period

 Personalized and programmatic member journey with timely and relevant curriculum to encourage and reinforce positive behavior change

 Omnichannel outbound member communications

 Eligible members can re-enroll for three (3) months after the initial six (6)-month enrollment with a maximum of three (3) re-enrollments allowed per member Program objectives included improving the member’s understanding of diabetes, reducing HbA1c levels, HEDIS gap closures, improving member satisfaction, and making behavior and lifestyle changes that lead to long-term health outcomes and quality of life. These objectives should impact lowering healthcare cost such as reduction in medical spend and inpatient cost. The purpose of this study is to analyze and quantify the cost benefits of the virtual program and determine the return on investment to the health plan

Methodology Inclusion Criteria

To be eligible for the case study, members must have enrolled in or been referred to (but not enrolled in) the Cecelia Health diabetes management program between February 1, 2022, and March 31, 2022. This date enrollment date for those enrolled and referral date for those referred is the “program date.” Members must also have continuous enrollment with the plan for six months prior to and including the month of enrollment with Cecelia Health and six months post the month of enrollment with Cecelia Health. After applying continuous enrollment constraints, the enrolled population loses just 15 members as seen in Table 1

Population Profiles Prior to Matching

Prior to running propensity score matching (see Propensity Score Matching section below), exploratory data analysis was performed to compare the member population enrolled in Cecelia Health to those members referred but not enrolled. Table 2 shows the mean values for the metrics that are available to be used in the propensity score matching model prior to matching. All spend values have been transformed into a six-month PMPM for ease of comparison.

An immediate takeaway is that the members who enrolled in Cecelia Health tend to:

 Be nine (9) years older on average, more likely to be on Medicare

 Have an average total medical PMPM of ~$838 prior to enrollment

 Have an average inpatient PMPM of ~$291 prior to enrollment

 Have an average amount of inpatient visits at twice the rate of those not enrolled