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

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Local News

Olivia Vanni / The Herald 
The Mukilteo Lighthouse. Built in 1906, it’s one of the most iconic landmarks in Snohomish County.
The Mukilteo Lighthouse. Built in 1906, it’s one of the most iconic landmarks in Snohomish County. (Olivia Vanni / The Herald)
Mukilteo mayor vetoes council-approved sales tax

The tax would have helped pay for transportation infrastructure, but was also set to give Mukilteo the highest sales tax rate in the state.

Marysville Mayor Jon Nehring gives the state of the city address at the Marysville Civic Center on Wednesday, Jan. 31, 2024, in Marysville, Washington. (Ryan Berry / The Herald)
Marysville council approves interim middle housing law

The council passed the regulations to prevent a state model code from taking effect by default. It expects to approve final rules by October.

x
State audit takes issue with Edmonds COVID grant monitoring

The audit report covered 2023 and is the third since 2020 that found similar issues with COVID-19 recovery grant documentation.

Bothell
Bothell man pleads guilty to sexual abuse of Marysville middle schoolers

The man allegedly sexually assaulted three students in exchange for vapes and edibles in 2022. His sentencing is set for Aug. 29.

Larsen talks proposed Medicaid cuts during Compass Health stop in Everett

Compass Health plans to open its new behavioral health center in August. Nearly all of the nonprofit’s patients rely on Medicaid.

State Attorney General Nick Brown's office posted a release announcing $720 million in nationwide settlements with eight drugmakers that manufactured opioid pills and worsened the nationwide opioid crisis. The state could receive more than $16 million, the release said. (Ryan Berry/Washington State Standard)
Snohomish County to receive portion of latest $16M opioid settlement

While the amount of money is still unknown, funding plans are already in place to help with drug abuse prevention, treatment and education.

District 2 candidates differ in public safety approach

Incumbent Paula Rhyne is facing challenger Ryan Crowther. The third candidate, Jonathan Shapiro, is no longer seeking the seat.

Community members gather for the dedication of the Oso Landslide Memorial following the ten-year remembrance of the slide on Friday, March 22, 2024, at the Oso Landslide Memorial in Oso, Washington. (Ryan Berry / The Herald)
The Daily Herald garners 6 awards from regional journalism competition

The awards recognize the best in journalism from media outlets across Alaska, Idaho, Montana, Oregon and Washington.

From left to right, Edmonds City Council Position 3 candidates Joseph Ademofe, Alex Newman and Erika Barnett.
Amid budget crisis, Edmonds City Council candidates talk revenue, affordability

Three newcomers are facing off for Position 3 on the council, currently held by council President Neil Tibbott.

Everett
Everett approves new fines for non-emergency lifts

The fire department will only issue fines for non-emergency lift assists at licensed care facilities, not for individuals at home calling 911.

Guns for sale at Caso’s Gun-A-Rama in Jersey City, New Jersey, which has been open since 1967. (Photo by Aristide Economopoulos/New Jersey Monitor)
After suing, WA gets carveout from Trump administration plan to return gun conversion devices

The Trump administration has agreed to not distribute devices that turn semi-automatic… Continue reading

The Wild Horse Wind and Solar Facility about 16 miles east of Ellensburg in central Washington is part of Puget Sound Energy’s clean energy portfolio. (Courtesy of Puget Sound Energy)
Megabill’s elimination of tax credits for clean energy projects could cost WA $8.7 billion

Washington households could see electricity costs increase $115 per year by 2029; 21,800 workers could lose their jobs by 2030, analysts say.

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.