25 Responses

  1. NewsFlash: First-Ever “Diabetes Health Plan” from UnitedHealthcare | Pro Health News

    [...] the original post:  NewsFlash: First-Ever “Diabetes Health Plan” from UnitedHealthcare  Mail this post Tagged as: Allergies, Cancer, Diabetes, diabetes-essentials, diabetes-health, [...]

  2. kassie
    kassie January 16, 2009 at 6:19 am | | Reply

    Our BCBS health care plan is doing the same thing – in return for phone contact with a health management nurse, we get all diabetes related co-pays waived.

  3. tmana
    tmana January 16, 2009 at 6:43 am | | Reply

    I’ve had United Health Care for a couple of years now, and found out in late 2007 that the plan we’re on is zero-pay for diabetes medications, strips, and lancets, and does not limit the amount of testing for Type 2′s — even those of us on diet-and-exercise only. (Our PCP, who handles our diabetes management, has occasionally questioned our frequency of testing, but is perfectly willing to write the scripts if our insurance is not kicking it back as unwarranted.) Now, we do pay co-pays for our checkups, and The Other Half does have a co-pay for his CDE visits, but at least until this year, all the related lab work and such has been completely covered. (We haven’t yet been to a doctor in 2009.)

  4. Brent
    Brent January 16, 2009 at 11:47 am | | Reply

    Aetna has something like this as well, and I signed up for it for my teenage T1 daughter. When the ‘nurse’ called to find out about us and help plan our care, she knew nothing about Type 1, and gave us absurd, outdated recommendations like limiting carbs and a ban on sugar. It was clear that, although when I signed up I told Aetna that she was Type 1, the nurse they assigned really had absolutely no expertise at all. So for us, Aetna’s program was not very helpful.

  5. Paul
    Paul January 16, 2009 at 2:53 pm | | Reply

    I had a similar experience with an insurance plan. The insurance used a group to help patients with certain chronic conditions including diabetes. I was contacted by nurse about signing up for this service. In the course of the conversation I asked what kind of experience they had with long term (at the time more than 45 years) type 1 diabetes. She informed me that they had a lot of diabetics in their system. Then she made a statement that surprised me. It was something like you know that your type could change. Now I know that I might get insulin resistance on top of the type 1, but baring the success of some of the experiments with reviving islet cells I will never cease to be type 1 (insulin deficient). Another time I did participate in the program, but they seemed to be most concerned over A1C results and me contacting them every three months. I am sure that their emphases is on type 2 rather than type 1.

  6. Diane
    Diane January 16, 2009 at 4:13 pm | | Reply

    Well, the concept is wonderful. However, if the people we have to deal with to continue to be eligible are not adequately informed and knowledgeable, then this will not be the help we need. It also remains to be seen what type controls/rules we will be required to follow and what information we need to provide….how detailed and laborious it might be. We’ll just keep hoping and praying that this type approach is workable and will continue to improve as time goes by.

  7. whimsy2
    whimsy2 January 16, 2009 at 5:22 pm | | Reply

    Does that ADA requirement mean you have to follow their diet plan? The high-carb one that raises blood glucose and is the cause for many diabetes-related complications?

  8. Meg
    Meg January 16, 2009 at 5:25 pm | | Reply

    I always thought that when you were insured as part of a group, the employer paid an amount per employee, not per employee with a premium increase if the employee had a chronic disease. So, I’m wondering where the $22,000 figure comes from. Am I wrong about this, Amy?

  9. whimsy2
    whimsy2 January 16, 2009 at 5:27 pm | | Reply

    Brent: What do you mean by “absurd, outdated, ridiculous recommendations such as ‘limiting carbs and sugar’”? This is VERY GOOD ADVICE for both type 1s and 2s and is decidedly NOT outdated, ridiculous or absurd.

  10. » NewsFlash: First-Ever “Diabetes Health Plan” from …

    [...] Originally posted here:  » NewsFlash: First-Ever “Diabetes Health Plan” from … [...]

  11. nonegiven
    nonegiven January 17, 2009 at 1:23 pm | | Reply

    I hope ‘must comply’ doesn’t mean you can’t decide a recommended med is not for you or that you have to use their diet or something.

  12. Lauren
    Lauren January 17, 2009 at 8:43 pm | | Reply

    This does not get to the heart of the problem, this does nothing to address the issue of what’s wrong with health care for diabetics or anyone else. “Must comply” is very scary language especially coming from a health insurance company — ultimately it can mean whatever they want it to mean. And United Healthcare was just fined massively by the state of California for their shady claims processing practices (http://www.calphys.org/html/cc602.asp). Don’t make the mistake of believing they will do what they say they’ll do.

    As long as health care is for profit, there will never be fairness and justice in the system. Sick people will always be viewed as liabilities on the balance sheet instead of human beings. A few years back the UHC CEO took home a ONE BILLION dollar profit from stock options. Think of how many people’s lives were lost, how many people were financially destroyed through treatment denials, how many people suffered to realize those profits. It’s just wrong.

    Health care in this country will never be fixed until we get these for-profit insurance companies out of the equation — plus they should be made to pay reparations to the people whose treatment they’ve denied. I cannot believe this system is tolerated by Americans. It’s morally revolting.

  13. kelly close
    kelly close January 18, 2009 at 6:05 pm | | Reply

    This seems directionally right (what united is doing) even if the numbers aren’t right. Meg, I think the $22,000 is what they have calculated in terms of costs for people with diabetes, on average. i hope they see the importance of getting the best people possible to help with diabetes and investing in their education. that was sad to learn about the educator that was behind the times.

  14. kelly close
    kelly close January 18, 2009 at 6:05 pm | | Reply

    This seems directionally right (what united is doing) even if the numbers aren’t right. Meg, I think the $22,000 is what they have calculated in terms of costs for people with diabetes, on average. i hope they see the importance of getting the best people possible to help with diabetes and investing in their education. that was sad to learn about the educator that was behind the times.

  15. pamela
    pamela January 19, 2009 at 12:52 am | | Reply

    kassie, which BC/BS plan do you have (and in what state)?

    Hear, hear Lauren. Major problems in US health care system not resolved by this plan. And yet I’d love to have my fees lowered b/c I take an A1C 4x/year, see my endo, have my eyes examined, test/bolus/basal multiple times daily to stay in control, etc.

    My fear, however, is that IF you get complications, you will be seen as a liability = your costs will rise. So IF you have kidney disease or retinopathy, for example, you may not get the same fee reductions (e.g. expensive dialysis drugs not covered). In other words, punishing those for whom good health is simply too hard to attain. Why? Because they have diabetes!

    ps I didn’t watch the video, so I don’t know if drugs/appts for serious diabetes-related illness would be covered, or just preventive/maintenance care.

    Amy, thanks for sharing this. I had no idea it was a trend.

  16. AC
    AC January 19, 2009 at 1:13 am | | Reply

    Thanks Amy, I admire your blog and this post has special meaning

  17. Kevin
    Kevin January 19, 2009 at 10:19 am | | Reply

    There are really very few people who represent that ‘average cost’ for a person with diabetes given that people in good control are on the very low end of cost and at the high end you get pretty high given the extreme cost of amputations, kidney dialysis treatments, etc… So, it’s really a no brainer to give those people who do what they’re supposed to do to take care of themselves and to pay them for it assuming you can verify that self-care is actually taking place. Other ways that these plans and employers deal with this opportunity to reward people have been in play for many years including gift cards to major retailers.

    Another thing they have been looking at is a thing called Differential Premiums although this is politically sensitive. In essence, if you can prove that you take care of yourself your premiums are less and/or if you can’t prove that you’re taking care then your premiums would be higher.

    What does everybody think about differential premiums as a way to reward self-care vs the new United diabetes specific plan?

  18. TF
    TF January 19, 2009 at 5:46 pm | | Reply

    You mentioned United Healthcare program as a “first”. Actually Medical Mutual of Ohio has a program similar to this called “Diabetes Advantage”

    Our daughter has been type 1 diabetic 5 years and has been part of this program for that entire time. We get all of our testing supplies free — no deductible. All infusion sets, test strips, etc are shipped to use quarterly. We still have to pay for quarterly visits to endocrinologist and insulin, but the pump supplies are huge. The pump was also covered under the same program 4 years ago. We didn’t have to pay anything toward the pump and it therefore was not applied to deductible, coinsurance, etc. All we have to do is have a quarterly phone call with their nurse & ask a bunch of questions about her health. They also have a 24×7 nurse and dietician available by 800#. Early on in our daughter’s condition, we utilized this service.

    I googled & found this other reference to it:
    http://provider.medmutual.com/Tools_and_resources/Newsletters_and_Bulletins/pdf/QualityC/QC_V1_I2.pdf

    Thanks for all you do to keep us all informed!

    Take care,
    Tom

  19. Meg
    Meg January 19, 2009 at 8:49 pm | | Reply

    Kevin , I think we already have an extreme version of differential premiums. If you have a chronic health condition like diabetes, you will not be insurable unless you are part of a group. Personally, I don’t think I or anyone else has Type I diabetes because of a moral failing. I don’t know how I can “prove” this to an insurance company.

  20. pamela
    pamela January 19, 2009 at 11:00 pm | | Reply

    kevin, are you saying that those on kidney dialysis & amputees did not do “what they were supposed to do”? This was my earlier fear – the assumption that complications indicate a PWD was not exercising adequate self-care. I think we all must know that there’s a bit of luck and genetics in how your diabetes plays out in the longterm, right? (it’s not all tight control = never any complications).

  21. kevin
    kevin January 20, 2009 at 7:51 am | | Reply

    Meg – so true. There is an extreme version of differential premiums already in place. My daughter has actually been part of the Texas Risk Pool for many years and I’ve found that way too many people don’t realize that there are health insurance plans underwritten by States to cover those people who are uninsurable by traditional health plans. The problem with these plans however are that their benefits, lifetime caps and monthly premiums are established based on the diagnosed condition (ICD-9 codes) and do not take into consideration the patient behaviors that relate directly to cost. If they did, they would see that the average cost of care for a person who practices self-care is no more than the population at large without a diagnosed chronic condition.

  22. kevin
    kevin January 20, 2009 at 8:07 am | | Reply

    Pamela – I think if you read my original comment again you’ll see that I’m not saying anything about differential premiums or rewards based on outcomes, complications, A1c numbers, etc… Rather – you can incent on behaviors.

    “So, it’s really a no brainer to give those people who do what they’re supposed to do to take care of themselves and to pay them for it [the act of practicing self-care] assuming you can verify that self-care is actually taking place.”

    The drivers behind differential premiums and the research shows that if you look at two different groups (those who practice self-care and those who do not) the group who does not practice self-care will have more complicaitons.

    While diabetic related outcomes aren’t under direct control, practicing self-care for the most part is and self-care is directly related to outcomes. For example, there is such a thing as a dialysis patient who adheres to a self-care routine vs. dialysis patients who do not practice self-care. I would predict that the patient who does practice self-care will have fewer complications and may defer end stage renal failure vs. the person who decides to not practice self-care.

    So to be clear, what I’m saying and cautioning is that these rewards must be tied to behaviors not outcomes.

  23. pamela
    pamela January 20, 2009 at 9:02 pm | | Reply

    Thx for this clarification. I agree that rewarding self-care can be a good thing. It’s not simple, however, nor is quantifying/qualifying what constitutes “self-care.” It will be interesting to watch insurance plans progress in this area.

  24. Kumar
    Kumar January 26, 2009 at 12:41 pm | | Reply

    Actually a private company provides you an opportunity to check up on how is your diabetes management and what you can do to prevent short and long term complications as an individualized report card specific to your condition. They also provide an Action card that guides you and your physician fill those inadvertent gaps in care (as they call them). They also provide access to over 400 videos on many medical topics and these are constantly updates.

    No need to ‘comply’ with any dictates and no nagging calls from nurses. The best part is everything is in printable and emailable form and costs less than a few copaysfor the whole year’s membership!

    You can goodle them at -
    http://www.mydiseasemanagement.com/php/viewAll.php?linkid=41

    Choose the diabetes program. They have been in business for over 5 years now.

  25. CINDY
    CINDY April 29, 2009 at 8:56 am | | Reply

    Look, the idea of “comply” is very threatening, but the Diabetes Health Plan is VOLUNTARY. If you want to save some cash, then join. If not, then continue to shell-out money for the co-pays. However, if you aren’t interested in diabetes self-care, then you probably aren’t going to your PCP regularly, anyway. So, you still don’t have to shell out the cash. This is not an dictatorship.
    I take great care of myself, for no particular reason, other than I feel better, and I get no rewards from my insurance company. Quit whining.

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