Reprinted from HEALTH PLAN WEEK, the most reliable source of objective business, financial and regulatory news of the health insurance industry.
By Patrick Connole, Editor
February 11, 2013 Volume 23 Issue 5
Featured Health Business Daily Story, Feb. 22, 2013
The movie catch phrase “if you build it, they will come” does not apply to health plans and their varied and many efforts to get members to adhere to diabetes prevention or care programs, but that has not stopped insurers from trying. And in fact, in January, UnitedHealth Group’s UnitedHealthcare unit released the results of a study showing that its Diabetes Health Plan (DHP) is working to improve the health of employees with diabetes and reduce related health care costs for employers.
The program has clicked with members because of the financial incentives being offered, the insurer says, leading to better health and lower costs. Health care costs for DHP participants rose at a 4% slower pace than for a control group not in the program, UnitedHealthcare’s study said. Program benefits include providing a number of diabetes supplies and diabetes-related prescription drugs at no charge, and the lure of no copayments for related doctor visits, at an estimated savings of up to $500 a year for the member.
Nearly 27 million U.S. adults are diabetic, and 79 million more have prediabetes. The cost of diabetes reached an estimated $194 billion in 2010. If trends continue, more than half of all Americans will have diabetes or prediabetes by 2020, according to UnitedHealth’s UnitedHealth Center for Health Reform & Modernization.
Speaking on Feb. 5 at AcademyHealth’s National Health Policy Conference in Washington, D.C., Ann Albright, Ph.D., director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC), said there need to be more and earlier interventions for people meeting the diabetes risk profile. Other speakers on a panel focused on the disease stressed the need for coordinated care, rather than just medicine or weight loss alone. Informing those in the pre-diabetes spectrum is vital since more than 90% in that class don’t even know they fall into the category, these officials said.
Up to 40% of a large employer’s health insurance claims costs can be tied to diabetes and related comorbidities, according to a survey of seven FORTUNE 100 companies (350,000 lives) conducted by the non-profit Center for Health Value Innovation in 2011 (HPW 7/4/11, p. 1). At the same time, more than 80% of diabetics ignore their physicians’ advice on how to manage their disease, according to CDC data.
Sam Ho, M.D., executive vice president and chief medical officer, UnitedHealthcare, tells HPW that the same value-based purchasing approach the insurer has taken with providers is being translated into the DHP, with incentive payments, a more modern benefit design and next-generation care management. “We put all this together for a more holistic approach,” he says.
The health plan scrubs aggregated claims and laboratory data to plug into its predictive modeling program to identify at-risk members who may be best served in the program, Ho says. There are also self-referrals. The DHP is offered with standard health plans or on a stand-alone basis. Members enroll online and use a portal to move through the care management process, he adds.
A multifaceted approach seems to work best, Ho says, including lifestyle changes, member and physician education and financial incentives. UnitedHealthcare data show the estimated annual cost for treating a “healthy” employee without a chronic disease is $4,400, versus the annual cost of $11,700 for people with diabetes without the complications. If someone has a complication, that number explodes to $20,700.
Michelle Mudge-Riley, physician, senior consultant and associate with McCarthy Actuarial Consulting, tells HPW the trick with diabetes is that you must understand one care strategy does not fill all. “You can’t create a blanket program and expect it to work for everyone,” she says. Medicine may work for some, while others require behavioral change or exercise, or a combination of all of these, Midge-Riley adds.
Financial Incentives Get Members to Treatment
Employers say financial incentives do drive better participation rates. Dianne Howard, director of risk and benefits management for the Palm Beach County School District in Florida, a UnitedHealthcare client, says adherence is vital to making any program work.
“The prior diabetes disease management program was set up so a nurse would call members who were diagnosed with diabetes to see if they wanted to join a disease management program. Even if the nurse connected with the member, which was not easy, there was low participation,” Howard tells HPW. “This program has financial incentives for the member in the form of 50% off on all copays for any diabetes-related treatment, medicines or supplies. The member has to participate by completing five required health actions for those who are pre-diabetic [doctor visit, cholesterol test, mammogram, colonoscopy and online health coaching]; or seven health actions for those who are diabetic, including the previous five required health actions plus Hemoglobin A1c and kidney function tests.”
The insurer then enrolls those diagnosed into the program. After the first year, the member can stay in it only if they complete the required health actions, she adds. “The reduced copay is the best incentive for our group. Once they realize the health benefits, I think they then switch and believe the better health is the best incentive,” Howard says.
The results have been positive for the Palm Beach employees in the diabetes program, and the numbers of those interested in joining continue to grow. “We saw compliance with these evidence-based medicine requirements in the enrolled group exceed compliance by those not enrolled by 30% for the A1c and the cholesterol tests and 10% better with doctor visits,” she says. What’s more, a health score used to measure projected medical costs decreased for 21% of the participants.
“We experienced a 9% reduction in our total net costs, saving about $2.9 million in our first year. It also means better health outcomes for these members. We’ve even seen some pre-diabetics have lab results returning to normal due to those members learning about healthy eating and exercise and actually following the recommendations of their medical professionals. That makes me feel good,” Howard says.
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