Insurance coverage tied to outcomes? | Medtronic/Aetna

Diabetes Technology Insulin Pumps
#1

Has anyone seen this news? I wish there were more details to understand how this would be executed.

"Medtronic Plc said on Monday it signed an agreement with health insurer Aetna Inc under which payment for its insulin pump systems will be tied to how well diabetes patients fare after switching from multiple daily insulin injections.

The deal is the latest example of the move toward contracts for prescription drugs and medical devices that attempt to bring down soaring healthcare costs by tying reimbursements to whether the products achieve their intended results.

The deal with Aetna will measure health outcomes for patients who transition to one of three Medtronic pumps that self-adjust to keep blood sugar levels in proper range based on patients’ individual needs for insulin.

“This agreement reinforces our shift towards value-based healthcare,” Hooman Hakami, president of the Medtronic diabetes group, said in a statement. “We know technology alone isn’t enough and ultimately improved outcomes are what matter.”

Full article here:

#2

I understand the logic of tying patient outcomes to financial contract terms but fear patient input in defining these terms will be left out.

Suzanne Winter, vice president of the Medtronic diabetes group in the Americas, said the Aetna agreement will initially focus on whether patients on its pumps achieve their A1c targets, a commonly used measure of blood sugar levels. The American Diabetes Association recommends A1c levels below 7.

In the future it may look at other measures, such as hypoglycemia episodes, time in proper glycemic range, and patient satisfaction, Winter said.

My A1c, for example tracks 0.5% to 1.0% higher than my glucose measures indicate. That includes fingerstick averages, CGM averages, and lab glucose. Studies have shown that the A1c number actually corresponds to a range of blood glucose exposure. For instance, an A1c of 6% maps to a range of blood glucose from 100 mg/dL to 152 mg/dL (5.6-8.4 mmol/L). Any system that does not recognize the limits of the measures used may end up unfairly penalizing outliers.

Will “time in proper glycemic range” be defined at, say, 80-180 mg/dL, 4.4-10 mmol/L (a range I see used at my endocrinologist’s office) when my 24/7/365 living with diabetes has taught me that my lower boundary of good glycemia is actually 65 mg/dL (3.6 mmol/L)?

As patients and participating members of this community, we are aware of how much diabetes varies from patient to patient as well as the numerous factors that can influence glycemic measures. I am favorable to the general concept of payment for performance but I can easily see the actual measures be set up without significant weight placed on patient input.

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#3

How will this approach impact patients that are already managing good control with their treatment and/or devices? It would seem to be based on “improvements” – what about “continued success?”

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#4

Medtronic commented that it will not impact current customers. For me, I can see why they do it, but it also has to be understood that not all things fall into ranges. Let’s face it, my mom reasonably health t1, she underwent a full negative turn when she became blind. Had this been in effect and it was a JNJ or Medtronic what wud happen? Yes i did not know exactly

#5

I heard about this last year in an off-the-record conversation with an employee of one of Medtronic’s pump competitors. This was long before the deal was public, so it was still rumor.

My understanding is that it does not affect the patient, it would only affect the financials between Medtronic and the insurance company.

Again, my understanding is only based on the rumor at the time, but what I heard is that if a person’s A1C does not improve, Medtronic will have to bear the cost, not the insurance company.

If this allows Medtronic to tie up another insurance company they way they did with United Healthcare, it ends up being a bad deal for diabetics across the land.

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#6

Interesting, and not apparent in that article.

#7

I agree, you can have good control of your blood glucose and still manage to have some complications from diabetes or even similar complications bought on for other reasons. My A1c has been ranging the last several years from the 5% range to 7% however I have issues with my left leg unrelated to diabetes such as neuropathy from a traumatic accident and multiple injuries to that leg. It’s possible at some point in time there will be nothing surgery can do and to be able to maintain some sort of normal motility it may be possible an amputation might result in a higher quality of life. But I guarantee people will see a diagnosis of type 1 diabetes and automatically that will be looked at as caused by poorly controlled diabetes.

That being said everything in healthcare and reimbursement is going towards outcome measurement. Its not just us diabetics.

#8

“If this allows Medtronic to tie up another insurance company they way they did with United Healthcare, it ends up being a bad deal for diabetics across the land.”

This exactly! I could not agree more! Every person deserves choice in their therapy. There is not one “right” pump for every person. Your T1D is not the same as your neighbor’s T1D. It’s ridiculous.

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