Insurance companies and employers begin to offer more help with chronic disease

Vanessa Aquinyi was stuck in diabetes denial until a care manager from her health insurance company convinced her to move out.

The Jacksonville, Florida resident didn’t want to start taking insulin. All the medicines she tried made her sick.

But Myriam Bercier, director of care at Florida Blue, has stayed away from phone check-ins. The nurse fed Akinniyi with information about her condition and talked about potential problems she could face such as vision loss.

“I cared, and I felt it,” Akini said. “That made me start to care more.”

Employers and insurance companies are showing renewed interest in programs like these that help people deal with chronic — and costly — health problems.

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

“Everyone wins if the patient is healthier,” said Dr. Samir Amin, chief medical officer of health insurance company Oscar, which is selling a new plan specifically for people with diabetes in individual insurance markets this year.

Programs that attempt to help people with chronic health problems can vary widely and have been around for years. They’re gaining traction again in individual and employer-sponsored coverage as billers focus more on helping patients get regular care rather than increasing costs like deductibles, which can keep people out of the health care system altogether.

Experts say these programs can lower health care costs and make patients happy. But they need frequent education. Some believe doctors’ offices – not insurance companies – should run them.

“It’s about relationships. … People don’t trust health plans or particularly want a call from their insurance company,” said Elizabeth Mitchell, CEO of Buyer Business Group on Health, a nonprofit coalition that works with big employers.

Akini had no issues trusting Florida Blue. The 61-year-old started talking to Bercier about a year ago, after Aquiny’s diagnosis prompted the insurance company’s care management team to reach out.

Her care manager helped her figure out how to get more exercise, track what she eats and change her diet to cut down on sugars and starches. Aquiny also began taking medication regularly.

“I just feel different now,” she said. “I have energy. I look at myself differently because I came out of those dark days of diabetes denial.”

Florida Blue started its diabetes program in 2014 and offers it to clients enrolled in individual insurance coverage.

Oscar has begun selling his diabetes plan in individual markets in several states for 2022 and may consider adding plans for other chronic health problems.

In his coverage of diabetes, Oscar appoints two care managers to help patients navigate the health care system. It also waives private patient costs for eye and foot exams and primary care doctor visits and limits insulin costs by $100 per month.

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

“Even if someone has amputations or they have a heart attack or stroke… you get them on the right combination of medications, you get them to communicate with their primary care doctor, and you can actually change the situation,” he said. .

Another insurer, Cigna, offers an individualized insurance plan designed specifically for diabetics for 2022. It is also introducing for the first time a plan targeting customers with specific breathing disorders, waiving patient-specific deductibles on supplies such as oxygen tanks.

“There are a lot of people out there who just don’t manage their circumstances, and a lot of times it’s about affordability,” said Lisa Love, CEO of Cigna. “If you can’t afford your prescription, you probably don’t have the motivation to go see your doctor.”

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

Outside of the individual insurance market, more and more insurance companies are beginning to provide assistance in managing care for people who have coverage through their employer. Humana, for example, is working with Virta Health to offer a program that uses nutritional therapy and telemedicine to try to reverse type 2 diabetes.

Benefits experts anticipate that these programs will become more common and grow more comprehensive by addressing other conditions. People often have more than one chronic condition and need help dealing with anxiety or depression, too, noted Stephen Neuldner, executive director with benefits consultant Mercer.

Employers are not only interested in cutting costs. Neweldner noted that programs can help attract and keep workers.

They relax employers, too, said Paul Fronstein, an economist at the Employee Benefits Research Institute.

“The fear is that your diabetics don’t take insulin, they have complications and end up in the emergency room,” Fronstein said. “Not only are your costs going up, your employees are out of work.”

Asheville, North Carolina, was at the forefront of this push more than 20 years ago when I started the Diabetes Care Management Program. He commissioned specially trained pharmacists to assist city employees.

Barry Banting, the pharmacist who ran the project for several years, said they met with their patients once a month to review medications, monitor blood pressure and answer questions.

The city also cut some expenses to make it easier for employees to get care. Bunting said the “low-tech, high-touch” approach worked. Research into the program found that for every dollar Asheville spent, the city recovered $4 in reduced health care costs.

The program has since been replicated in other cities. One of the main reasons for its success, Bunting said, is regular patient-pharmacist contact.

He said, “Accountability is really the key, knowing someone is going to ask you, ‘How are you? ”

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The Associated Press’s Department of Health and Science receives support from the Howard Hughes Medical Institute’s Division of Science Education. AP is solely responsible for all content.

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