Sunday, June 1, 2008

A Type 1 Diabetic's Insights About Insurance, Quality and Cost (& an erratum re Lifemasters)

While DiabetesMine is a famous must-read blog for all things diabetic, the Disease Management Care Blog discovered this morsel at Finding Our Way. Ms. Erika also has type 1 diabetes and her latest blog is a telling essay that gives the patient's points of view on all these high falutin concepts about insurance, quality and cost. When I read this, I thought about:

Risk vs. retail: Can we be confident that the Material Girl's efforts are reasonably destined to save her and her insurance company money in excess of the $14,000 per year? Suppose a cheaper pump were used and testing was limited to 4 times a day? Cost would go down and the risk of increased claims expense might go up, but by not as much. Maybe the retail dimensions are more important: her insurer can use its purchasing power to gain discounts on the cost of supplies and share the expense outside notions of insurance risk. Reconciling both functions is difficult but it's the right thing to do.

Benefit design and silos: it's not clear if the yearly cap of $3500 applies to all costs or some; it's possible that "durable medical equipment" like pumps have a different cap. The point is that from the patients' point of view, it doesn't really make that big a difference. Money is money. Health is health. Maybe there is a role for 1st dollar coverage of 'no-brainer' health care like pumps.

Consumer Directed Health Plans or variants thereof: it's pretty obvious that Running Mama is going to blow right through her out of pocket cap in just a few months. If interpreted correctly, this new insurance could possibly represent a simple cost transfer from the insurer to the enrollee. On the other hand, it's clear the 'consumer' is now carefully weighing the pros and cons of high frequency testing and making rational economic decisions based on her values and life style.

The Doctors: Think docs cost a lot of money? Think again. Depressing isn't it? Of the 14 grand, her physician occupies only $500. Yet, that doc presides over a whopping amount of money. It seems to the DMCB that the doc deserves better compensation in general and should also be rewarded for making sure the $14,000 is spent in the best interest of the patient with dimensions that include quality and value.

Disease management: This patient is obviously doing such a good job with DM, if I were a vendor, I'd stay away and move onto the next patient. However, perhaps there is a future role for DM companies is to help persons navigate the insurance benefit design. This will be examined in a future post.

Thanks Erika, for sharing.


Postscript: the DMCB has issued its first ever erratum (and hopefully last) on a prior post, mistaking Lifemasters for Healthways. The DMCB has made the necessary corrections & regrets the error.

1 comment:

erika said...

Thank you for your insight.

Technology is moving forward, but insurance coverage seems to be slow to follow. Continuous glucose monitoring systems are changing the management of diabetes, but the high cost and lack of insurance coverage has left it out of the reach of many diabetics (including myself). The potential to stay in good control and good health, and avoid the high cost complications and hospital visits should make the coverage "worth" it.

You are is money and health is health. Diabetes management shouldn't be a privilege of the wealthy only, and decisions about health shouldn't be based on financial means. It's sad when you have to sacrifice control over your diabetes in order to buy groceries for the month. Do test strips really need to cost $1 each? Crazy.

The thing that gets me is that my new insurance plan has 100% coverage for preventive care, but none of it applies to my endo visits, or obsessive finger-sticks. The way I see it, I'm preventing a huge expense for them in the future. Oh is what it is.

Again, thank you for your comments on my blog. I look forward to reading more.