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Can a Health Plan Stall an Epidemic?

Les Masterson, for HealthLeaders Media, February 4, 2009

As someone whose father succumbed to diabetes, I have seen how the disease ravages the body and leads patients down the path of countless hospital trips, daily insulin needles, and chronic comorbidities, such as heart disease and kidney disease.

Though much is known about how diet and exercise can keep the disease in check, diabetes has reached epidemic proportions in this country. The American Diabetes Association estimates nearly 24 million Americans have diabetes, and one-quarter of them don't even know they have it. Another 57 million, one-quarter of adults, are considered pre-diabetic, which means they have elevated blood glucose levels and are on the path to diabetes if they do not change their lifestyles.

As policymakers and health leaders look for ways to reduce healthcare costs through major reforms, one of the country's largest health insurers, UnitedHealthcare, has created a health plan just for diabetics and pre-diabetics.

"Diabetes is the obvious place to start," says Tom Beauregard, CEO of UnitedHealthcare's United Essentials in Hartford, CT, noting how diabetes leads to other chronic illnesses.

The new health plan combines value-based benefit design with wellness programs. The theory behind value-based benefit design, also called value-based insurance design, is that cutting copays for life-saving medications increases adherence, which in turn improves patient outcomes and saves money in the long run by averting ER visits and hospitalizations, and decreases costs associated with chronic disease.

Launched in the self-insured (large employer) market, the Diabetes Health Plan works this way: diabetics and pre-diabetics who follow their treatment plans and evidence-based guidelines receive incentives, such as free services and medications, online monitoring, wellness coaches, and self-management programs.

Depending on the patient's condition, the compliance requirements could include regular lab evaluations, exams, preventive care, and wellness program participation. By requiring compliance, UnitedHealthcare is demanding the individual take responsibility and reinforcing that individual patients are in control of their health outcomes.

UnitedHealthcare finds those eligible for the program through either claims data or a voluntary employer-offered biometric screening following an education campaign about the disease.

Including pre-diabetics in this plan could save the most money long term. Reaching a patient at the time of diagnosis has the biggest affect on patient activation and a person's potential for making lifestyle changes. By allowing pre-diabetics into the health plan, UnitedHealthcare is looking to prevent a later diabetes diagnosis and costly medical services.

"I believe someone who is identified as pre-diabetic . . . will be highly motivated to participate in a plan like this if they understand the disease," says Beauregard.

UnitedHealthcare estimates that those involved in the program will save $250-$500 per year by not paying copays for diabetes-related pharmaceuticals and it could cut the $22,000 that employers pay to care for the average diabetic annually.

Two questions will decide whether the Diabetes Health Plan is a success and whether UnitedHealthcare and its competitors try similar methods to expand diabetes programs and move into other disease states:

  • Will those who take part comply at a higher rate than current diabetics?
  • Can this health plan reduce costs and improve member health status?

"If what we see is high rates of screening, high rates of enrollment, improvements in compliance, and lower costs, then you can see this moving not just to other specialty plans, but also down market," says Beauregard.

Wellness and disease management programs have been unable to stall the diabetes epidemic so UnitedHealthcare is trying something new. Value-based benefit design has been successful in increasing medication compliance for those with chronic illness so that portion of the Diabetes Health Plan should work. Member compliance and wellness are the areas that health insurers will need to follow closely and that will decide whether UnitedHealthcare and other insurers create disease-specific health plans.


Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.
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