Health insurance companies are rightfully criticized when they make mistakes, but there are times when an insurer creates programs that could help improve the health status of its members.
That's the case in four states where UnitedHealth Group launched two diabetes programs with help from YMCA of the USA and Walgreens last week that the companies hope will prevent and control diabetes, pre-diabetes, and obesity.
UnitedHealth Group has been a leader in designing disease-specific programs, most notably its Diabetes Health Plan. As someone whose father died from complications of diabetes, I know firsthand what the disease can do to a person and how it leads to further complications. As a child and young adult, I watched my father waste away as diabetes led to heart attacks and kidney failure. Ultimately, he spent all but one week of the last 18 months of his life in a hospital.
My father passed along his blue eyes and love of baseball and animals to me, but I also got his predisposition to diabetes. The last time my blood sugar was tested, about a year ago, I was on the cusp of pre-diabetes so there is a legitimate chance that I too will have to live with diabetes one day. I do not look forward to a possible future of insulin shots, diabetes complications, and diet restrictions, but that's the hand I, and millions of other Americans, have been dealt.
UnitedHealth Group's programs are the Diabetes Prevention Program and the Diabetes Control Program. The Diabetes Prevention Program is designed to help those who are at-risk of diabetes prevent the disease through learning healthy eating strategies, increased activity, and other lifestyle changes. YMCA of the USA will partner with UnitedHealth to offer the prevention program. Trained lifestyle coaches will conduct behavior-modification programs over 16 sessions. After the core sessions, participants will meet monthly for added support.
UnitedHealth said the prevention program is based on the U.S. Diabetes Prevention Program that was funded by the NIH and CDC. That program found that "lifestyle changes and modest weight reduction" can prevent or delay the onset of the disease.
The Diabetes Control Program, meanwhile, will help those already with diabetes learn how to better control their illness through education and support from trained Walgreens pharmacists. The pharmacists will teach diabetics using NIH and CDC guidelines about reducing risk factors and improving health.
UnitedHealth will provide the services free of charge to plan participants enrolled in employer-based health insurance plans. The large insurer said this is the first time that a U.S. health plan will pay for all the costs for evidence-based diabetes prevention and control programs.
"For the first time in the U.S., health plans and employers will offer real-time reimbursement to community-based healthcare providers and pay for services not historically covered," said Tom Beauregard, executive vice president of UnitedHealth Group. "The pilot data showed that paying for these services works—people get and stay healthier, leading to dramatically lower healthcare costs for employers and the healthcare system."
Not only will the trainers and pharmacists get paid for their work, but will get higher payments for helping participants exceeding weight loss goals. UnitedHealth is also providing swipe cards so Walgreens will process payments at the point of service and get paid within 24 hours.
The programs will start in six markets in four states: Cincinnati, Columbus, and Dayton, OH; Indianapolis; Phoenix; and Minneapolis-St. Paul. The collaboration hopes to roll out the programs nationally in the next three years.
This project brings together powerful entities, but one key missing ingredient is the primary care physician. If this program is to become a success, including PCPs will be critical. This will mean regular communications among the insurer, pharmacist, and physician so they all know the medications, treatments, and test results for the patient.
Having a pro-active, properly trained pharmacist to help an individual improve his or her health status is a positive step, but only if it's done with physician involvement.
That being said, there is reason for hope. Creating a benefit design that removes cost barriers has been shown to improve patient medication and treatment adherence. Focusing on diabetes is the right start because the disease can lead to other ailments, but these projects hopefully will lead to other specific disease plans, such as heart disease and asthma.
These are the kinds of innovations health insurers and employers will need to try in order to remove cost barriers and lower long-range health costs. That's beneficial on a systemwide level, but let's also remember the personal reasons for these kinds of programs—they may help diabetics and prediabetics live longer lives and cause fewer young men to lose their fathers too soon.
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Les Masterson is an editor for HealthLeaders Media.