Medtronic, Aetna Announce Outcomes-Based Agreement for Diabetes Patients

Medtronic on Monday announced an outcomes-based, risk-sharing agreement with Aetna for patients who move from multiple daily injections (MDI) to an insulin pump to manage their diabetes. The agreement will measure health outcomes for patients who move to Medtronic’s insulin pump with SmartGuard™ technology and includes patients with both type 1 diabetes (T1D) and type 2 diabetes (T2D).

The agreement covers Medtronic’s new MiniMed 670G system, approved by FDA in September 2016 as the first hybrid closed loop system.

“This agreement reinforces our shift towards value-based healthcare. We know technology alone isn't enough and ultimately, improved outcomes are what matter,” Hooman Hakami, president of the Diabetes Group at Medtronic, said in a statement. “Our goal is to continue to lead by driving innovation that demonstrably improves patient outcomes, elevates patient experience and lowers the total cost of care.”

The agreement comes amid concerns that insurers were declining to cover the most cutting-edge technologies in diabetes care, including those like the MiniMed 670G, that meet the FDA criteria for the “artificial pancreas.” JDRF recently launched a campaign to press insurers to give people living with expanded choices and limited out-of-pocket costs in diabetes technology.

According to the statement from Medtronic, the agreement will give Aetna members access to Medtronic’s diabetes technology and support services, and ties a portion of Medtronic’s reimbursement to meeting clinical improvement thresholds for patients making the transition.

The agreement will look at improvement of the patient experience, improvement of clinical outcomes, and the total cost of care.

Outcomes-based reimbursement agreements are increasingly common, especially for newer technologies or therapies. The decision to record quality-of-life measures is significant, as these data are not always captured in claims studies. A study published by researchers from Northwestern and UnitedHealth this month in The American Journal of Managed Care^® about the cost-effectiveness of switching from MDI to insulin pump technology found that the benefits were often not realized until year 2 or 3, but the study notably was based on medical claims and lab results, and did include quality-of-life measures.

“We are pleased to be working with a leader in the healthcare space who is aligned with our goal of transforming diabetes care for the benefit of patients so they can live with greater freedom and better health,” said Suzanne Winter, group vice president of the Americas, Diabetes Group, Medtronic. “This agreement is an important first step as we look to broadening our partnership to facilitate patient access to the most advanced diabetes management solutions across the care continuum that not only ensure outcomes, but lower the overall cost of care for this chronic and burdensome disease.”