UnitedHealth Group (NYSE: UNH) is launching the Diabetes Prevention and Control Alliance, a partnership with YMCA of the USA and Walgreens to help prevent and control diabetes, pre-diabetes and obesity.

The Diabetes Prevention and Control Alliance is anchored by two innovative and integrated programs including the Diabetes Prevention Program, which is designed to help people at risk for diabetes prevent the disease through healthy eating, increased activity, and other lifestyle changes, and the Diabetes Control Program, which will help people with diabetes better control their condition through education and support from trained pharmacists. UnitedHealth Group will cover these services at no charge to plan participants enrolled in employer-provided health insurance plans, marking the first time in the country that a health plan will pay for evidence-based diabetes prevention and control programs.

Both programs have been tested through controlled trials or pilot projects with the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), YMCA of the USA, Indiana University, clinical centers, employers and retail pharmacies. There is substantial evidence that supports early and aggressive intervention to help people avoid the health and financial toll of diabetes.

“We’re privileged to bring together partners from the public, private and non-profit sectors to launch the Diabetes Prevention and Control Alliance, which reinforces our commitment to stem the rising tide of diabetes and obesity that is already having devastating consequences for individuals, families and our country,” said Stephen Hemsley, president and CEO of UnitedHealth Group. “We are leveraging our national health care resources, the YMCA’s and Walgreens’ presence in local communities, our combined wellness expertise and the experience of two innovative, proven pilot programs to help people make lifestyle changes to prevent or control diabetes.”

UnitedHealth Group is using its national presence and broad assets in technology, health data, evidence-based medical decision-making, disease management and wellness programs to enhance and expand the Diabetes Prevention Program and Diabetes Control Program. Both will employ UnitedHealth Group’s extensive data and advanced analytics to reach out to people with diabetes, as well as those with pre-diabetes, many of whom are unaware that they are at risk for the disease. In addition, individuals may be referred to the program by their doctor or pharmacist.

“It is through innovative partnerships like this one that we can improve progress against an epidemic that threatens both the nation’s health and its resources,” said Ann Albright, PhD, RD, director of CDC’s Division of Diabetes Translation. “This proven intervention provides an outstanding opportunity for community-based, health care, and public health communities to substantively work together to prevent type 2 diabetes in people at risk.”

According to the CDC, in 2007 nearly 24 million people in the United States had diabetes, 24 percent of them undiagnosed. Another 57 million people, or 26 percent of the adult population, are considered pre-diabetic, with about 85 percent of them unaware of their condition. The vast majority of people with pre-diabetes are struggling with obesity. Obesity is a cause of many preventable health problems including diabetes, heart disease and some forms of cancer.

Diabetes Prevention Program: Addressing Obesity to Prevent Diabetes

UnitedHealth Group will partner with YMCA of the USA to offer the Diabetes Prevention Program, which uses a group-based lifestyle intervention designed especially for people at high risk of developing diabetes. In a group setting, a trained lifestyle coach helps participants change their lifestyle by helping people eat healthier and increase their physical activity, and learn about other behavior modifications over the 16-session program. After the initial 16 core sessions, participants meet monthly for added support to help them maintain their progress.

The Diabetes Prevention Program is based on the original U.S. Diabetes Prevention Program, funded by the NIH and CDC, which showed that with lifestyle changes and modest weight reduction, a person with pre-diabetes can prevent or delay the onset of the disease by 58%. Researchers at Indiana University School of Medicine were able to replicate the successful results of the National Diabetes Prevention Program in conjunction with the YMCA of Greater Indianapolis in a group setting. The Alliance will now enable the program to expand to many more communities across the nation.

“As part of our charitable heritage, YMCAs are committed to helping those in our communities live longer, stronger and healthier,” said YMCA of the USA President and CEO Neil Nicoll. “UnitedHealth Group’s vision represents a major paradigm shift for health care delivery in our country and YMCAs stand ready to be part of a new health care model that values prevention. We look forward to working with UnitedHealth Group’s Diabetes Prevention and Control Alliance to help the millions of Americans at highest risk of developing diabetes – a disease that often robs individuals of their good health and quality of life.”

Diabetes Control Program: Reducing Dangerous, Costly Diabetes Complications

UnitedHealth Group will partner with retail pharmacies, beginning with Walgreens, to offer the Diabetes Control Program, which provides people with diabetes access to local pharmacists trained to help manage their condition and improve adherence to their physicians’ treatment plans. Pharmacists will provide education and behavioral intervention, risk-factor reduction and health promotion, all in the convenient setting of a local pharmacy. The community-based pharmacists’ role in managing diabetes is consistent with NIH and CDC guidelines¹ .

“Walgreens is proud to be selected by UnitedHealth Group, alongside YMCA of the USA, to be part of this new program and we look forward to collaborating with such strong and innovative partners,” said Colin Watts, Walgreens Chief Innovation Officer. “For years, Walgreens has been committed to serving the needs of people with diabetes and believes the Diabetes Prevention and Control Alliance is the right approach for treating one of the most pervasive chronic disease states in the country.”

Incentives for Diabetes Prevention and Control

A key to the programs is UnitedHealth Group’s offering insurance coverage for these services through its health insurance plans. This means millions of employees with diabetes or pre-diabetes will have access to new, convenient ways to help them manage their conditions better. Employers, in turn, will be supporting a healthier, more productive work force, leading to lower health care costs due to fewer doctor and hospital visits.

Results-based incentives will help drive performance. For example, a YMCA lifestyle coach will receive a higher payment for helping an individual achieve greater weight loss, as well as reimbursement for each patient’s participation. Also, advanced health plan swipe-card technology introduced by UnitedHealth Group will enable Walgreens to process payments at the point of service and be paid within 24 hours. The YMCA also will be paid automatically through a paperless system, using an innovative UnitedHealth Group tool.

“For the first time in the U.S., health plans and employers will offer real-time reimbursement to community-based health care providers and pay for services not historically covered,” said Tom Beauregard, executive vice president of UnitedHealth Group. “The pilot data showed that paying for these services works – people get and stay healthier, leading to dramatically lower health care costs for employers and the health care system.”

Diabetes and its complications cost the United States an estimated $174 billion in 2007, according to the CDC.

Alliance Roll-Out and National Expansion

Diabetes Prevention and Control Alliance programs will be available initially in six markets in four states: Cincinnati, Columbus and Dayton, Ohio; Indianapolis; Phoenix, and in Minneapolis-St. Paul for participants in self-insured employer-provided health plans purchased from Medica. The programs will roll out nationally through 2010, 2011 and 2012.

The programs will be available to self-insured health plan customers and their family members with diabetes or pre-diabetes.* Plan participants whose employers offer the programs and who are identified with diabetes or pre-diabetes through UnitedHealth Group’s sophisticated screening model (based on historical claims analysis and biometric screening) will be invited to participate voluntarily in the appropriate Alliance program. UnitedHealth Group also is rolling out the programs to fully-insured customers in 2010 launch markets and considering future expansion to fully-insured customers in other markets. UnitedHealth Group employees also will have access to the programs as they roll out.

In addition, UnitedHealth Group has entered into an agreement with Minnesota-based health insurer Medica to offer the programs to a wide range of the company’s employer-sponsored plans in Minnesota. The programs will be available to other insurance companies and employers as well.

The Diabetes Prevention and Control Alliance is one of many UnitedHealth Group programs and services that fight diabetes, obesity and related health problems in creative, practical ways to help improve health care quality, expand support and coverage, and help bend the cost curve.

Click here for more resources. To hear a presentation on the Diabetes Prevention and Control Alliance by Deneen Vojta, MD, Senior Vice President of the UnitedHealth Center for Health Reform and Modernization, at the CDC’s Diabetes Translation Conference, go to preventtype2diabetes.nologyinteractive.com.

About UnitedHealth Group
UnitedHealth Group (www.unitedhealthgroup.com) is a diversified health and well-being company dedicated to helping people live healthier lives and making health care work better. With headquarters in Minnetonka, Minn., UnitedHealth Group offers a broad spectrum of health benefit programs through UnitedHealthcare, Ovations and AmeriChoice, and health services through Ingenix, OptumHealth and Prescription Solutions. Through its family of businesses, UnitedHealth Group serves 70 million people nationwide.

¹ Team Care Comprehensive Lifetime Management for Diabetes, by The National Diabetes Education Program, a joint program of the National Institutes of Health and the Centers for Disease Control and Prevention. 2001
* Self-insured plans generally are used only by larger employers, with claims administered by an insurance company. In these programs, the employer funds covered health care costs for participating employees and family members.

A new study published in the March issue of Diabetes Care, a journal of the American Diabetes Association suggests that the sooner people with diabetes start taking metformin, the longer the drug remains effective.

According to a Kaiser Permanente study, metformin, an inexpensive, generic drug that helps patients prevent dangerously high blood sugar levels, worked nearly twice as long for people who began taking it within three months of their diabetes diagnosis. This is said to be the first study to compare metformin failure rates in a real-world, clinical practice setting. Other studies compared failure rates of metformin only in clinical trials.

According to a news release announcing the study, metformin is recommended as a first-line agent in the treatment of type 2 diabetes, but in most patients it eventually stops working, forcing them to take additional medications to control their blood sugar. Each additional drug adds extra costs and the possibility of more side effects including weight gain, so this study is welcome news for newly diagnosed patients, researchers said.

“This is an important finding for the 30 million people world-wide who are diagnosed with type 2 diabetes every year. The sooner they start taking metformin, the better and longer it seems to work,” said the study’s lead author Jonathan B. Brown, PhD, an investigator with the Kaiser Permanente Center for Health Research in Portland, Ore. “This study suggests that to gain full benefit from metformin, patients should start taking it as soon as they find out they have diabetes.”

According to the news release, researchers used electronic health records to follow nearly 1,800 people with diabetes in Kaiser Permanente’s health plan in Washington and Oregon for up to five years. Metformin failed at a rate of only 12 percent a year for the patients who began taking it within three months of diagnosis. That compares to a failure rate of 21.4 percent per year for patients who started taking metformin one to two years after diagnosis, and 21.9 percent per year for those who didn’t start taking the drug until three years after they were diagnosed.

“We believe that starting the drug early preserves the body’s own ability to control blood sugar, which in turn prevents the long-term complications of diabetes like heart disease, kidney failure, and blindness,” said study co-author Gregory A. Nichols, PhD, an investigator with the Kaiser Permanente Center for Health Research. “The American Diabetes Association recommends that patients start taking metformin and make lifestyle changes as soon as they are diagnosed. This study provides more evidence to back up that recommendation.”

The press release noteThe study was funded by Novo Nordisk, Inc., a company that does not make or sell metformin and has no financial interest in, or connection to, Kaiser Permanente.

Study authors include: Jonathan B. Brown, PhD, MPP, and Gregory A. Nichols, PhD, from the Kaiser Permanente Center for Health Research in Portland, Ore., and Christopher Conner, PharmD, PhD, from Novo Nordisk, Inc., Seattle.

Click here to read the full study:

http://care.diabetesjournals.org/content/early/2009/12/29/dc09-1749.full.p df+html

Findings released today and detailed in the analysis Low Consumption and Higher Medicare Cost: Consumption Clusters in a Medicare Fee-for-Service Population, examine how individuals utilize benefits and services under the Medicare program. The research suggests that beneficiaries with chronic diseases who consume the least of their Medicare benefits and services (referred to as “low consumers”) and potentially under manage their disease may experience an acute event that requires costly emergency room visits and hospitalizations.

The research, spearheaded by the National Minority Quality Forum (The Forum), analyzed Medicare data over a six-year period. The Forum found that Medicare beneficiaries may be clustered into five consumption groups (crisis consumers, heavy consumers, moderate consumers, light consumers and low consumers) based on how much Medicare reimburses for services provided to beneficiaries in any year. The two most-costly clusters are crisis consumers and heavy consumers — representing only 11 percent of Medicare beneficiaries, but 65 percent of all costs. These are dynamic clusters as consumption patterns among beneficiaries can significantly vary from one year to the next. Beneficiaries who are low consumers one year may become heavy consumers the next sparked by a critical and often costly health event. There is ample evidence that in the immediate future, significant increases in reimbursements may be anticipated for those beneficiaries with diabetes who rank among the lowest consumers of benefits. It is likely that similar patterns exist for those with other chronic diseases.

“The findings paint a new picture of the Medicare beneficiary living with a chronic disease and how that individual utilizes the program,” said Gary Puckrein, PhD., Founding Partner of the Diabetes Care Project and President and CEO of the National Minority Quality Forum. “If we can identify these patients, who are under-managing their chronic condition putting them at high-risk for disease complications, we can intervene to help these individuals manage their disease more effectively, and, ultimately, reduce overall health care costs.” One out of every four Medicare dollars is spent on beneficiaries with diabetes, with a high percentage attributed to tertiary illness caused by unmanaged or under-managed diabetes.

“We know that diabetes and other chronic conditions disproportionately affect the elderly, and with an aging population and a rapid influx of Baby Boomers entering the Medicare program, we need to better understand the barriers associated with managing their chronic diseases,” said James R. Gavin III, MD, PhD, CEO and Chief Medical Officer, Healing Our Village and Chairman Emeritus, National Diabetes Education Program. “If we can better understand our Medicare patients, we can help them achieve better health outcomes.”

The Diabetes Care Project (DCP), founded by The Forum, Roche Diagnostics and in partnership with the American Association of Diabetes Educators (AADE) and Healthways, Inc., is a new coalition of patient advocates and health partners who are committed to dramatically reducing acute events that are a consequence of diabetic complications through early interventions and improved chronic-care management (www.diabetescareproject.org). In 2010, the DCP plans to undertake a series of projects that will help better understand the low consuming diabetic, and their impact on the health care system. The purpose of these initiatives is to offer guidance as to how policies, regulations, targeted interventions, education, and personalized diabetes care management plans may help improve patient outcomes and lower costs for the entire health system.

Diabetes is a growing public health epidemic affecting over 23 million Americans. According to the Centers for Disease Control and Prevention, type 2 diabetes, fueled by rising rates of obesity, accounts for nearly 90-95 percent of all people with diabetes and disproportionately affects minority and aging populations in the U.S. (nearly 20 percent of Medicare beneficiaries have diabetes). The U.S. spends approximately $174 billion in annual total costs for diagnosed diabetes with $166 billion in direct medical costs.

Source: Diabetes Care Project

The National Business Coalition on Health (NBCH) gave UnitedHealthcare a 2009 eValue8 Health Plan Innovation Award for programs that help engage physicians and patients to achieve better health outcomes.

UnitedHealthcare’s Patient-Centered Medical Home (PCMH) program and Diabetes Health Plan were recognized by the NBCH for their ability to help enhance health care safety and quality while reducing costs. Both initiatives use UnitedHealthcare’s industry-leading technology and data resources and integrate patient and physician information in order to help drive more informed health care decisions.

“UnitedHealthcare’s Patient-Centered Medical Home program and Diabetes Health Plan were selected because both are the kind of innovations that are significant drivers of health status,” said Dennis White, senior vice president of value based purchasing at NBCH. “Purchasers are very interested in innovations like these as they align incentives, restructure care delivery and provide tools that keep people healthy.”

“We are honored to receive this award from the National Business Coalition on Health as recognition that our company’s continued innovation is helping people live healthier lives. The Patient-Centered Medical Home and Diabetes Health Plan are examples of how consumer information and education, comprehensive program support, and financial incentives help physicians and patients tackle rising health care costs while driving better health outcomes,” said Sam Ho, M.D., UnitedHealthcare executive vice president and chief medical officer.

Coordinating Care At A “Medical Home”
UnitedHealthcare’s PCMH program involves primary care practices in Arizona, Colorado, Ohio, New York and Rhode Island and was developed in close collaboration with national primary care specialty societies including the American Academy of Physicians, American College of Physicians, American Osteopathic Association and American Academy of Pediatricians. In the PCMH model, patients receive coordinated care from their primary-care physician, or “medical home,” rather than fragmented and episodic care from various health care providers or facilities. The model promotes enhanced disease prevention and care of chronic conditions. It also emphasizes behavioral health support and patient education, not just the diagnosis and treatment of injury and illness.

UnitedHealthcare provides participating PCMH primary care practices with technology, infrastructure support and care-coordination services. These improved information systems are designed to enhance patient access to care; help improve the quality and safety of the care experience as well as the delivery of preventive and chronic care; and drive patient satisfaction. All medical home projects include innovative payment models to primary care physicians, derived from anticipated savings due to better coordination of care and prevention of complications in chronic diseases.

Diabetes Health Plan
UnitedHealthcare’s Diabetes Health Plan is designed to help employers control the escalating costs of insuring diabetic and pre-diabetic employees and their families while improving their health. According to the American Diabetes Association (ADA), one out of every five health care dollars is spent caring for someone diagnosed with diabetes, while one in 10 health care dollars is attributed directly to diabetes.

The first-of-its-kind Diabetes Health Plan goes further than traditional diabetes wellness programs by providing patients with financial incentives for adhering to certain routine preventive care compliance requirements such as having regular blood sugar checks, routine exams and preventive screenings, which can result in better self-management of their care. Plan benefits, which can include some free diabetes supplies and diabetes-related prescription drugs, as well as lower co-payments for related doctor visits, can potentially save individuals up to $500 a year in addition to their regular health care benefits.

In addition to helping people live healthier lives, the preventive steps under the Diabetes Health Plan can help significantly lower a diabetic employee’s total health care costs, which average more than $22,000 a year, according to UnitedHealthcare data.

About the National Business Coalition on Health and eValue8
NBCH is a national, non-profit, membership organization of 60 business and health coalitions, representing over 7,000 employers and 25 million employees and their dependents across the United States. NBCH and its members are dedicated to value-based purchasing of health care services through the collective action of public and private purchasers. eValue8� is a product of the National Business Coalition on Health and is the nation’s leading evidence-based request for information (RFI) tool used by coalitions and major employers to assess and manage the quality of their health care vendors. For additional information visit: www.nbch.org.

About UnitedHealthcare
UnitedHealthcare (www.unitedhealthcare.com) provides a full spectrum of consumer-oriented health benefit plans and services to individuals, public sector employers and businesses of all sizes, including more than half of the Fortune 100 companies. The company organizes access to quality, affordable health care services on behalf of more than 25 million individual consumers, contracting directly with more than 600,000 physicians and care professionals and 5,000 hospitals to offer them broad, convenient access to services nationwide.�UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.

A new survey has found that nearly one-third of doctors surveyed said they did not have enough time and did not receive sufficient reimbursement to provide comprehensive care to their patients with diabetes.

Bayer's CONTOUR USB Meter (PRNewsFoto/Bayer Diabetes Care)

According to the results of a study of endocrinologists and primary care doctors published today in American Health & Drug Benefits, 32 percent of physicians felt unable to provide comprehensive diabetes care, and most cited time or reimbursement as the major barrier. Furthermore, 83 percent of physicians surveyed said Medicaid reimbursement was inadequate, while 67 percent said private insurance reimbursement was inadequate.

Physicians surveyed said they did not have adequate resources — including medical and administrative time, facilities, staff and materials — to ensure multi-disciplinary team care (32 percent), to provide lifestyle and behavior modification counseling (28 percent), or patient education on self-care and preventing complications (15 percent). Fewer than half (47 percent) of doctors surveyed said they had adequate resources to provide psychological and social status assessments.

Self-monitoring blood glucose levels

The most common service that doctors provided their patients with diabetes was instruction in, and evaluation of, self-monitoring blood glucose levels. Blood glucose monitoring is critical for patients to prevent serious complications such as hypoglycemia, the leading cause of diabetes-related hospitalizations. While 89 percent of all doctors surveyed said they or their staff provided this service, fewer than half provided other services important to managing diabetes, such as medical nutrition therapy (36 percent) and multi-disciplinary care coordination (49 percent). Nearly three-quarters of all doctors surveyed said their practices provided annual eye exams and blindness education (74.5 percent) and weight loss counseling and physical activity instruction (76 percent).

“Diabetes requires multidisciplinary care and a team-based approach for the best outcomes,” Lana Vukovljak, Chief Executive Officer of the American Association of Diabetes Educators, said. “In addition to aggressively managing their blood glucose levels and monitoring their overall health, these patients benefit when provided substantial education on nutrition and the importance of weight loss, physical activity and smoking cessation,” said Ms. Vukovljak.

Data for the study was collected via a web-based survey of primary care physicians and endocrinologists as well as during a follow-on, online discussion group of a sample of physicians representing the two specialties.

Source: National Changing Diabetes Program

Web Site: http://www.ncdp.com/
http://www.novonordisk.com/

When I first conceived of writing about how health insurance plans were possibly using social media technologies like Facebook and Twitter to engage their members to seek better health, I was expecting to find more applications like the one at http://twitter.com/ss1.

Now diabetics can quickly add sugar and med entries via Twitter direct message to the ss1 Twitter account. SugarStats is a simple and easy-to-use interface to allow individual to input and access their data from home, school, work, even while on the road.

The application, which can also be accessed via a mobile device application, the web and through Endo, is operated by SugarStats LLC, a small company based out of Hawaii.

A free account can be established by going to www.surgarstats.com. Once the account has been set up, data can be entered using Twitter and a variety of other portable input devices. SugarStats will track your sugar glucose levels along with the elements that affect those levels such as medication, food intake and physical activity. Users can then easily share this information with their health care professional, family and friends to get further consultation, support and advice to lead to better health.

According to a blog established to promote the service, tracking diabetes is a simple as logging on to Twitter.com and posting a short message like this:

d ss1 bg 108 Good pre-meal BG, I’m feeling great this morning!

or

d ss1 med rap 6 Trying 6 units of NovoRapid to cover dinner

Then an entry of 108 goes directly into your SugarStats account at the date and time of the message.

If you want to share your sugar info with your Twitter circle you can enable the option within SugarStats to have new entries posted to your Twitter account, otherwise it is confidential and can be accessed in the form of graphs and charts by logging onto your account at http://www.sugarstats.com/.

For all the details and instructions check out http://www.sugarstats.com/