With new health law, insurers target diabetics

MIAMI — Diabetics beware. Your insurance company is looking for you.

As hundreds of thousands of diabetics get health coverage under the federal law, insurance companies are aggressively targeting this glut of new patients, who are expensive to treat and often lax in taking medications and following their diet.

Insurers are calling diabetics when they don’t pick up prescriptions or miss appointments. They are arranging transportation to get them to the doctor’s office and some are even sending nurses on house calls in an effort to avoid costly complications that will have big impact on their bottom lines.

Before the Affordable Care Act, some diabetics struggled to find insurance because of their pre-existing condition. But the new law no longer allows companies to refuse them or charge more, making early intervention even more critical.

About 60 percent or so people with Type 2 diabetes can keep side effects at bay by simply managing sugar levels, exercising and watching their weight, said Dr. Sam Nussbaum, a former endocrinologist at Harvard’s Massachusetts General Hospital and an executive vice president for the insurer WellPoint.

On the flip side, if the disease is ignored, it can lead to multiple, severe complications. It’s the leading cause of heart disease, strokes, kidney failure and vision loss.

A relatively healthy person with diabetes can cost insurers around $5,000 a year.

“But if you let any of those long-term, difficult complications develop, then you’re talking $100,000 dollars plus,” Nussbaum said.

About 26 million Americans have diabetes, and two-thirds of them are overweight or obese. Approximately 8 percent of Americans are estimated to have the disease, and insurers anticipate at least that percentage of the 7.5 million people now insured under the federal law will have diabetes.

Shelley Dayman, who lives in an Orlando suburb, has struggled for years to manage her disease, in part because loves to bake and eat her sweet creations. A few years ago, the 62-year-old woman lost her foot in a car accident. Doctors reattached it, but she uses a wheelchair and can’t exercise. She lost her job, her health insurance and started stretching her insulin because she couldn’t afford it.

Last year, she was rushed to the hospital after she started talking gibberish while on the phone with her sister. Dayman’s blood sugar was off and she spent an expensive two days in the hospital.

“My insulin was the last thing I was thinking about,” said Dayman, describing the struggle many diabetics have managing their disease and life events.

She recently gained insurance under the Affordable Care Act, finding a Humana plan that costs less than $2 a month thanks to a $574 tax credit. While her new insurer hasn’t come calling yet, she can probably expect it if she gets out of line.

Insurers already have a bevy of programs tailored to diabetics and they are starting new ones.

WellPoint started recruiting diabetics last fall, when the health care law took effect, to a six-week program. The workshops in Atlanta, Indianapolis and St. Louis cover everything from monitoring sugar levels to finding emotional support. Early results have been positive.

“You’re talking about an improved quality of life, but a lot less expenses related to chronic conditions that develop later …. hypertension , end stage renal disease, lots of different conditions,” said Kathy English, a former nurse who is spearheading the program.

Sarah Luke, 73, said she struggled to manage her weight and sugar levels after being diagnosed with diabetes six years ago, with each failed attempt leaving her more discouraged.

The Kennesaw, Ga., woman saw a flier and decided to give it a try. The workshops focus on a single goal each week, making it easier by teaming up with a fellow diabetic known as an “accountability” partner. By week two, she was drinking more water and had cut diet-Coke and artificial sweeteners from her diet. By the end of the program, Luke had lost 11 pounds and was exercising four times a week. Her blood pressure is actually lower now than it was when she was taking medication.

“I owe a lot to this workshop. It’s changing my life,” said a teary Luke. “Every single week I felt a sense of accomplishment that gave me courage to go to the next level.”

Insurers have gotten savvy figuring out patients who skip appointments or aren’t taking their medicine, and many have customized plans for diabetics that offer everything from pharmacy home delivery services to home health aides.

In Cigna’s current program, where the majority of consumers are new to insurance, a nurse might go to a patient’s house for a head-to-toe assessment, even checking toenails for infections. That might seem small, but an infection can make havoc on blood sugars, said Christine Crowe, a nurse who oversees the program.

Managing insulin pumps, periodic eye exams and other care can be overwhelming for patients. But Cigna’s program boasts a 42 percent lower hospital admission rate and a 24 percent lower short-term complication rate.

“We’re using every opportunity to cast the net wide … because we know there may be gaps or lapses,” said Crowe.

Talk to us

More in Local News

Everett Police Chief Dan Templeman announces his retirement after 31 years of service at the Everett City Council meeting on Wednesday, Sept. 27, 2023 in Everett, Washington. (Olivia Vanni / The Herald)
Everett police chief to retire at the end of October

Chief Dan Templeman announced his retirement at Wednesday’s City Council meeting. He has been chief for nine years.

Boeing employees watch the KC-46 Pegasus delivery event  from the air stairs at Boeing on Thursday, Jan. 24, 2019 in Everett, Wa. (Andy Bronson / The Herald)
Boeing’s iconic Everett factory tour to resume in October

After a three-year hiatus, tours of the Boeing Company’s enormous jet assembly plant are back at Paine Field.

A memorial for a 15-year-old shot and killed last week is set up at a bus stop along Harrison Road on Wednesday, Sept. 13, 2023, in Everett, Washington. (Ryan Berry / The Herald)
Teen boy identified in fatal shooting at Everett bus stop

Bryan Tamayo-Franco, 15, was shot at a Hardeson Road bus stop earlier this month. Police arrested two suspects.

Mike Bredstrand, who is trying to get back his job with Lake Stevens Public Works, stands in front of the department’s building on Wednesday, Sept. 27, 2023, in Lake Stevens, Washington. Bredstrand believes his firing in July was an unwarranted act of revenge by the city. (Ryan Berry / The Herald)
Lake Stevens worker was fired after getting court order against boss

The city has reportedly spent nearly $60,000 on attorney and arbitration fees related to Mike Bredstrand, who wants his job back.

Chap Grubb, founder and CEO of second-hand outdoor gear store Rerouted, stands inside his new storefront on Thursday, Sept. 21, 2023, in Gold Bar, Washington. Rerouted began as an entirely online shop that connected buyers and sellers of used gear.  (Ryan Berry / The Herald)
Used outdoor gear shop Rerouted finds a niche in Gold Bar

Seeking to keep good outdoor gear out of landfills, an online reselling business has put down roots in Gold Bar.

Naval Station Everett. (Chuck Taylor / Herald file)
Everett man sentenced to 6 years for cyberstalking ex-wife

Christopher Crawford, 42, was found guilty of sending intimate photos of his ex-wife to adult websites and to colleagues in the Navy.

Snohomish County Executive Dave Somers speaks to the crowd during an opening ceremony at the new PAE2 Amazon Fulfillment Center on Thursday, Sept. 14, 2023, in Arlington, Washington. (Ryan Berry / The Herald)
Snohomish County executive pitches $1.66B budget

Snohomish County Executive Dave Somers announced his proposed budget Tuesday afternoon. Public comment is slated to begin Oct. 10.

Lars Kundu wipes away tears during his sentencing Thursday, Sept. 28, 2023, at Snohomish County Superior Court in Everett, Washington. (Ryan Berry / The Herald)
5 years after fatal hit and run, Lake Stevens man sentenced to prison

Lars Kundu, 28, pleaded guilty in May for the 2018 death of Chad Keeler. He was handed more than 6 years in prison Thursday.

Jamel Alexander, center, listens as a Snohomish County jury records their verdict of guilty, in the murder of Shawna Brune, on Tuesday, May 18, 2021 in Everett, Washington.  Alexander was convicted in the first degree murder of Brune. (Andy Bronson / The Herald)
Appeals court orders new trial in Everett woman’s stomping death

Appellate judges ruled that additional evidence should have been admitted in Jamel Alexander’s trial for the murder of Shawna Brune.

Most Read