As hundreds of thousands of diabetics get health coverage under the federal law, insurance companies are aggressively targeting this glut of new patients, who are expensive to treat and often lax in taking medications and following their diet.
Insurers are calling diabetics when they don't pick up prescriptions or miss appointments. They are arranging transportation to get them to the doctor's office and some are even sending nurses on house calls in an effort to avoid costly complications that will have big impact on their bottom lines.
Before the Affordable Care Act, some diabetics struggled to find insurance because of their pre-existing condition. But the new law no longer allows companies to refuse them or charge more, making early intervention even more critical.
About 60 percent or so people with Type 2 diabetes can keep side effects at bay by simply managing sugar levels, exercising and watching their weight, said Dr. Sam Nussbaum, a former endocrinologist at Harvard's Massachusetts General Hospital and an executive vice president for the insurer WellPoint.
On the flip side, if the disease is ignored, it can lead to multiple, severe complications. It's the leading cause of heart disease, strokes, kidney failure and vision loss.
A relatively healthy person with diabetes can cost insurers around $5,000 a year.
"But if you let any of those long-term, difficult complications develop, then you're talking $100,000 dollars plus," Nussbaum said.
About 26 million Americans have diabetes, and two-thirds of them are overweight or obese. Approximately 8 percent of Americans are estimated to have the disease, and insurers anticipate at least that percentage of the 7.5 million people now insured under the federal law will have diabetes.
Shelley Dayman, who lives in an Orlando suburb, has struggled for years to manage her disease, in part because loves to bake and eat her sweet creations. A few years ago, the 62-year-old woman lost her foot in a car accident. Doctors reattached it, but she uses a wheelchair and can't exercise. She lost her job, her health insurance and started stretching her insulin because she couldn't afford it.
Last year, she was rushed to the hospital after she started talking gibberish while on the phone with her sister. Dayman's blood sugar was off and she spent an expensive two days in the hospital.
"My insulin was the last thing I was thinking about," said Dayman, describing the struggle many diabetics have managing their disease and life events.
She recently gained insurance under the Affordable Care Act, finding a Humana plan that costs less than $2 a month thanks to a $574 tax credit. While her new insurer hasn't come calling yet, she can probably expect it if she gets out of line.
Insurers already have a bevy of programs tailored to diabetics and they are starting new ones.
WellPoint started recruiting diabetics last fall, when the health care law took effect, to a six-week program. The workshops in Atlanta, Indianapolis and St. Louis cover everything from monitoring sugar levels to finding emotional support. Early results have been positive.
"You're talking about an improved quality of life, but a lot less expenses related to chronic conditions that develop later .... hypertension , end stage renal disease, lots of different conditions," said Kathy English, a former nurse who is spearheading the program.
Sarah Luke, 73, said she struggled to manage her weight and sugar levels after being diagnosed with diabetes six years ago, with each failed attempt leaving her more discouraged.
The Kennesaw, Ga., woman saw a flier and decided to give it a try. The workshops focus on a single goal each week, making it easier by teaming up with a fellow diabetic known as an "accountability" partner. By week two, she was drinking more water and had cut diet-Coke and artificial sweeteners from her diet. By the end of the program, Luke had lost 11 pounds and was exercising four times a week. Her blood pressure is actually lower now than it was when she was taking medication.
"I owe a lot to this workshop. It's changing my life," said a teary Luke. "Every single week I felt a sense of accomplishment that gave me courage to go to the next level."
Insurers have gotten savvy figuring out patients who skip appointments or aren't taking their medicine, and many have customized plans for diabetics that offer everything from pharmacy home delivery services to home health aides.
In Cigna's current program, where the majority of consumers are new to insurance, a nurse might go to a patient's house for a head-to-toe assessment, even checking toenails for infections. That might seem small, but an infection can make havoc on blood sugars, said Christine Crowe, a nurse who oversees the program.
Managing insulin pumps, periodic eye exams and other care can be overwhelming for patients. But Cigna's program boasts a 42 percent lower hospital admission rate and a 24 percent lower short-term complication rate.
"We're using every opportunity to cast the net wide ... because we know there may be gaps or lapses," said Crowe.