Diabetes is essentially a self-managed disease, according to the American Diabetes Association.
With its new Aetna Leap Gold Plan, Aetna Health Insurance makes a leap into the sometimes laggard world of self-care by empowering members with a more affordable and somewhat less complicated way of taking care of themselves — and sweetening the deal with gift card rewards.
The program, a first for Aetna, includes easier access to the specialists that diabetics normally require and a more forgiving bottom line on their out-of-pocket expenses, including free diabetes supplies and care management advice.
“By creating a personalized solution that incorporates the health care providers, primary care providers and specialists with the right incentive for the participants, we can help prevent some of the more serious conditions within the diabetic population,” noted Remy Richman, an executive director for the local market based at Aetna’s Blue Bell office.
“The uniquely personalized plan offers lower deductibles and lower co-pays, and in some cases no costs, to the member to access diabetic care. Some examples of specialists would be endocrinologists, podiatrists, nutritionists. And there is no charge for diabetic supplies or diabetes education. We’re removing some of the typical barriers for our members to access their care. “We’ve simplified the product for this segment of the population in the marketplace, as there are only two numbers that a member needs to remember: a co-pay and a deductible.”
When patients are engaged on a personal level the information provided becomes far more meaningful, Richman explained.
“We have a better opportunity to engage them in their health and improve the quality of their life and avoid more severe conditions,” she pointed out.
With “substantial” health dollars being spent on the diabetic population every year, and roughly 86 million pre-diabetic Americans over the age of 20, as of 2012, preventive efforts will clearly benefit not only the insurer but the patient as well, Richman allowed.
“It means that we’re likely able to prevent some of the more severe conditions that take place. Are there things that people can do differently to improve their health that can offer a better outcome?”
There are incentives, not unlike those offered by credit card and other companies, for keeping an eye on blood glucose numbers and tracking them online via the Aetna site.
“In many of our plans individuals can receive up to $160 in cash or gift card incentives to do some basic health care activities, such as visiting their doctor, or exercising,” Richman noted.
In Southeastern Pennsylvania the numbers members need to be concerned with are a deductible of $3,200 for members who access care among the plan’s most preferred providers; $50 for preferred brand name drugs; $5 for generic drugs and no charge for supplies like glucose meters and testing strips.
Incentives for members include a $50 gift card for getting an A1c blood test twice a year and a $25 gift card for connecting a glucometer or biometric tracker to the Aetna website.
The Health Care Cost Institute (www.healthcostinstitute.org) reports that in 2013, $14,999 was spent per capita on health care for people with diabetes; per capita health care spending for children with diabetes rose 7 percent from 2011 to 2012 and 9.6 percent from 2012 to 2013, and that between 2011 and 2013, children with diabetes had the fastest per capita spending growth.
In 2013, more than $2,500 was spent per child with diabetes on branded insulin, more than four times what was spent on branded insulin for middle-aged adults ($589) and pre-Medicare adults ($617).
In addition to Southeastern Pennsylvania, Aetna is debuting Leap in Charlotte, N.C., Phoenix and Northern Virginia.
In the latter two states Aetna has partnered with Banner Health and Innovation Health.
“In the Philadelphia market this is not a co-branded product but in the other markets we were happy to (partner) with the large health systems,” Richman noted. “With co-branded relationships with these integrated delivery systems it symbolizes health insurers and providers working together much better than we have in the past. What we find is that with consumers there is a very high degree of trust with their health care partner and they’re much more likely to take action on their health when their health care provider is directly contacting with them,” Richman added.
“If there is a trust with their provider community, when their physician calls them they’re going to respond. They will respond 100 times faster if their doctor contacts them than if their health insurance company contacted them.”
Date: January 11, 2016