And we wonder why health insurance is so expensive…

January 26, 2007 at 12:33 am | Posted in The Sweet Life | 15 Comments

I received this letter from my dear friends at BC/BS today:

IMPORTANT HEALTH NOTICE

Dear Ms. Sweet:

We have provided important health information for you in this letter. We know that it is not always easy for individuals who have your condition to remember what they can do to stay on track with their health.

[Could you be a little more condescending please? Pretty please, with cherries and whipped cream on top? Oh wait, that might not be good for someone who has my “condition”]

To make it easier we have listed below tests or medications that may be helpful to you in managing your health.

[Do you mean, managing your costs?]

It is important that you talk with your doctor to see if these tests and/or medications are right for you.

[See above, re: condescending]

  • Cholesterol test

For your convenience, the back of this letter gives you a description of certain tests and medications and their importance. Understanding what you are taking and why you may need them may be helpful to you.

The funny thing is, I had a cholesterol test about a month ago. It was fine.

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15 Comments »

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  1. lol, your ‘inner voice’ is a crack-up ๐Ÿ™‚

  2. Well you have to see where they’re coming from.

    Since they don’t really care about chronic conditions and then screw themselves paying for the acute stuff that comes up as a result, they want to minimize those later costs.

    What I don’t understand is how apparently smart people can be so stupid. If health insurers helped us take care of our ongoing conditions, then they wouldn’t end up footing the bill as often for the lousy things that some of us get saddled with as a result.

    Let’s see. We won’t adequately cover test strips (cost savings for insurers about $1,000 a year – I being generous).

    Ooops you need dialysis? Well that’s about $70,000 per person per year. So one year of dialysis would have covered the needed test strips for two people for 35 years.

    I wish insurance companies would wake up about this stuff.

    Yowch!! That was me falling off my sarcastic soapbox.

  3. Sorry about missing paras.

    I think I need to put in two line feeds to get them in wordpress.

    I wonder if your template needs to be tweaked for tags?

  4. I received a similar letter when DH started working for the insurance company. It was more about how to take care of myself, the importance of testing and seeing my Dr. It was 100% written for T2’s and I flipped.

    I actually had him go in with it and tell them how condescending I felt it was.

    They actually created a T1 letter that was much, MUCH better. ๐Ÿ˜‰

  5. I already went through a similar experience with my insurance company (hey, at least we have insurance) when they tried to enroll me in a “disease management” program which consisted of someone routinely calling me to discuss my “condition” and offering unhelpful hints largely geared towards people with type 2 (not type 1) as I do not have hyperlipidemia, hypertension and my last A1C was 5.0 — how the hell are they going to improve upon that without killing me in the process?

    Anyway, you might be interested in knowing that an article published in a 2004 edition of The Wall Street Journal revealed that no study has proven that so-called disease management programs have yet to prove that they justify the cost being spent by healthcare providers on them. I’ll try to paste the article text below (hopefully it fits):

    The Informed Patient: Does Disease Management Pay Off?
    By Laura Landro, The Wall Street Journal
    October 20, 2004

    A growing number of disease-management programs offer to monitor patients with chronic conditions and help avoid dangerous complications that might lead to catastrophic and expensive illnesses tomorrow. But the long-term cost effectiveness of such programs has been hard to measure — and that is raising some thorny issues in the debate over how to contain health-care costs.

    By most estimates, people with chronic diseases account for more than two-thirds of the nation’s $1.6 trillion medical bill, a figure that is expected to grow as baby boomers age. The aim of disease management, whether through the family doctor or a health-plan service, is to educate patients about their disease and help them manage its symptoms, such as controlling blood sugar in diabetics to stave off blindness, kidney failure and amputations.

    The percentage of employer-sponsored health plans offering disease-management programs grew to 58% last year from 41% the year before, according to Mercer Human Resources Consulting. A number of health plans outsource such work to more than 100 companies that have crowded into the market. Typically, chronically ill patients are monitored over the phone via nurse call centers, which work with information provided by labs, doctors and pharmacies. Disease-management programs are now expanding to include depression, cancer, kidney disease, obesity and lower-back pain.

    There is plenty of evidence to show that taking better care of chronically ill patients can improve the quality of life, slow the progression of disease and reduce hospitalizations. “We’ve made real progress in keeping people healthier who have chronic illnesses,” says Edward Wagner, director of the MacColl Institute for Healthcare Innovation at the nonprofit Group Health Cooperative’s Center for Health Studies in Seattle. “But we still don’t know definitively what the economic impacts of disease management are.”

    While he supports doctors’ efforts to help their own patients manage disease, Dr. Wagner expresses skepticism about outsourced disease-management programs, which sometimes use automated response systems to check on patients. Hands-on efforts “should not be mixed up with the more expensive and more visible activities of disease-management vendors, where evidence has been very flimsy,” Dr. Wagner says.

    Last week, the Congressional Budget Office raised its own concerns, saying in a new report that there is insufficient evidence that disease management can reduce overall health spending, or generate savings for federal health programs such as Medicare, which covers the oldest and sickest patients. While the CBO report says disease-management programs can be worthwhile even if they don’t reduce costs, it notes that there haven’t yet been enough broad population-based studies or clinical trials to demonstrate that disease-management programs cut costs — and there is a chance disease-management programs could actually raise costs by increasing the amount of medical care patients use.

    The report touches on delicate subjects. For example, staving off health problems of chronically ill patients can improve and extend life, but the longer a patient lives, the report notes, the more likely he or she is to die later of more serious illnesses, such as cancer, which cost more to treat.

    Medicare is about to launch an ambitious pilot program to test disease-management programs. That plan is expected to include about 10 to 12 different sites around the country, covering 20,000 or more patients each. The CBO says it will monitor that study, using it to help weigh the costs versus benefits.

    Christobel Selecky, president of the Disease Management Association of America, a trade group, and executive chairman of LifeMasters, a leading disease-management company, says that the congressional report does not reflect the most recent studies showing the clear cost benefits of disease management. Today, studies will be presented at the group’s annual meeting in Orlando that show cost savings from 10 different diabetes-management programs and 11 asthma programs.

    Cigna Corp., the big insurer, also says disease-management is cost-effective. A study in the most recent edition of Health Affairs of diabetic patients in Cigna health-care plans showed that the quality of care was higher and the overall cost of care significantly lower in plans with disease-management programs than in those without such programs. Indeed, Cigna saved more than it spent.

    “These programs have a profound impact on the quality of care and costs on a short- to intermediate-term basis,” says Allen Woolf, Cigna’s national medical director. While it may not be clear if over the duration of a patient’s life the programs decrease costs, for commercial insurers who may cover any given employee for five to seven years, “in those frames our data and the medical literature provide very strong support for offering these programs.”

    Robert Stone, executive vice president of disease-management firm American Healthways, which runs Cigna’s programs, says that in addition to reducing costs for sicker patients, “if you get the newly diagnosed and healthier patients in the programs and help them stay in relatively good health, you can reduce later costs.” Large employers are renewing their disease-management contracts because they see clear savings, he adds.

    David Cutler, a professor of economics at Harvard University, says it’s important to factor in benefits the CBO report didn’t consider, such as increased productivity and fewer absences from work. But even if disease management is at best a break-even proposition, “from the societal level, comprehensive disease-management programs are clearly worth the investment,” says Mr. Cutler. “What we care about is being healthy and having a higher quality of life, and if we can get there at no net long-term cost, that is undoubtedly a good thing.”

    E-mail Informedpatient@wsj.com

    URL for this article:
    http://online.wsj.com/article/SB109822237688649826.html

  6. Our old insurance company enrolled me in one of those “disease management” programs. It involved a nurse from the insurance company calling me AT WORK every month. She’d ask things like what my A1C was, what my weight was, etc. I finally had to tell her that since I work in a room with several other people, I really don’t care to discuss those things over the phone. I also told her that I wasn’t comfortable sharing that information with anyone other than my doctor.

    And yeah, my cholesterol has always been fine. Its my trigs that are high. Gag.

  7. There are so many things in the health care industry that make you feel like numbers on a page. I get those impersonal letters all the time too, plus call surveys from my HMO asking questions like, “do you take a daily aspirin”?

  8. I wonder if I will be getting a letter soon? We even have the same insurance company!

    Who writes those things? I would like to know.

    e

  9. I’ve gotten similar letters before. It’s infuriating. Who died and made them boss? I also had someone call me once and ask me if I wanted to join some phone support thing with some no nothing nurse who would tell me to use Equal instead of sugar in my coffee. Uhm, no thanks. I’ll pass.

  10. My insurance company needs to enroll me in a mental health management program because they drive me crazy.

  11. This reminds me of the time when they called about this new personal diabetes management thing they set up with RNs. The “nurse” asked me which type I had, and then she asked me if I took insulin.

    Uh, no, I’m a type 1 diabetic who controls it with diet and exercise.

    ::rolls eyes::

    You’d think an RN working for a health insurance company starting a new diabetes management program would actually know something about the disease she’s supposedly trying to help me with!

    Needless to say, I said no. And then asked them to not call me back.

  12. Hey – I have so many conditions that I have my own case manager. Too funny that it’s a friend of mine….just keeps things easier.

  13. Sheesh! I get a similarly condescending one from CVS if I don’t refill my prescription on time…

  14. Hell, at least it didn’t tell you to stop eating the damn dog.
    We get things like that periodically for Charlie. Mostly saying his vaccines are due. Hello idiots, have you EVER paid for a vaccine for him? So… do ya kinda think that maybe there is a reason for that, like because he doesn’t get them? And maybe, oh maybe, if you check your files you’ll see exactly why.
    I’m still waiting on one with his “condition” though. Good god if they can tell me what his condition is I’ll never complain again. I promise.

    Oh, but I did get one when he was a few months old stating that they have come to the conclusion that he has no father. Thanks, folks.

  15. Laughing! Too funny. I got the same letter. BC/BS is constantly trying to enroll me in their “Special diabetes care” plan to the point of calling my husband at work. “We just want to make it easy, so that you don’t have to rely so much on your provider.” Yeah, cause you know, a random telephone operator’s going to be so much more helpful. Grrrr. Thanks for the laught.


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