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A conversation with Blue Circle Health CEO and co-founder Dr. Len D’Avolio
Why is type 1 diabetes so hard to manage in the U.S. healthcare system? In this episode of Around the Circle, Scott Johnson talks with Dr. Len D’Avolio about how healthcare incentives, not a lack of innovation or expertise, make living with T1D unnecessarily difficult, and how Blue Circle Health is addressing gaps in care to show that a different care model is both possible, and necessary.
Living With Type 1 Diabetes in a System That Wasn’t Built for It
Living with type 1 diabetes (T1D) is a full time, lifelong responsibility. It requires constant attention, decision making, and access to insulin, technology, and education. Yet the U.S. healthcare system often makes these basics expensive, fragmented, or out of reach.
How Healthcare Economics Shape Outcomes
Dr. D’Avolio has spent more than 20 years working across healthcare, from software engineering and data science to academic medicine, public health, and healthcare innovation. A key learning has shaped his career: healthcare outcomes follow incentives.
In the U.S., more than 95% of healthcare reimbursement is fee for service. That means hospitals and clinics are paid when people are sick, not when they are healthy. This structure rewards volume and complexity, not prevention, education, or long term support.
The result is a system that performs well in acute care, like surgeries or emergency treatment, but struggles with chronic conditions like type 1 diabetes, that require daily management and ongoing guidance.
Despite spending more per person than any other developed country, the U.S. consistently ranks near the bottom on health outcomes. People die sooner than they should, and chronic disease care falls short; not because of a lack of good doctors or technology, but because the system incentivizes the wrong things.
Why Type 1 Diabetes Is Especially Hard to Manage
Type 1 diabetes does not fit into a quick, appointment-based model of care. Dr. D’Avolio describes a metaphor from Dr. Alice Carr that resonated deeply with him. Living with T1D is like piloting a plane that never lands.
You did not ask to be the pilot, but you are responsible for keeping the plane in the air at all times. Every day, you must factor in blood glucose levels, food, insulin, stress, exercise, sleep, and hormones. Insulin is the fuel. CGMs and automated insulin delivery systems are the instruments. The consequences of getting it wrong are serious.
While it is possible to live a long and healthy life with type 1 diabetes, that depends on reliable access to fuel (insulin), instrumentation (CGMs and devices), and training. Too often, the healthcare system limits access to exactly those things.
Dr. D’Avolio emphasizes that this is a fundamental injustice. We would never withhold fuel, instruments, or training from a pilot responsible for keeping a plane in the air, yet people with T1D face these barriers every day.
Short visits, delayed approvals, coverage barriers, and lack of education make a demanding condition even harder.
The Gap Between What People Need and What They Get
The healthcare system often treats type 1 diabetes like other conditions, with brief visits and episodic care. That approach does not match the reality of a condition that requires daily self management. Dr. D’Avolio points out a fundamental mismatch.
People with T1D need continuous education, prevention, and support, but the system is built around triage and acute care. This gap between what people need to stay healthy and what the system provides is the core problem Blue Circle Health was created to address.
What Blue Circle Health Is and How It Helps
Blue Circle Health is a free, six month virtual clinical care, education, and support program for adults living with type 1 diabetes. The program was funded into existence by the Helmsley Charitable Trust with a clear goal: to design care around what people with T1D actually need to succeed.
From day one, the team works to fill gaps. That may include access to insulin, help navigating insurance, connecting to other resources, and addressing immediate barriers. But Dr. D’Avolio stresses that the larger goal goes beyond triage.
Over six months, participants build skills, confidence, and understanding to manage T1D over a lifetime. The care model allows time to experience real life highs and lows, reflect on them, and learn how to respond. To date, Blue Circle Health has supported more than 1,000 people across 20 states and Washington D.C., with continued expansion underway.
Care That Supports Both Patients and Providers
Blue Circle Health works alongside existing care teams, not in place of them.
Many healthcare professionals recognize that the current system limits what they can provide. Blue Circle Health fills the gaps between appointments with education, behavioral health support, and practical help that providers often wish they could offer, but cannot under current reimbursement rules. Today, referrals from more than 100 clinics are the largest source of program participants; a sign that providers see real value in this model of care.
Why Community Matters in Type 1 Diabetes Care
One of the most important lessons Dr. D’Avolio learned is the power of community. Many adults living with type 1 diabetes do not know anyone else with the condition. Blue Circle Health makes connection a core part of care, through peer support, group events, and shared experiences. To Blue Circle Health, community is considered a key component of T1D care that should be prescribed to all. Community improves health, reduces isolation, and helps people learn from one another. Dr. D’Avolio believes connecting people with T1D should be a standard part of care everywhere.
Showing That Better Care Is Possible
Changing healthcare policy takes time and often follows a crisis. Blue Circle Health cannot change the entire system alone, but it can demonstrate what works.
By measuring outcomes carefully and sharing results, the organization aims to show that better outcomes are possible, and potentially at lower cost, when care is designed around prevention, education, and support rather than volume and complexity. If even parts of this model are adopted more broadly, it could shift how type 1 diabetes care is delivered.
A Final Takeaway
Type 1 diabetes care in the U.S. is not failing because of a lack of expertise, technology, or innovation. It is failing because incentives and systems are misaligned with what people need to stay healthy.
Blue Circle Health exists not because it should have to, but because the current system leaves critical gaps. By closing those gaps and demonstrating a better way forward, it shines a light on what type 1 diabetes care can and should look like.
