Ensuring Patient Access

Ensures Better Outcomes

Diabetes Access Action Center

A recent decision by United Healthcare has set a dangerous precedent for restricting patient access to therapies prescribed by their healthcare professionals. The diabetes community must come together to ensure this decision does not represent the beginning of a larger, dangerous trend. If this happens, access to lifesaving management tools will be limited – or eliminated entirely – and competition in the marketplace that spurs innovation and results in better tools for patients will be reduced. And patients will suffer. This is about us, and we MUST join together and use the power of our collective voice to prevent actions by payors that limit access.

Never has it been more clear that…

One size does not fit all.

Who should prescribe the best treatment: the medical team who knows them as a patient,  or the insurance company who knows them simply as a number?

 


Formulary restrictions and “preferred provider” agreements, according to health insurance companies, improve care and save money.

We ask these questions:

Does One Size Fit All?

What exactly do the
Professional Standards of Care
say?

NO.

The standard of care starts with a focus on Patient-Centered plans, explicitly stating, “one size does not fit all.”
Specifically adding, “Clinical practice guidelines are key to improving population health; however, for optimal outcomes, diabetes care must be individualized for each patient.

Is it Patient-Centered?

Does It Empower Patients and their care teams to drive success with diabetes?

NO.

One Size Fits All undermines the
relationship between
the patient
and their healthcare team.
One Size Fits All prevents
appropriate individualized
care plans

and decreases
patient participation
in self care.
 

Does It Follow ADA Standards of Care?

The ultimate question. Does it clearly comply with ADA's 2016 peer-reviewed standards of care?

NO.

Those guidelines require that:
“Treatment decisions should be timely and based on evidence-based guidelines that are
tailored to individual patient
preferences, prognoses, and comorbidities.”
Diabetes Care
2016;39(Suppl. 1):S6–S12 | DOI: 10.2337/dc16-S004

Restricting access to treatment as prescribed by a medical professional restricts optimum health outcomes.


A “preferred” or “exclusive” treatment option is not an option at all; it is a barrier to the best outcomes for each individual with diabetes.


 

What Must Be Done?

T

he diabetes community, which includes patients, caregivers, medical professionals, and healthcare companies must stand united and share this message to the CEOs and CMOs of top health insurance companies:

The only way to ensure better patient outcomes is to ensure access to supplies and services.

ACT NOW

If our community does not act now, the studies have shown that this restriction of access will increase. This must be stopped and a dialogue between the community and ensurer begin. 

0 Million Individual Patients
0 Million Individual Outcomes

Share The Facts

FACT

Insurance companies are often a barrier to coordinated delivery of chronic care, which has shown to be an effective in improving the quality of diabetes care. - Diabetes Care 2016;39(Suppl. 1):S6–S12 | DOI: 10.2337/dc16-S004

FACT

When insurance companies prevent patients from receiving their choice of treatment, many patients do not receive their treatment at all in up to 1 in 5 patients. - Prescriptionprocess.com

FACT

Partnerships between insurers and vendors that limit therapeutic choices may impair a patient's access to certain treatments and tools, and adversely affect patient outcomes. - American Diabetes Association, May 2016

Get more facts here. 

What The Experts Are Saying

And by experts, we mean the health insurance companies Chief Medical Officers’ (CMO) and CEOs’ in their own words…

Health care is not a commodity — it is our lives. Giving consumers the full picture of quality and price information gives them “value transparency” and ultimately makes the health care industry more effective and efficient at serving patients. As Warren Buffett put it, “Price is what you pay, value is what you get.” We believe that our members deserve the highest value care possible.
Stephen Ondra, MD , Chief Medical Officer, HCSC
For example, if a physician has a patient with diabetes, the physician needs to educate the patient about the appropriate use of the patient’s diabetic medications and to ensure early on that the patient sees a retinal expert or a kidney expert to lessen the likelihood of diabetic complications. It’s the educational conversation with the patient that is the responsible act the clinician should be accountable for. The physician needs to ask: “How do I maximize the health of this person with diabetes?” By supporting the physician’s efforts to be more proactive on the educational front, we diminish the risk of waiting for the person with diabetes to suffer kidney failure.
Roy A. Beveridge, MD, Chief Medical Officer, Humana
If you come to the conversations about improving health and healthcare with a deep respect for the teams responsible for partnering with patients, then you can really tap into the intrinsic motivations, the heart that people bring to their work. With that kind of understanding, you can really make great progress.

What Can YOU Do Right Now?

 

Help health insurance companies understand

ONE SIZE DOES NOT FIT ALL.