How the Medtronic-UHC Controversy is Being Spun

Commentary

As you probably have heard by now, UnitedHealthcare recently made a very unpopular decision with the diabetes community by choosing Medtronic as its preferred supplier of insulin pumps. Reactions came swift and furiously on the diabetes blogosphere, and there have been several coordinated efforts to protest this move.

To see how this plays out, it might be helpful to see how the principle players reacted publicly in the initial days of this controversy.

First, let’s examine how UnitedHealthcare rolled out this decision. The policy shift was given a brief mention in a thick 31-page brochure:

“As part of our ongoing efforts to provide a better member experience, while increasing quality and lowering the overall cost of diabetes care in the United States, UnitedHealthcare has reached an agreement with Medtronic to become the preferred, in-network durable medical equipment (DME) provider of insulin pumps for UnitedHealthcare Community Plan and Commercial members, effective July 1, 2016.

Our goal is to provide the opportunity for a better care experience by providing our members with access to advanced diabetes technology and comprehensive support services while learning how advanced technology can be applied to improve outcomes and reduce costs. We also aspire to find new ways to analyze the total cost of care for diabetes management, bring a value-based approach to diabetes care for UnitedHealthcare members and place greater focus on quality rather than the volume of care delivered.”

Standard corporate argle-bargle. UnitedHealthcare is a huge insurance provider, and this is not their first rodeo when it comes to announcing unpopular medical decisions. They took a “less is more” approach – give the info quietly, and get out.

As of May 10th, UnitedHealthcare didn’t release any kind of press release about the move, or the controversy that followed. In fact, the company hasn’t bothered to put out a press release on their site since April 6th. They did, however, respond to a Healthline reporter with more argle-bargle.

In other words, they’re not losing sleep about this. At least not yet.

The news was broken by Tandem, the chief pump rival of Medtronic. On May 3rd, Tandem officials put out a statement condemning the move, which, they argue, would shave off just under 10 percent of their current pump business. This from Tandem Diabetes Care CEO Kim Blickenstaff:

“Having diabetes isn’t a choice. How people manage it should be. Insulin pumps are not a one-size-fits-all solution. Selecting which pump is the best fit for a person to manage their therapy needs should be a decision made between a person and their healthcare provider.”

It was an unusual move by Tandem to break the news of a story that will negatively affect its own bottom line. The risk of this move is that the company will be perceived as whining about being outmaneuvered. (In the future, Tandem, might I suggest that you leak info like this to the press, like everyone else does, rather than break the news yourself?) At the very least, Tandem appears to have been caught flat-footed.

For its part, Medtronic has chosen to follow a similar “less is more” strategy as UnitedHealthcare. A cursory look at their library of press releases shows no mention of the controversy, as of May 10th. Also, Medtronic’s Twitter feed is pretty mute on the subject, with a few polite tweets on the subject so far. Here are two:

Three days after the controversy started, JDRF put out a statement that seemed to comment on it:

“Living with type 1 diabetes (T1D) is a constant challenge; it’s a complex, exhausting and unpredictable disease. People with T1D overcome this challenge on a daily basis. To do so – and to achieve better outcomes – they must have access to the right tools. We know better diabetes outcomes are critical. We are committed to our mission to accelerate life-changing breakthroughs to cure, prevent and treat T1D and its complications. The ultimate measure of success for JDRF is people with diabetes achieving better outcomes (lower A1c, less hypoglycemia, easier diabetes management, fewer complications, etc.) until there is a cure. Our strategic plan is laser-focused on helping people with T1D achieve better outcomes and working across all stages of the development pipeline to ensure people with diabetes have access to and benefit from the research advances JDRF and our partners support. We believe reduced access means people may not achieve better outcomes! (italics in original)”

The statement goes on for four more paragraphs. You know what it doesn’t do? Mention either Medtronic or UnitedHealthcare by name. It appears that JDRF wanted to be Switzerland on this.

It didn’t work. JDRF’s May 6th Facebook post with this statement was quickly filled with messages filled with frustration over the “non-response”, as one commenter put it.

JDRF officials gathered that they had swung and missed, so they tried again with a more-specific post, which, as of May 10th, is pinned to the top of the page:

“We feel the recently announced decision by UnitedHealthcare to select Medtronic as the preferred provider of insulin pumps limits the choice of people living with ‪#‎diabetes‬, and reduces access to therapies and tools that benefit them. While we are still endeavoring to learn all the implications of the arrangement, JDRF is deeply troubled by this decision, and we strongly urge United Healthcare and Medtronic to reconsider it.”

JDRF’s chief organized critic, The Juvenile Diabetes Cure Alliance, has so far been mute on this topic.

Another important player has weighed in on this controversy – investors. Between April 29th and the morning of May 10th, Tandem has lost 34 percent of its value. Medtronic has not seen nearly as appreciable of a change in its stock price in that time, but insulin pumps are not the company’s main business focus. (For the record, it did gain two percent.)

So that is where we stand at the moment. The fundamental question will be whether UnitedHealthcare and Medtronic will feel the same pressure that JDRF did to address this issue. That might very well come down to how forcefully JDRF advocates for change. Ultimately, it seems the only way change might come is if the diabetes community continues to make noise at the same volume or higher.