Diabetes prevention can be led by health insurance companies

Whether I’m wearing my health policy hat or seeing patients in the office, one condition continues to surface as a source of concern and frustration.

Diabetes, one of the nation’s most serious and costly health burdens, now affects almost 25 million people in this country — a conservative estimate. Another million new cases are diagnosed each year.

Three years ago, the American Diabetes Association estimated the total diabetes cost in the U.S. to be a staggering $174 billion.

As we know all too well, diabetes is one of the most complex and time-consuming conditions for physicians to treat and for their patients to manage.

Diabetes — especially type 2 — is also one of the most challenging conditions to prevent.

Government funded studies have clearly demonstrated that individuals with risk factors or prediabetes can prevent or delay the onset of the disease by participating in group coaching sessions, changing their eating and exercise habits, and losing about 5% of their total body weight.

But that’s not as simple as it sounds!

For years, social scientists have understood that behavior change is extremely difficult for most people, more so without structured programs and support systems.

Given the scheduling demands on physicians and their office staffs, where can a person go to receive additional information or counseling about diabetes prevention? Where can patients with type 2 diabetes receive the ongoing support and encouragement necessary for meeting and sustaining behavior change goals?

Equally important, how does the average person pay for these services? Even those with health insurance are faced with increases in deductibles and copayments.

Imagine my surprise, then, on reading an announcement of a promising new approach.

Kudos to UnitedHealthGroup, one of the nation’s largest health insurers, for mounting an innovative attack on type 2 diabetes!

Under a recently announced two-part proposal, UnitedHealth will team with the YMCA and retail pharmacies to introduce an ambitious program in seven cities across the U.S.

Using local YMCAs as venues, the insurer will offer participants in employer-provided health insurance plans free access to a series of 16-week Diabetes Prevention Programs for individuals at risk of developing type 2 diabetes.

These group-based educational interventions will focus primarily on changing lifestyle behaviors (moving, for instance, toward healthy eating and appropriate exercise) in order to achieve modest weight loss, thus preventing or delaying the onset of diabetes.

As an additional incentive, the nonprofit YMCAs will receive performance-based payments, with higher payments for those participants who complete the full program or lose an appropriate amount of weight.

The second part of the proposal, a Diabetes Control Program, will be based at partner retail pharmacies. Aimed at reducing the more dangerous and costly complications of diabetes, these programs will provide free access to pharmacists who are specially trained to help people with prediabetes or diabetes manage their conditions and improve adherence to their physicians’ treatment plans.

So, what makes this new approach important?

Our country now has the most expensive — but far from the best quality — healthcare in the world. The newly enacted federal healthcare law aims not only to extend medical coverage to all citizens but also to bring healthcare costs under control.

As the nation looks to rein in healthcare spending and employers attempt to hold down costs for their employees, the UnitedHealthGroup/YMCA/Walgreens partnership seems to be a move in the right direction.

Some policy experts see this initiative as an example of the kinds of strategies health insurance companies must undertake to demonstrate their relevance in light of the new healthcare law.

I am inclined to agree with those who believe that collaborations such as this will serve as models for the future of health insurance on a national level.

David B. Nash is Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University and blogs at Nash on Health Policy.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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  • Jen

    Diabetes — especially type 2 — is also one of the most challenging conditions to prevent.

    I think I know what you were trying to say here, and it might just be semantics, but type 1 *cannot* be prevented. The way this sentence is worded, it sounds like both can be prevented.

    There is so much misinformation and lack of understanding about the differences between the two.

  • Doc99

    Lifestyle education should begin in grammar school. Healthy food choices, Physical fitness, etc should be a national imperative. Waiting for adulthood seems too little too late, as this horse will have already left the barn.

  • http://www.drmintz.com Matthew Mintz, mD

    Agree with Doc99 that this needs to start earlier.
    Agree with Dr. Nash, that the “partnership seems to be a move in the right direction.” However, this will not be enought. In the diabetes prevention program (DPP), the study that shows that lifestyle changes can prevent diabetes, the lifestyle intervention was pretty intense. Patient had pre-packaged meals and much more than a few trips to the YMCA for exercise. In fact, the study protocol gave each patient a pair of Nike sneakers. Small initiatives and pilot programs are OK, but we need to do much, much more.

    • r watkins

      Are you saying our insurance preiums should be used to buy pre-packaged meals and running shoes for those who refuse to lose weight on their own?

  • http://wellescent.com/health_forum/topics Wellescent Health Forums

    From the insurer’s standpoint, there is ample incentive to run such prevention programs if they can limit the need to cover the often unbounded costs associated with the more expensive aspects of Type-2 Diabetes treatment. With insurers now facing challenges in applying lifetime dollar limits on their insurance plans, managing costs through prevention funding is likely to become far more prevalent.

  • http://www.diabeticmenu-blog.com diabetes

    Nice to know that there insurance companies for diabetic persons.Are those companies can guarantee a good benefits?

  • http://www.musclerepairshop.com Butch Phelps

    I agree 100%. If we can get better support for people before they become sick, we can make the most difference in cost. It’s like not maintaining your car and wanting for the engine to low up, then try to figure out how to low the cost of replacing engines. When all we need is to maintain the car and prevent the engine blow up.

  • Doug

    I actually take a more pessimistic view. When I ask my Type 2 DM patients why they have the disease, maybe 5% understand it’s due to their excess body weight, hyperlipidemia, and decreased insulin sensitivity.

    Whenever I try to patiently explain the links, they then head out into an advertising world that bombards them with images of calories that is far more appealing and bountiful than my dour comments.

    Upon returning to my office, they have forgotten the lessons from the prior visit, and I start again, like Sisyphus, pushing the rock up the hill. It gets a bit discouraging.

    I’d suggest instead a draconian system of financial measures. If your BMI and/or A1C start leaving normal levels, your health insurance increases by a sliding scale until you’re paying considerably higher premiums. I don’t see any other way of influencing behavior other than hitting people in the pocketbook.

    Sure, the complaints will be loud & long, but visit any school these days and observe a group of children to realize that likely a fourth of them will be Type 2 diabetics by their 20′s. They’re too young to realize the physical and psychological wreckage from a diet of sugared sodas and fast food, and we’re being too complicit in not sounding the alarm.

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