Optimizing Care for Chronic Conditions: Insights for Health Plans on Key Health Markers

For healthcare leaders at health plans, digital health companies, and public health organizations, the effective management of chronic conditions across member populations is a top priority. Adopting accessible and informative health solutions can redefine care strategies, leading to improved health outcomes, stronger member engagement, and better quality metrics. This post explores essential health markers for managing chronic conditions—HbA1c for diabetes, various cholesterol types, and indicators of kidney function—and highlights how convenient at-home testing options can empower health plans in their proactive care initiatives.

HbA1c: A Central Marker for Diabetes Management

The HbA1c (hemoglobin A1c) test serves as a crucial diagnostic tool in the realm of diabetes care. With a significant portion of the U.S. adult population managing diabetes or prediabetes, this test offers a practical way to screen for prediabetes, confirm a diabetes diagnosis, and guide long-term treatment.

The HbA1c blood test measures the amount of glucose attached to hemoglobin in red blood cells. Since red blood cells typically circulate for about three months, the HbA1c result provides an average snapshot of a person’s blood sugar levels over that approximate period. This offers a more comprehensive view of glucose control compared to single-point blood sugar readings.

Understanding HbA1c Levels Across Age Groups

Generally, for adults, HbA1c values are categorized as follows for diabetes diagnosis:

• A healthy HbA1c level is typically under 5.7%.
• Prediabetes is indicated by levels between 5.7% and 6.4%.
• A diagnosis of type 2 diabetes occurs when the level is 6.5% or higher.
• The general target for most adults with diabetes is an HbA1c below 7%.

It's important to recognize that what is normal HbA1c by age can vary. As individuals get older, their HbA1c levels may naturally trend upward, even without a diabetes diagnosis. This age-related increase means that "normal" can shift, reflecting physiological changes.

Discussions among healthcare professionals continue regarding appropriate normal A1c levels for seniors. Organizations such as the American Diabetes Association (ADA), American Geriatrics Society (AGS), and the International Diabetes Federation (IDF) suggest more lenient HbA1c targets for those over 65, potentially ranging up to 8.5% or 9% for individuals with complex health profiles. This approach acknowledges that aggressive glycemic control in older, vulnerable populations can increase the risk of severe hypoglycemia. Despite these differing guidelines, a personalized approach to diabetes management for older adults is widely advocated.

What is the GSD HEDIS Measure?

The GSD HEDIS Measure is the Glycemic Status Assessment for Patients with Diabetes. It evaluates the percentage of diabetic patients whose glycemic status was adequately controlled. It’s important to note that individuals who are already diagnosed with diabetes have ranges different than the “standard” values. Thus, key threshold values are set to:

• HbA1c level of < 8.0% (good control)
• HbA1c level of > 9.0% (poor control)

Achieving HbA1c Reductions: "How Much Can A1c Drop in 3 Months?"

A common question among those aiming to improve their metabolic health is "how much can A1c drop in 3 months?" Significant reductions are achievable through consistent lifestyle adjustments. For members with initially high HbA1c levels (e.g., 9% or above), a decrease of 1 to 2 percentage points is often observed. Even a reduction of 0.5 percentage points is considered a meaningful clinical improvement.

Effective strategies for naturally lowering HbA1c include:

• Dietary Choices: Emphasizing fiber-rich foods, combining carbohydrates with protein or healthy fats to moderate blood sugar spikes, opting for complex carbohydrates with a lower glycemic index, and reducing intake of added sugars and highly processed foods.
• Regular Physical Activity: Engaging in consistent moderate-intensity exercise, complemented by strength training, helps cells utilize glucose more efficiently. Brief walks after meals can also contribute to better blood sugar control.
• Adequate Sleep: Prioritizing sufficient, quality sleep supports hormonal balance and insulin sensitivity, both crucial for glucose metabolism.
• Stress Management: Chronic stress can elevate cortisol, leading to increased glucose production and potentially higher HbA1c levels. Techniques for stress reduction are beneficial.
• Gut Health Support: Emerging research suggests a healthy gut microbiome can positively influence glucose metabolism.

Various factors, including an individual's background (e.g., race), specific medical conditions (like certain anemias or kidney issues), particular vitamin deficiencies, high triglyceride levels, and even geographical altitude, can impact HbA1c readings. For health plans, providing access to at-home HbA1c test options allows members to regularly monitor their metabolic status, facilitating early detection of concerns and informed conversations with their healthcare providers.

Understanding Cholesterol: Beyond the Basics

Cholesterol, while vital for bodily functions, can pose health risks at elevated levels, particularly concerning cardiovascular health. Beyond commonly discussed LDL ("bad") and HDL ("good") cholesterol, Very-Low-Density Lipoprotein (VLDL) cholesterol also plays a key role.

Decoding "VLDL Cholesterol"

VLDL cholesterol means Very-Low-Density Lipoprotein cholesterol. Its primary function is to transport triglycerides, a type of fat, from the liver to various tissues throughout the body. While essential for energy, elevated VLDL cholesterol levels are linked to the development of plaque within artery walls, increasing the risk of cardiovascular events such as heart attacks and strokes. Generally, a healthy VLDL level is considered to be below 30 mg/dL.

Accessible Cholesterol Screening: Home Health Solutions

For health plans aiming to enhance preventive care, home cholesterol test kits and at-home cholesterol test options offer a convenient and accessible way for members to monitor their lipid profiles. These kits typically involve a simple finger-prick blood collection. The sample can then be analyzed on a portable electronic device for immediate results or sent to a certified laboratory for a more comprehensive analysis.

These at-home tests can measure:

• Total cholesterol
• HDL (high-density lipoprotein)
• LDL (low-density lipoprotein), often an estimated value
• Triglycerides
• Some advanced tests may also provide an estimated VLDL cholesterol level.

When sourced from reputable providers and used as directed, FDA-cleared home cholesterol tests are considered reliable. They serve as valuable tools for members to track their cholesterol levels between clinical appointments, understand how lifestyle changes are impacting their health, and identify potential risks early.

Assessing Kidney Health

Maintaining healthy kidney function is fundamental to overall well-being. Impaired kidney function can lead to chronic kidney disease (CKD), a long-term condition that occurs when the kidneys are damaged and can’t filter blood as well as they should. This leads to a buildup of waste products and excess fluid in the body. Common causes include diabetes, high blood pressure, autoimmune disease, genetic disorders, and certain medications. While traditional assessments of kidney function often rely on estimated glomerular filtration rate (eGFR) calculated from creatinine levels, creatinine can be influenced by factors such as age, gender, and muscle mass, sometimes leading to less clear or variable results.

Biomarkers for KED HEDIS Measure

The KED (Kidney Health Evaluation for Patients with Diabetes) HEDIS measure looks at the percentage of members 18–85 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR), during the measurement year.

Empowering Proactive Care with At-Home Solutions

For decision-makers in healthcare, integrating accessible at-home health solutions for A1C, cholesterol, and kidney function markers can offer profound advantages:

• Enhanced Member Engagement: The convenience of at-home testing encourages members to take a more active and consistent role in managing their health.
• Early Detection and Intervention: Regular monitoring allows for earlier identification of chronic condition risks or progression, enabling timely and effective interventions.
• Improved Health Outcomes: Proactive management can help prevent the onset or progression of conditions like type 2 diabetes, mitigate cardiovascular risks, and support better kidney health, ultimately leading to a healthier population.
• Richer Data for Care Management: Data from consistent at-home testing provides health plans with deeper insights into population health trends and individual member needs, facilitating more precise and personalized care strategies.
• Support for Quality Measures: By boosting screening rates and fostering better health outcomes, these solutions can contribute positively to HEDIS and Star ratings.

By embracing the insights offered by these key health markers and leveraging convenient at-home testing options, health plans can significantly enhance their strategies for optimizing care for chronic conditions, fostering healthier, more engaged member populations, and achieving stronger performance metrics.

If you’d like to learn more about Ash and how we can help your member populations identify and manage chronic conditions, contact us here.