Good Intentions: HMO Covers Only One Brand of Meter and Syringe—Patients, Educators Challenge Policy and Create Change

| Jul 1, 1999

Imagine if a free glucose meter showed up at your door. You'd be thrilled, right? Well, it happened to David Fogarty, but he wasn't thrilled. This Berkeley, California, father was fuming mad. Fogarty's HMO, Health Net, sent a free Precision Q.I.D. meter to his 11-year-old son, Lucas, and to all its other members with diabetes. The catch was, Health Net would soon stop covering strips for Lucas's One Touch Profile.

The Health Net policy cost Jon Carroll almost $40. A columnist for the San Francisco Chronicle, Carroll says he didn't know about the coverage changes when he went to pick up supplies, and the pharmacist told him Health Net would no longer cover his Glucometer Elite strips. Carroll doesn't want a Precision Q.I.D. meter, so he paid $39.95 out of his own pocket for a two-week supply of Elite strips.

Health Net sent out the Precision Q.I.D. meter and an accompanying letter in March to its California members with diabetes. The opening paragraph states, "...we continually research new products and technologies looking for those that will best help you to maintain and improve your health status. When we find superior products, we are quick to designate them as 'preferred.'"

Fogarty doesn't agree that the Precision Q.I.D. is superior to Lucas's One Touch Profile.

"We've been managing well, thanks to a great doctor and good technology," says Fogarty.

Fogarty says the Profile has several features that the Precision Q.I.D. lacks, and this could threaten Lucas's good control. One example is a time-date memory, which is crucial to their family. "We can look at Lucas's numbers from his school day, when we're not with him," says Fogarty. They didn't feel as safe without this feature, and Fogarty took action.

One Syringe Only

Along with limiting members to the Precision meter only, Health Net also restricted its members to using Precision's Sure-Dose insulin syringes, which only come in the longer length. Fogarty told Health Net that Becton Dickinson's short needle is crucial for Lucas because of his young age.

Fogarty and others, including many diabetes educators and endocrinologists, warned Health Net that one meter and one syringe for all people with diabetes does not work.

Health Net got the message. The company is reviewing every complaint it receives about the policy, and, at least in the Fogartys' case, allowing coverage of Lucas's preferred meter and syringe.

Meters Help Those Who Don't Know About Testing

For Health Net, the road to this policy was paved with good intentions.

"We were attempting to reach more diabetic patients who weren't already using glucose monitors, either because they weren't prescribed one by their doctors, or they don't have durable medical equipment coverage," says Warren Strauss, MD, Health Net's regional medical director.

Many Health Net members, according to Strauss, actually wrote to thank the company, because they never knew before that they had to test their blood sugars. But, he says, "I don't disagree that this was not the best way to handle this."

California health care professionals don't disagree either.

"Each person needs individualized care," says Mindy Schwartz, RN, CDE, a diabetes educator at California Pacific Medical Center in San Francisco. When Schwartz got word of the Health Net mailing, she immediately sat down to write a protest letter.

On behalf of all the diabetes educators at her center, Schwartz first writes, "We want to acknowledge Health Net for promoting blood glucose monitoring." However, she says, "There is no one tool that can be used for all people with diabetes."

Gloria Yee, RN, CDE, of the University of California, San Francisco/Stanford University Diabetes Teaching Center in San Francisco, was appalled by Health Net's move. At the time, Yee had been working with a patient who has had diabetes for 30 years. This woman was still using visual strips, and was finally convinced to take on a glucose meter. "It took a lot of work for her to learn to use a meter," says Yee, "then that meter was taken away, and she would have to learn to use another one. She had only been using a meter for two weeks."

Professionals were shocked by Health Net's actions, and it appears that Health Net got a shock from the amount of complaints it received.

What's the Deal?

Although Health Net restored coverage for Lucas's supplies, Fogarty still has concerns about the future, and about an arrangement between Health Net and Abbott Laboratories, the maker of the Precision Q.I.D. meter.

How this decision to cover only one meter and one syringe came about is unclear. The letter accompanying the Precision Q.I.D. meters states that "research" led the company to this "superior product."

A Health Net employee, however, said that it wasn't research, but a contract between the two companies. Neil Higashida, associate vice president of pharmacy for Health Net, says that Abbott Laboratories won a "bidding war" against other companies to have its meters sent out.

Regardless of what spawned the mass mailing, it quickly fizzled, due in great part to the voices of members with diabetes and diabetes educators.

No Education Provided

Schwartz and her fellow educators agree that both the idea and the execution of it were flawed. In the time after the Precision meters went out, says their letter, "We have had many patients arrive in the center very confused after being instructed on one type of meter, and then being sent a Precision Q.I.D. in the mail without any instruction except to call the 800 number."

Customer service lines do not provide adequate instruction, says Schwartz and her colleagues. The letter continues, "People should be observed by a qualified individual to assess their abilities to use the meters correctly."

Doctors Not Prescribing Glucose Monitors

Few would disagree that individual education on self-monitoring of glucose levels is best, but it's not a perfect world. Health Net was trying to fill in the gaps of a system that lets people with diabetes fall through the cracks.

"It's hard for Health Net to reach out to 5,000 doctors and say, 'Why aren't you giving monitors to all your diabetic patients?'" says Strauss. "We can't communicate with our doctors like that, because the doctors don't all have uniform knowledge. At least, if you have this glucose monitor that came in the mail, you can call your doctor and say, 'What do I do with this?'"

Health Net made a decision to go above the doctor-patient level, which is obviously failing some people with diabetes, and take what Strauss calls a "public health approach," something he says more and more HMOs are forced to do in today's health care atmosphere.

"Some people are not adequately treated by their physicians, and managed care is increasingly charged with looking at these people," adds Strauss.

Strauss says that Health Net appreciated the communication with its members, those who were grateful for their first glucose monitors, as well as those who already had monitors and didn't want them replaced by the Precision Q.I.D.

"At least there is not a dormant public," says Strauss. "Everybody in business responds to the public." And Health Net learned that the public needs choice in their diabetes products.

According to Yee, "To think that one meter is perfect and meets all the needs of all people with diabetes is ludicrous."

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