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Tuesday, November 17, 2015

How One Insurance Plan Makes Health Care Affordable for People with Chronic Conditions

Due to high deductibles in health plans, many insured consumers still have trouble being able to afford the health care they need. Some forward-looking health plans are taking steps to make sure their members can afford care to manage chronic conditions, such as diabetes, hypertension, and asthma. Patients do not have to meet a deductible for services to manage these conditions, and cost-sharing (such as copayments) is affordable. Among these plans is Maine’s successful Community Health Options Plan. We spoke with its Chief Medical Officer, Dr. John Yindra, about the plan’s experience thus far.


Families USA: What chronic conditions does your plan target in its Chronic Illness Support and Care Management Program? 


Dr. John Yindra

Dr. Yindra: We target diabetes, chronic obstructive pulmonary disease (COPD), asthma, hypertension, and coronary artery disease. 

Families USA: How do you make it affordable to manage those conditions?

Dr. Yindra: Members with these conditions pay nothing for certain generic medications. For brand name medications that treat those conditions, they do not have to meet a deductible and their costs are 50 percent cheaper than for regular medications. Members do not pay any cost-sharing to see primary care providers to manage these conditions nor for associated lab work and testing. For services such as cardiac rehabilitation or an environmental home assessment for people with asthma, costs are minimal. [View the Chronic Illness Support Program brochure.

Families USA: Do you have any data yet to show the impact of this chronic illness support program?

Dr. Yindra: Our HEDIS quality scores for diabetes HbA1c testing are very high. Compliance statistics for some of the common medications to treat the diseases we target are pretty good. The program has been tremendously popular with our members. [Editor’s note: HEDIS, the Healthcare Effectiveness Data Set, measures the performance of health plans on various quality-of-care measures. For instance, one measure looks at the percentage of diabetic patients in the health plan whose blood sugar levels are under control.]

Families USA: What does your plan do to make care affordable for patients with mental illness?

Dr. Yindra: Currently, we do not charge deductibles or cost-sharing for the first three visits to any of our mental health providers, including psychiatrists. In the future, I would like to expand our chronic illness support program to other illnesses, including depression. 

Families USA: How has this program affected your plan’s finances? Is it sustainable?

Dr. Yindra: Our costs do not exceed our estimates and the program seems to be financially viable. 

Families USA: Do you foresee offering low cost-sharing for treatments for additional illnesses in the future?

Dr. Yindra: We are fielding requests that other illnesses be added to the list. I would like to expand to other illnesses. If we continue to incentivize our members to get treatments that are documented as highly effective, we will probably have to increase the cost-sharing in some way for treatments that are not proven to be as highly effective. That will be a fine line to walk.

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