The role of insurance companies in the treatment of patients with diabetes

Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: I have seen insurance companies run away from the new guidelines. I have seen insurance companies choose older guidelines with less intensive approaches and use older drugs instead of newer ones. Do you think you can create an insurance coalition that will not only adopt the new guidelines, but also help disseminate them so that we can enable everyone to use them?

Jaime Murillo, Ph.D: I will talk about what I saw. The role of insurance companies has evolved. They were in the background. When I was practicing, no one wanted to hear about an insurance company, including me. Now I see the insurance company coming out on top. They said, “We want to be part of the solution. We want to cooperate. We want to be stakeholders in this decision.”I’m optimistic about that. There’s no arguing about that. I think as you see more of them coming out, you’ll soon see others follow suit. This is a perfect example; the forum we have today. You see it in other places where medical societies have never included payers in their seminars, forums or meetings. Now you actually see people coming and talking. Because we realize that if we don’t solve it together, it will never be solved.

Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: I will tell you, as I mentioned before, I was involved in the medical society. I was president of ACE [the American College of Endocrinology] and leads many of their initiatives. We always invited payers. The payers did not always show up, especially the most important payer. The one that covered the most patients never appears. Getting payers to participate is still a problem. I’m also aware of the fact that we love the team approach, but we don’t have enough people to care. Also, full disclosure for today’s discussion, we mentioned the Diabetes Cardiometabolic Institute think tank. Last year, we published a recommendation for multispecialty practice that comes from the perspectives of cardiologists, endocrinologists, nephrologists, and primary care physicians. The way we did this was not for primary care physicians; it was for non-specialists because not everyone knows everything. I think the cardiologist should perhaps exercise more control over the patient. The primary care physician should exercise more control. Based on this, it is very easy to follow the recommendation of the party. This year, what we did to help with that and deal with the timing of when to intervene and when to manage — because it’s often lost in the guidelines — again we had a panel of experts, cardiologist, endocrinologist, nephrologist and primary care help doctors. Eugene was there. Jennifer was there. I was there too. Much of this early intervention and management intensity is group consensus and is presented in publications. We hope to see it in a few weeks. This is a full disclosure discussion of where we come from. What we have published can help support this approach and perhaps help guide writing. Does anyone else have anything else they would like to say or add to this discussion?

Jennifer B. Green, Ph.D: I would just like to add that cost issues aside, good diabetes management and cardiovascular risk reduction is for everyone with diabetes, not just the select few who can afford these drugs. We need to figure out how to make this investment so that the health of everyone with diabetes improves.

Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: Absolutely agree. Hey, any last words?

Jaime Murillo, Ph.D: I will add sifting. I think there are many people with undiagnosed illnesses. We need to change the way we think about healthcare. We wait for people to come to our office or hospital in an emergency.

Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: Pay for it, pay for it. You just paid for it [LAUGHTER].

Thank you. And for our viewing audience, we hope this American Journal of Managed Care® stakeholder meeting is rich and informative. DCMi [Diabetes Cardiorenal & Metabolism Institute] will soon publish a consensus, as I said, document on early intervention and intensive management of the diabetic patient in cardiorenal-metabolic disease that complements the DCRM Multispecialty Practice Recommendation. We will host additional roundtable discussions exploring the topics of further care for managing cardio-renal-metabolic systems. Thank you all.

Transcript edited for clarity.

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