Examining diabetes health benefits in health plans of large employers.
Components of the contract specifications (also known as model purchasing specifications) for diabetes care that were developed by George Washington University (Washington, D.C.) and the Centers for Disease Control and Prevention were applied to 20 health plans from two Fortune 500 companies as well as the Federal Employee Health Benefits Plan to investigate the extent of diabetes-related benefits available to employees. Diabetes-related benefits covered a range of services and supplies that include insulin, physician visits, immunizations, diabetes preventive assessments, foot and eye exams, hemoglobin A1c tests, orthotics, diabetes self-management education, case management, smoking cessation, obesity treatment, and exercise training. The 20 health plans included health maintenance organizations, preferred provider organizations, point of service plans, and one indemnity plan. Services and supplies were assigned to three tiers: tier 1, general diabetes care; tier 2, specialty diabetes care; tier 3, lifestyle services. Services and supplies were considered covered even if they required authorization by the provider (e.g., doctor referral, recommendation, or prescription) or the health plan. Tier 1 services and supplies received more comprehensive coverage by all health plans. Differences in coverage were more notable in tiers 2 and 3 than in tier 1. Tier 3 (lifestyle services) received less coverage than tiers 1 and 2.
Cooksey
Clay
C
Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop K-10, Atlanta, GA 30341-3717, USA. ccooksey@cdc.gov
Lanza
Andrew P
AP
D003284:Contract Services / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000628:therapy*; D006264:Health Benefit Plans, Employee / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007357:Insurance, Physician Services / Q000191:economics; D008329:Managed Care Programs / Q000191:economics; D011314:Preventive Health Services / Q000191:economics*; D011634:Public Health; D014481:United States