HTF Blog: Liver disease

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Non-Invasive Liver Exams and Chronic Care Management Improve Health, Safety and Productivity of Nation’s Professional Truck Drivers

John Gingrich

Professional truck drivers, fleet owners and fleet safety officers are seeking strategies to help keep drivers at peak health so they can remain productive and stay safe behind the wheel. Maintaining an adequate pool of employees is an ongoing struggle for many fleet owners, with serious health issues being a key reason for driver turnover.

Solving this problem is important, especially given the shortage of professional drivers in the United States. The trucking industry reports 80,000 fewer available drivers compared to 2019, with projections of 160,000 fewer by 2028. What’s more, drivers suffering from poorly or uncontrolled chronic diseases carry potential implications for the safety of the American driving public.

Uncontrolled hypertension, diabetes, sleep apnea and respiratory dysfunction are examples of the types of medical conditions that will preclude a driver from attaining licensure and continuing with their livelihood.

In a recent survey conducted by the Healthy Truckers Association, one in three professional truck drivers expressed concerns about diabetes and one in two about obesity. Fatty liver disease (FLD), including non-alcoholic fatty liver disease (NAFLD) and the more problematic non-alcoholic steatohepatitis (NASH) are conditions that accompany the epidemics of obesity and diabetes, often leading to advanced fibrosis and liver cancer, liver transplantation, increased risk of cardiovascular events and all-cause mortality.

Liver disease has been inextricably linked to metabolic syndrome (MetS) and obesity and may result from work-related conditions that include long hours on the road with limited opportunities for physical activity, healthy food and regular shift and sleep patterns.

The good news is that non-invasive, rapid and painless examinations can accurately assess liver health to support liver and metabolic health. Early identification of drivers at risk for liver disease and engagement, combined with health coaching, are essential. Such a program fosters healthier living to ensure that professional drivers get on the road to better health and continue to pass the required bi-annual medical exam to maintain a CDL.

Health Challenges Among Professional Truck Drivers

According to the Centers for Disease Control and Prevention (CDC) research, seven out of ten professional truck drivers are obese in the United States alone, leading to coronary diseases insomnia and Type 2 diabetes. Obesity is a key risk factor for diabetes, with 89% of U.S. adults aged 18 years or older diagnosed with diabetes being overweight or having obesity, which is defined as a body mass index (BMI) of 25 kg/m2 or higher. Interventions to impact these conditions have traditionally been ineffective.

Diabetes is one of the leading causes of disability and death in the United States. One in 10 Americans have diabetes – more than 30 million people – and another 84 million adults are at high risk of developing Type 2 diabetes.

Diabetes and obesity are closely linked to MetS and insulin resistance. NALFD, the accumulation of lipids in liver cells not associated with the consumption of alcohol, and NASH are highly prevalent in people living with MetS and are recognized not only as leading causes of liver disease, but also contributors to increased cardiovascular disease (CVD) mortality among people living with Type 2 diabetes. Not simply a result of alcohol consumption, NAFLD is the most common type of liver disease in the Western world.

Focus on NAFLD

NAFLD affects roughly 100 million Americans and costs the U.S. healthcare system $32 billion annually. In a recent retrospective analysis among Medicare Advantage plans, the annual cost of NAFLD was $9,062 for a new diagnosis and $5,363 for long term management versus $4,111 per matched control.

Costs per patient and overall costs per year are the result of inpatient hospitalization and outpatient appointments, emergency department visits, organ transplantation, medical procedures or new diagnoses, new medications or changes to existing medications and mortality. Moreover, one in every 17 people in the United States is employed by the trucking industry, with the average truck driver being a 55-year-old male.

Because NAFLD and NASH are so tightly intertwined with obesity, diabetes and lifestyle, more coordinated engagement is needed to support behavioral changes that will result in better outcomes across the co-morbid conditions affecting the professional truck driver population. Chronic care management (CCM) provide the opportunity to cost-effectively improve that coordination, especially when combined with non-invasive liver exams to detect and monitor progress in lifestyle changes.

Lifestyle Change Can Halt or Reverse Liver Disease

NAFLD is reversible if caught in the early stages and accompanied by lifestyle changes. To help maintain a good clean liver, professional truck drivers should eat fresh, whole foods and skip the high-fat, high-sugar “Western” diet that a recent study determined was a source of liver inflammation.

If left untreated, over time, liver disease can lead to a more serious stage called cirrhosis, a scarring of the liver that can lead to liver failure – the number one reason for liver transplants for end-stage liver disease or liver cancer. Along with CCM programs, Lifestyle Change Programs (LCPs) that include diet and exercise can have a big impact. One such program designed for professional drivers showed that even 3%-5% weight loss improved liver health.

CMS has found that CCM programs reduce costs and improve outcomes to address chronic conditions, including Type 2 diabetes and obesity.

Non-Invasive Tool for Addressing Liver Disease

As part of a CCM program, non-invasive exams—such as FibroScan or transient elastography—are designed to improve individual health outcomes, lower payer costs by avoiding expensive, invasive interventions and enhance the financial performance of practices.

This combination improves care coordination as part of a comprehensive care plan for patients with NAFLD, NASH, Type 2 diabetes, obesity and/or the underlying MetS that contribute to the progression or risk of developing advanced liver disease.

Rapid and non-invasive assessment of liver fat and stiffness can assist in reducing unnecessary diagnostic procedures, additional treatments and cost associated with progressive liver disease. At point of care or in the primary care setting, physicians can provide liver stiffness and fat assessment as a component of a wellness visit rather than waiting for serious and more damaging symptoms to occur.

Among its many benefits, non-invasive exams provide consistency and evidence; standardize care and provide patients and providers with state-of-the-art technology; and are covered by CMS and most commercial insurance plans for diagnosing and monitoring chronic liver disease. As part of an overall liver assessment, these exams can be performed by a medical assistant and interpreted by the physician and take about 10 minutes to perform.

With limited options for primary care, healthy food and exercise, professional drivers face significant barriers for improving their health. A focus on chronic care management and health and wellness programs can support these efforts. Innovative, point-of-care tools play a key role in measuring lifestyle change, improving patient engagement and giving fleet owners an opportunity to provide the resources and means to improve quality of life for driver
health and well-being.

John Gingrich

CEO, Echosens North America

With more than 20 years of global medical device and health care sales, marketing and general management experience at AxoGen, Inc., Hologic, Inc., Boston Scientific Corporation and Unilever, N.V, Gingrich now leads the development and execution of the Echosens U.S. strategy for expanding the utilization of FibroScan® technology in the assessment of chronic liver disease. As a member of the broader global executive leadership team, he works to implement the Company’s transformation plan and shape the future of Echosens.

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