The Affordable Care Act has made health care available to millions of Americans who previously were excluded from insurance coverage due to pre-existing illnesses. Because no one can be turned away and charged extra, insurance companies have become more proactive in detecting and managing diseases such as diabetes, requiring regular monitoring and care.
Insurers Target Diabetics to Detect and Manage the Disease
Approximately 8 percent of Americans are estimated to have diabetes, and insurers anticipate that at least that percentage of the 7.5 million people now insured under the Affordable Care Act will have the disease. Because of this, insurers are aggressively targeting diabetics to detect and manage the illness and prevent complications.
Regular Monitoring and Care Yields Rewards for Diabetics and Insurers
According to Dr. Sam Nussbaum, a former endocrinologist at Harvard’s Massachusetts General Hospital and an executive vice president for the insurer WellPoint, about 60 percent of people with Type 2 diabetes can keep side effects at bay by simply managing sugar levels, exercising and watching their weight. Unmanaged, diabetes can lead to heart disease, strokes, kidney failure and vision loss.
A relatively healthy person with diabetes can cost insurers around $5,000 a year. Once long-term, difficult complications develop, the disease can cost over $100,000 a year.
Insurers Monitor and Guide Diabetic Patients
To avoid costly complications, insurers now call diabetics when they don’t pick up prescriptions or miss appointments, and even arrange transportation to get them to the doctor’s office or send nurses on house calls.
When the Affordable Care Act went into effect, WellPoint started a six-week workshop program for diabetics, covering such things as monitoring sugar levels and finding emotional support. In Cigna’s program, a nurse might visit a patient’s house for a head-to-toe assessment. By helping patients manage insulin pumps and offering periodic eye exams and other care, Cigna reports a 42 percent lower hospital admission rate and a 24 percent lower short-term complication rate.