UnitedHealthcare uses financial rewards to encourage people with diabetes to take care; lower costs

Insurer UnitedHealthcare is trying to encourage people with diabetes to take better care -- and to save themselves, and eventually their employers and the insurer, a lot of money. The Diabetes Health Plan gives patients financial rewards for taking routine preventive-care steps, such as having regular blood sugar checks, routine exams and preventive screenings.

MINNEAPOLIS, Minnesota – Insurer UnitedHealthcare is encouraging people with diabetes to take better care — and to save themselves, and eventually their employers and the insurer, a lot of money.

The Diabetes Health Plan goes beyond traditional diabetes wellness programs by giving patients financial rewards for taking routine preventive-care steps, such as having regular blood sugar checks, routine exams and preventive screenings, according to the Minneapolis health care insurer.

These steps are aimed at improving patients’ management of their disease, which cost the U.S. economy $175 billion in 2007, according to the American Diabetes Association. The steps also get diabetic patients involved in their own care, which costs an average of more than $22,000 per person a year, according to the insurer’s data.

“One of the best ways to control escalating health care costs is to encourage people to adopt healthier behaviors and take preventive steps,” said Dr. Deneen Vojta, senior vice president of UnitedHealth Group. But it’s impossible for people to live healthier — with the goal of managing or avoiding diabetes — if they don’t know they have the disease.

While nearly 24 million people in the United States had diabetes in 2007, only one-in-four knew they had the disease, the association said. Another 57 million people were considered pre-diabetic –having higher-than-normal blood sugar but not high enough to count as diabetes. Again, about a fourth of pre-diabetics were unaware of their condition.

The Diabetes Health Plan promises to identify people who have diabetes or pre-diabetes and then equip those who are identified to manage or avoid the disease, Vojta said.

To get an idea of where to go with its benefits, UnitedHealthcare piloted its Diabetes Health Plan among three big employers — General Electric, Hewlett-Packard and Affinia Group this year. The employers liked the plan so much, they’ve renewed or expanded their participation for next year. UnitedHealthcare is rolling out the plan for employees of other large, self-insured employers on Jan. 1.

“We’re definitely keeping it,” said Keith Clark, health and safety director for the Gastonia, N.C.-based Global Filtration Division of Affinia, a maker of after-market automotive parts and supplies.

Diabetes Health Plan benefits vary by employer and can include some free diabetes supplies and prescription drugs, as well as lower co-payments for related doctor visits. The benefits could save patients up to $500 a year, UnitedHealthcare said. The plan also requires people with diabetes and pre-diabetes to be educated about the disease and its management.

In addition to the cost savings offered by UnitedHealthcare, Affinia contributes $200 to a health reimbursement arrangement account (HRA) when an employee signs an agreement to work with a doctor to manage their diabetes, Clark said. The company contributes another $200 to the HRA account when the employee completes an educational program about the disease and its management. Another $200 is contributed if the employee complies with a schedule for tests, exams and other measures.

“So that’s up to $600 you can get in your HRA account” per year, Clark said. Spouses of employees can earn another $600 for a total of $1,200 in contributions per couple, he said. Employees can pay medical expenses not covered by employers’ insurance with tax-free contributions to their HRA accounts.

Money may not be the best way to encourage people with diabetes to live healthier, said Dr. Paul Robertson, president of Medicine & Science, the research arm of the diabetes association. “In my experience, the patients I work with typically are turned off if they’re offered money,” said Robertson, who does clinical research with patients who have diabetes. “They would rather do it because they would rather do it. Money spoils that.”

Even pregnant women who develop gestational diabetes may not be motivated by money, Robertson said. But healthy people who have adult-onset diabetes in their families might take cash to change some behaviors to avoid developing the disease, he said.

Dr. Randy Cebul, director of Better Health Greater Cleveland, applauded the health plan because it gets diabetic patients engaged with their doctors and their care. Better Health Greater Cleveland is an alliance of hospitals, doctors and health care organizations, agencies and insurers in Northeast Ohio committed to improving the health and care of people in the region who are living with chronic diseases, starting with diabetes.

“Is this a novel idea? Yes,” said Cebul, who has several appointments in Greater Cleveland, including professor of medicine and director of the Center for Health Care Research and Policy. “I think it’s a good idea. I think physicians would like it. It makes patients part of the picture.”

Cebul said there’s little research evidence to indicate that financial incentives motivate people who have diabetes. But the idea of using clever incentives to require patients to do better for themselves — and for things that the doctor can’t fix — is a good one, he said.

Affinia’s filtration division has been doing wellness programs for its 1,500 employees in North and South Carolina for years, Clark said. “We started looking at costs as compared to health risks and diabetes was definitely one of the higher costs to our health plan.”

So Affinia helped pilot the Diabetes Health Plan with UnitedHealthcare. “You don’t see a short-term return, but we hope to see a return over the long-term, not only for the company, but for the employees, ” he said. “I think the biggest thing we want to do with it is to empower our people to manage their diabetes the correct way.”

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