Diabetes has become one of the most significant healthcare challenges facing health plans today. What was once viewed primarily as a chronic medical condition is now a complex population health issue that impacts quality performance, healthcare costs, member satisfaction, and long-term outcomes. [cdc.gov]
More than 40 million Americans are currently living with diabetes, representing approximately 12% of the U.S. population. At the same time, an estimated 115 million adults have prediabetes, creating a growing pipeline of future chronic disease burden. Even more concerning, nearly 11 million people with diabetes remain undiagnosed. [cdc.gov]
For health plans, the message is clear: diabetes management is no longer simply about treating disease. It is about identifying risk early, supporting members consistently, closing care gaps, and creating meaningful engagement that leads to better outcomes.
The Rising Impact of Diabetes
The prevalence of diabetes continues to rise across the United States. Adult diabetes rates have increased from 11.2% in 2001-2004 to 13.5% in 2021-2023, placing increasing strain on members, providers, and healthcare systems alike. [cdc.gov]
The impact stretches far beyond elevated blood glucose levels. Individuals with diabetes face a higher risk of cardiovascular disease, kidney disease, vision loss, neuropathy, and other serious complications. Managing these risks often requires multiple medications, routine screenings, lifestyle modifications, and ongoing coordination among providers. For many members, that can feel overwhelming. [cdc.gov]
Health plans frequently encounter challenges such as:
- Medication non-adherence
- Missed preventive screenings
- Limited health literacy
- Transportation barriers
- Social determinants of health concerns
- Fragmented care coordination
- Low member engagement
These challenges don’t just affect individual health outcomes. They can also hinder a plan’s ability to improve quality goals, achieve Star Ratings measures, and manage overall healthcare costs.
The financial impact is substantial. The annual economic burden of diagnosed diabetes in the United States exceeds $412 billion, including both direct and indirect healthcare expenses. [American Diabetes Association] [American Diabetes Association]
Why Diabetes Is a Star Ratings Priority
For Medicare Advantage and other value-based organizations, diabetes management is directly connected to quality performance.
Many of the measures that influence Star Ratings and quality measures are tied to chronic condition management, including medication adherence, kidney health evaluations, preventive screenings, and ongoing member engagement. Success in these areas requires much more than identifying a gap in care. It requires helping members understand why quality-of-care matters and the importance of supporting them every step of the way.
Every missed screening, medication refill, or provider follow-up represents more than a missed measure; it represents a missed opportunity to help a member avoid complications and maintain better health.
As healthcare continues to shift toward value-based care, plans must build strategies that address both clinical and behavioral barriers to success.
The GLP-1 Era: Opportunity and Responsibility
In recent years, GLP-1 therapies have transformed the conversation around diabetes management.
These medications have demonstrated significant benefits in blood sugar control, weight management, kidney disease, and cardiovascular risk reduction for many individuals living with Type 2 diabetes. As awareness and demand continue to grow, health plans are navigating new questions around access, affordability, utilization management, and long-term adherence. [American Diabetes Association]
CMS has acknowledged this growing need through initiatives such as the Medicare GLP-1 Bridge Program. The demonstration program, launched in July 2026, provides eligible Medicare beneficiaries access to certain GLP-1 therapies while CMS evaluates broader approaches to chronic disease and obesity management. [cms.gov]
While expanded access is an important step forward, medication alone is not enough.
The most effective treatment plan is only successful when a member comprehends it, follows it, and remains engaged with the treatment plan over time.
That is why health plans must focus not only on therapy access, but also on educating members, supporting their health goals, and promoting medication adherence.
Medication Adherence: The Missing Link in Better Outcomes
Medication adherence remains one of the strongest drivers of clinical success for individuals managing chronic conditions.
Despite this, many members struggle to stay on therapy due to cost concerns, side effects, transportation challenges, competing priorities, or a lack of understanding about their treatment plan.
Simply reminding members to refill prescriptions is rarely enough.
Effective adherence programs require personalized outreach, member education, barrier identification, and ongoing support. When plans can successfully improve adherence, they often see benefits that extend across the healthcare continuum, including improved outcomes, reduced utilization, fewer avoidable complications, and stronger quality performance.
At PlanPlus, medication adherence is more than a measure. It is a core area of expertise. We understand that every member’s journey is different, and sustainable behavior change requires a thoughtful, personalized approach.
How PlanPlus Helps Members Navigate Diabetes and Chronic Conditions
Diabetes is not a condition that can be managed through isolated interventions. It requires a comprehensive, whole-person strategy that addresses clinical, behavioral, and social factors.
Through our Diabetes Care Management Program driven by our Member Experience & Outcomes Team, PlanPlus works alongside health plans to provide proactive support that helps members stay connected to their care and achieve better outcomes.
Our Member Experience & Outcomes Team helps members:
- Improve medication adherence
- Understand and manage their condition
- Complete recommended preventive screenings
- Address barriers to care
- Navigate healthcare resources
- Strengthen provider engagement
- Stay on track with treatment plans
By meeting members where they are and providing personalized support, we help transform healthcare from a reactive experience into a proactive partnership.
Closing Care Gaps and Improving Quality Performance
Health plans today face increasing pressure to improve performance across diabetes-related quality measures while maintaining a positive member experience.
PlanPlus helps plans take a focused, data-driven approach to care gap closure through targeted outreach, member engagement strategies, and chronic condition management expertise.
Whether addressing medication adherence measures, encouraging preventive screenings, supporting kidney health evaluations, or helping members navigate complex treatment regimens, our goal remains the same: connecting members to the care they need at the right time.
Most importantly, we recognize that behind every care gap is a real person facing real challenges.
When plans prioritize engagement and support alongside clinical interventions, meaningful improvement becomes possible.
Looking Ahead
The future of diabetes care will continue to evolve as new therapies, technologies, and CMS initiatives emerge. However, one reality remains constant: improving outcomes requires more than prescribing medication.
Success depends on helping members understand their condition, engage in their care, adhere to treatment plans, and access the resources they need to thrive.
As diabetes prevalence continues to rise and innovative therapies like GLP-1s reshape treatment strategies, health plans need partners that can bridge the gap between clinical strategy and member action.
At PlanPlus, we combine medication adherence expertise, chronic condition management, care gap closure strategies, and member engagement solutions to help health plans improve outcomes, strengthen quality performance, and support healthier populations.
Because improving a measure is important, but improving a member’s health is what drives lasting success.
References
- American Diabetes Association. (n.d.). Statistics about diabetes. https://diabetes.org/about-diabetes/statistics/about-diabetes
- Centers for Disease Control and Prevention. (n.d.). National diabetes statistics report. U.S. Department of Health and Human Services. https://www.cdc.gov/diabetes/php/data-research/index.html
- Centers for Disease Control and Prevention. (n.d.). State burden toolkit. U.S. Department of Health and Human Services. https://www.cdc.gov/diabetes/burden-toolkit/index.html
- Centers for Disease Control and Prevention. (n.d.). Stop diabetes complications. U.S. Department of Health and Human Services. https://www.cdc.gov/diabetes/prevention-type-2/stop-diabetes-complications.html
- Centers for Disease Control and Prevention. (n.d.). United States diabetes surveillance system: National diabetes statistics report. U.S. Department of Health and Human Services. https://usdss.cdc.gov/diabetes/report.html
- Drucker, D. J. (2024). Efficacy and safety of GLP-1 medicines for type 2 diabetes and obesity. Diabetes Care, 47(11), 1873-1888. https://diabetesjournals.org/care/article/47/11/1873/156807/Efficacy-and-Safety-of-GLP-1-Medicines-for-Type-2
- Petersen, M., Dall, T. M., Chen, Y., Albanese-O’Neill, A., Bursell, S. E., Buxbaum, J. D., Carris, N. W., Choi, S. E., Colombo, M., Desai, U., Duncan, I., Egwuatu, N. E., Gabbay, R. A., Gillespie, C. W., Greenlund, K. J., Hirsch, I. B., Isom, S., Johnson, E. L., Kruger, D., … American
- Diabetes Association. (2024). Economic costs of diabetes in the U.S. in 2022. Diabetes Care, 47(1), 26-43. https://diabetesjournals.org/care/article/47/1/26/153797/Economic-Costs-of-Diabetes-in-the-U-S-in-2022
- Centers for Medicare & Medicaid Services. (2026). Medicare GLP-1 Bridge. U.S. Department of Health and Human Services. https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge