Medtronic is striking a first-of-its-kind agreement with Minnesota's largest health plan in which the device maker will pay back the insurer if patients using a specific Medtronic diabetes device don't see their blood sugar levels stay within an acceptable range.
The "value-based" arrangement, to be unveiled Monday, is designed to make it easier for Blue Cross and Blue Shield of Minnesota members to obtain and use a Guardian Connect continuous glucose monitor from Medtronic.
The agreement requires Medtronic, which has operations headquarters in Fridley, to pay rebates to the Eagan-based Blue Cross insurer if its members with diabetes who receive Medtronic's Guardian Connect device fail to keep their blood sugar levels within a targeted range for a specific period of time while using the device. Patients who participate in a Medtronic user-engagement program called the Inner Circle can earn up to $300 a year to offset the cost of the monitor and sensors.
"This is the first time we are entering into a value-based agreement that has as its primary metric achievement of [a plan member's] time-in-range. That means being in a very healthy range for their glucose," said Suzanne Winter, vice president for the Americas region of Medtronic's diabetes group.
The insurer is reclassifying the device as a pharmacy product instead of durable medical equipment, which means that some Minnesota Blue Cross members with traditional copay plans will pay less for the Medtronic blood monitor and disposable sensors. That's because members often reach out-of-pocket spending caps for drugs long before they hit personal spending caps on medical equipment.
"Our two organizations really came together to partner on a novel approach to impact the health of our … insulin-dependent diabetic members, where they are going to have access to this newer, continuous glucose monitoring technology," said Dr. Mark Steffen, interim chief medical officer at Blue Cross and Blue Shield of Minnesota. "Not only are they going to have access to the newest technology, it's going to be easier to get the technology because it's on their pharmacy benefit."
Diabetes is a blood sugar disorder that takes two main forms. Type 1 diabetes is an autoimmune disorder in which the body can't make insulin to consume blood sugar, while Type 2 diabetes (the more prevalent form) means a person can't effectively use the insulin they make.
Having too much blood sugar because of diabetes can lead to long-term health problems including skin infections, eye problems and nerve damage. Having too little blood sugar can lead to short-term problems like shakiness, headaches, confusion and loss of consciousness, which can be especially problematic if the person is doing an activity like driving when the "low" hits.
