Comments on: NewsFlash: First-Ever “Diabetes Health Plan” from UnitedHealthcare

By: CINDY

CINDY — Wed, 29 Apr 2009 15:56:03 +0000

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.

By: Kumar

Kumar — Mon, 26 Jan 2009 19:41:46 +0000

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.

By: pamela

pamela — Wed, 21 Jan 2009 04:02:48 +0000

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.

By: kevin

kevin — Tue, 20 Jan 2009 15:07:09 +0000

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.

By: kevin

kevin — Tue, 20 Jan 2009 14:51:32 +0000

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.

By: pamela

pamela — Tue, 20 Jan 2009 06:00:20 +0000

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).

By: Meg

Meg — Tue, 20 Jan 2009 03:49:20 +0000

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.

By: TF

TF — Tue, 20 Jan 2009 00:46:08 +0000

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

By: Kevin

Kevin — Mon, 19 Jan 2009 17:19:31 +0000

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?

By: AC

AC — Mon, 19 Jan 2009 08:13:02 +0000

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