Insurers, employers start offering more help for chronic diseases
Vanessa Akinniyi denied diabetes until the care manager of her health insurance company coaxed her out.
Residents of Jacksonville, Florida, don’t want to start taking insulin. All the drugs she tried made her sick.
But Miriam Bercier, the Florida Blue’s nursing manager, checked in by phone. The nurse provided Akinniyi with information about her condition and talked about potential problems she might have, such as vision loss.
“She cares, and I feel it,” Akinniyi said. “It made me start to care more.”
Insurance companies and employers have renewed interest in such programs to help people deal with long-term and potentially costly health problems.
They are identifying patients with diabetes or high blood pressure and connecting them with care managers who can answer questions about medications or help them make changes to their diets.
Some plans also waive or reduce costs for medical visits, eye and foot exams, and supplies like insulin pumps. Their goal is to encourage people to get regular care so they don’t need expensive hospitalization when their untreated condition gets worse.
“If patients are healthier, everyone wins,” said Dr. Sameer Amin, chief medical officer of health insurer Oscar, which sells a new plan specifically for people with diabetes in the personal insurance market this year.
Programs that try to help people with chronic health problems can vary widely and have been around for years. They’re gaining traction again in personal and employer-sponsored insurance, as bill payers focus more on helping patients get regular care, rather than raising costs like deductibles, which can keep people out of the health care system entirely.
Experts say these plans can reduce healthcare costs and keep patients happy. But they need regular education. Some argue that doctors’ offices — not insurance companies — should run them.
“It’s about relationships. … People don’t trust health plans, or specifically want a call from their insurance company,” said CEO of Health Buyers Business Group, a nonprofit alliance that works with large employers Elizabeth Mitchell said.
Akinniyi fully trusts the Florida Blues. The 61-year-old started talking to Bercier about a year ago, when Akinniyi’s diagnosis prompted the insurance company’s care management team to reach out.
The care manager helped her figure out how to get more exercise, track what she was eating, and make changes to her diet to reduce sugar and starches. Akinniyi also started taking medication regularly.
“I feel different now,” she said. “I’m full of energy. I see myself differently because I’m out of the dark days of diabetes denial.”
Florida Blue started its diabetes program in 2014 and offered it to customers enrolled in individual insurance.
Oscar begins selling its plans for diabetes in individual markets in several states in 2022, and may consider adding plans for other chronic health conditions.
In its diabetes coverage, Oscar assigns care managers to help patients navigate the healthcare system. It also waived out-of-pocket costs for patients’ eye and foot exams and primary care doctor visits, and capped insulin costs to $100 a month.
Amin said they believe this approach could improve health by making routine care more accessible, even in advanced cases.
“Even if someone has an amputation or a heart attack or stroke … you get them on the right medication, put them in contact with their primary care physician, and you can actually turn things around,” he said.
Another insurer, Cigna, is offering an individual insurance plan specifically for people with diabetes in 2022. It also launched a program for customers with certain breathing disorders, waiving patient deductibles for supplies such as oxygen tanks.
“There’s a lot of people out there who can’t control their condition, and a lot of times it comes down to affordability,” said Cigna executive Lisa Lough. “If you can’t afford a prescription, maybe you’re not motivated to see a doctor.”
In most states, the annual registration window in which people can buy coverage for 2022 ends on Saturday.
Outside of the individual insurance market, a growing number of insurers are beginning to offer care management assistance to those who are underwritten by their employers. For example, Humana is partnering with Virta Health to offer a program that uses nutritional therapy and telemedicine to try and reverse type 2 diabetes.
Benefits experts hope these programs will become more common and more comprehensive by addressing other conditions. People often have more than one chronic disease and need help dealing with anxiety or depression, notes Steven Noeldner, an executive at benefits consultant Mercer.
Employers aren’t just interested in cutting costs. These programs can help attract and retain workers, Noeldner noted.
They also reassure employers, said Paul Fronstin, an economist at the Employee Welfare Institute.
“The worry is that your diabetics aren’t taking insulin, and they have complications and end up in the emergency room,” says Franstin. “Not only are your costs higher, your employees are losing their jobs.”
Asheville, North Carolina, was at the forefront of this push when it launched a diabetes care management program more than 20 years ago. It puts specially trained pharmacists in charge of helping city employees.
They meet with patients monthly to check medications, monitor blood pressure and answer questions, said Barry Bunting, a pharmacist who has run the program for years.
The city has also reduced some fees to make care more accessible to employees. The “low-tech, high-touch” approach worked, Bunting said. A study of the program found that for every dollar spent in Asheville, the city could reap $4 in return from lower health care costs.
The program has since been replicated in other cities. A big reason for its success, Bunting says, is the regular contact between patients and pharmacists.
“Accountability is really key,” he said, “knowing that someone is going to ask you, ‘How are you?'”