Tuesday, January 27, 2009

UHC vs Diabetes: The Interview

Last week, we noted that United HealthCare has introduced a new program to help insured diabetics (and "pre-diabetics") cope with and finance their expensive health care. In a followup, I asked to speak with someone from the program's development team in order to help our readers understand how it came about, and how it's intended to work.
Alex Nelson, their PR contact, graciously arranged for me to interview Tom Beauregard, the CEO of UHC's R&D arm, United Essentials [ed: oddly, and after much searching, I could find no link to that entity]. Mr Beauregard and I spoke for some time, and we're delighted to present the fruits of that discussion:
So, who is Tom Beauregard?
Mr Beauregard runs the Research and Product Development arm of UHC. He's been with them for about 3 years; the previous 20 were spent consulting in this area.
What prompted this new effort?
Demand from employers, primarily. They want to move away from cost-shifting toward more "Value Based Insurance." The goal is to target communications to modify behaviors.
Some employers have begun encouraging voluntary efforts in this regard, and UHC decided to set up its own program to augment these, starting with diabetes and weight management.
How is this program different from previous endeavors?
The goal is to offer incentives based on compliance with ADA (American Diabetes Association) standards. It's both a carrot and stick approach: folks who continue to comply with the stated objectives receive extra benefits, at no cost, while those that "fall off the wagon" are directed back to the basic insurance plan.
[ed: Some might view this as somewhat "Big Brotherish;" I think it's good business sense - up to a point. More on that later]
I can see how this could help those currently suffering from diabetes, but what, exactly, is a "pre-diabetic?"
According to UHC and the ADA, these are folks with elevated levels of HBIC and cholesterol, who haven't - yet - developed full-blown diabetes, but are at increased risk of doing so. The standards, set forth by the ADA, aren't arbitrary; they estimate that up to 26% of adult Americans are "pre-diabetic."
[ed: And here's where I have to draw a line. I take issue with UHC's apparently uncritical acceptance of this whole "pre-diabetes" phenom. The ADA claims that "(p)re-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes."
And just where does that 57 million come from? The ADA doesn't say, and, at something like 20% of the population, it doesn't pass the smell test. I think that this whole idea of alarming the public over obviously inflated numbers does more to harm a cause than to help it. The other "23.6 million" is similarly suspect. If you're wondering why the ADA would be okay with these inflated, perhaps spurious numbers, remember that many organizations rely on public perception for fundraising purposes]
One very simple way to decrease this risk is through weight loss, so the program includes numerous tools to help facilitate this.
Sounds like a plan. But why only self-insured groups? Is there a plan to expand it to fully insured plans?
UHC decided to focus on SI groups first, to get a feel for how many people would both sign up, and subsequently stay with it. It's easy for folks to say "sure, I'd be interested in such a plan," but the real test comes when it's actually offered to them, and they have to make the conscious decision to participate. And once they're on the plan, how many will stick with it? That can only be determined by trying it out in a controlled setting.
If the metrics bear out, then the company will consider expanding the program (in one form or another) to their fully insured groups.
We truly appreciate Mr Beauregard's time and candor, and will keep an eye on the plan's progress. He also indicated that he'd be happy to answer any other questions we might have, so readers are invited to suggest them in the comments.
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