Health

Insurers and employers are starting to help more with chronic diseases

Vanessa Akinniyi was stuck in diabetes denial until her health insurance company’s care manager talked her into it.

A Jacksonville, Florida resident was reluctant to initiate insulin delivery. All the medications she tried made her nauseous.

But Florida Blue care manager Miriam Berssier refused to do phone checks. The nurse gave Akini information about her condition and talked about potential problems she might face, such as loss of vision.

“She cared, and I felt it,” Akinnius said. “It made me start caring more.”

Insurers and employers are showing renewed interest in programs like these to help people cope with chronic – and potentially costly – health problems.

They identify patients with diabetes or high blood pressure and connect them with care managers who can answer questions about medications or help them change their diet.

Some plans also remove or reduce fees for doctor visits, eye and foot exams, and supplies such as insulin pumps. They aim to encourage people to receive regular care so that they do not need an expensive hospital stay when their untreated condition worsens.

“Everyone benefits if the patient gets healthier,” said Dr. Samir Amin, chief physician at Oscar, a health insurance company that is selling a new plan specifically for people with diabetes in selected insurance markets this year.

Programs that try to help people with chronic health problems can vary greatly and have been around for many years. They are gaining traction again in personal and employer-sponsored insurance as bill payers focus more on helping patients get regular care rather than additional costs like deductibles that can keep people out of the healthcare system entirely.

Experts say these programs can cut healthcare costs and make patients happy. But they require frequent training. And some think they should be run by doctors’ offices, not insurance companies.

“It’s about relationships…People don’t trust health plans and especially don’t want to be called by their insurance company,” said Elizabeth Mitchell, CEO of Purchaser Business Group on Health, a non-profit coalition that works with major employers.

Akinnius had no problem trusting Florida Blue. The 61-year-old began talking to Bercier about a year ago after Akini’s diagnosis prompted an insurance company management team to contact him.

The care manager helped her figure out how to exercise more, watch what she eats, and change her diet to cut down on sugar and starch. Akinsky also began taking medication regularly.

“Now I just feel different,” she said. “I have energy. I see myself differently because I’ve come out of those dark days of diabetes denial.”

Florida Blue launched its diabetes program in 2014 and offers it to clients enrolled in private insurance.

Oscar has begun selling its diabetes treatment plan in select markets in several states for 2022 and may consider adding plans to treat other chronic health problems.

In diabetes insurance, Oscar appoints care managers to help patients navigate the healthcare system. It also exempts patients from out-of-pocket expenses for eye and foot exams, as well as primary care physician visits, and caps insulin costs at $100 per month.

Amin said they believe this approach can improve health even in advanced cases, simply by making it easier to get regular care.

“Even if someone has had an amputation or had a heart attack or stroke… you give them the right set of medications, you put them in touch with their doctor, you can really make a difference.” he said.

Another insurer, Cigna, is offering a customized insurance plan specifically for diabetics for 2022. It is also debuting a plan focused on clients with certain breathing problems, waiving patient deductibles for consumables like oxygen tanks.

“There are a lot of people who don’t live up to their terms and in many cases it comes down to affordability,” said Cigna chief executive Lisa Loh. “If you can’t afford a prescription, you may not be motivated to go to the doctor.”

The annual enrollment window during which people can purchase coverage for 2022 ends on Saturday in most states.

Outside of the private insurance market, a growing number of insurers have begun offering care management assistance to people who are covered through their employer. Humana, for example, is working with Virta Health to offer a program that uses diet therapy and telehealth to try to reverse type 2 diabetes.

Benefits experts expect these programs to become more widespread and more comprehensive by addressing other issues. People often have more than one chronic condition and need help managing anxiety or depression, says Stephen Noeldner, Mercer’s head of benefits consultant.

Employers are not only interested in cutting costs. These programs can help attract and retain workers, Noeldner said.

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They also reassure employers, says Paul Fronsteen, an economist at the Workers’ Benefits Research Institute.

“I’m afraid your diabetics don’t take insulin, they get complications, and they end up in the emergency room,” Fronsteen said. “Not only have your costs gone up, but your employees have gone out of work.”

The city of Asheville, North Carolina was at the forefront of this push more than 20 years ago when it launched a diabetes treatment program. He entrusted specially trained pharmacists to help city workers.

They met with their patients once a month to discuss medications, measure blood pressure and answer questions, ”said Barry Bunting, a pharmacist who led the project for several years.

The city has also cut some spending to make it easier for workers to care for the sick. According to Banting, the “low tech, high touch” approach worked. A study of the program found that for every dollar Asheville spent, the city received $4 in health care cost savings.

The program has since been replicated in other cities. According to Banting, the main reason for the success was the constant communication between the patient and the pharmacist.

“Accountability is really the key,” he said, “knowing that someone will ask you, “How are you?”


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