DIABETES

We break diabetes care down into three care pathway levels. Your health care team will help you choose the level that is appropriate for you. Diabetes care is very complex and for uninsured patients, very, very expensive. This is a new program, which we are using to make an attempt to care for the estimated 200,000 uninsured diabetics in the state of Missouri. We expect this program to evolve.

Each Care Pathway monthly price includes:

  • every 3 month virtual visits
  • hemoglobin A1c tests every 3-6 months
  • the pathway medications (except insulin which costs an additional $25-$99/month).
  • diabetes education and supplies for home foot testing
  • additional care recommended but not provided in price: annual eye exam.

DIABETES LEVEL 1

$20 / Month

Medications to your Home

One oral medication, usually metformin. Free shipping to your home.

Labs

hemoglobin A1c tests every 3-6 months, annual urine test for kidney damage

Virtual Clinic Visits

every 3 months

$20 / Month

CHOOSE PATH

DIABETES LEVEL 2

$30 / Month

Medications to your Home

Two or three oral medication, usually glipizide and sometimes pioglitazone added to metformin. Free shipping to your home.

Labs

hemoglobin A1c tests every 3-6 months, annual urine test for kidney damage

Virtual Clinic Visits

every 3 months

$30 / Month

CHOOSE PATH

DIABETES LEVEL 3

$45 / Month

Medications to your Home

Prescription for insulin plus oral medications (for type 2 diabetics). We like to use the intermediate duration NPH insulin with usually one or two injections per day.

Supplies

supplies to test blood sugar at home

Labs

hemoglobin A1c tests every 3-6 months, annual urine test for kidney damage

Virtual Clinic Visits

every 3 months

Text Messages

intensive text message-based insulin titration program

$45 / Month

CHOOSE PATH

Additional care recommended but not provided in the price: annual eye and foot exams.


Persons with type 1 diabetes: our level 3 plan can be used for type 1 diabetics. We wish every type 1 diabetic could see an endocrinologist, but would rather them get care through our program than to not get care. Similar to the above, we will bill you $45/month for a program including test strips, glucose meter, 4 diabetic clinic visits per year (or more if needed), a hemoglobin A1c every 3 months, needles and an annual microalbuminuria test. We then have them purchase regular (brand Novolin R) or NPH insulin (brand Novolin N) or combination products (Novolin 70/30) from Wal-mart through their $25 program or insulins the above website from here. We will, of course, provide prescriptions for insulins. The Valyou program at the Sanofi website noted previously will provide up to up to 10 packs of pens and/or 10mL vials per month for $99. You can combine different types of insulins to provide rapid-acting insulin for meals and long-acting insulin for your baseline. So for a type 1 diabetic, it should be a Big Tree cost of $45/month plus a $99/month for long acting and short acting insulins. Or if you want to use the older insulins, $45/month + $25/vial from Wal-Mart.

*The billed cost of this program is $45/month and then we provide a coupon and prescription to get Novolin N at a low price through GoodRx at your local pharmacy. Depending on insulin use, the total monthly cost of the program is about $75-80. You also have the option of using the program from the makers of Lantus here. This program provides insulins for $99/month, which would take the total cost of care to $144/month for medications, labs and doctor visits.


Many patients with diabetes also have high blood pressure and high cholesterol, which are covered in other care pathways. We can add care pathways together, or you may save money by being a member of one of our Big Tree memberships. Our Virtual package, for example, is $35/month, which covers all virtual doctor visits and then we buy your medicines and supplies and resell them to you at cost. This plan also gets you treatment for other chronic conditions such as high blood pressure and cholesterol for only the price of the medicine (less than a dollar a month), as well as treatment for acute conditions such as sinus infections and UTIs for only the cost of the medicine (usually less than $1-2). Our Unlimited package ($59/month) would also include unlimited in-person visits at our Columbia location or our mobile clinics.

Package Monthly PlanMedication CostsDoctor VisitsLabs/SuppliesTotal Annual Cost
BT Level 3$45NPH/+$25$0$0$960
BT Level 3$45Lantus/+$99$0$0$1,728
Traditional Care$0NPH/$104$980$676$2,690
Traditional Care$0Lantus/$367$980$676$6,060

FAQ:

Is talking to your team as good as going to the Mayo Clinic or some other fancy health system?

Yes and no. In the end, everyone treats diabetes and depression with the same few medications. From a diagnostics perspective, I wish everyone could get care from the top internists at Mayo. Unfortunately, that is not possible. Countries must either ration health care by price or by making you stand in line (Uwe Reinhardt, if I remember right). Our country rations by price. The more you pay, the better your care, and, there are no cheaper options. We are just trying to leverage mobile technology, mid-level providers and generic medications to help lower the cost of care. If you are a multi-millionaire, then head up to Mayo and buy your medications at Walgreens. Or we can prescribe you the same exact medication for a much cheaper price. An insurance broker compares this to buying Busch beer at a Cardinals game or at a gas station across the street from the stadium. Same beer. Different price.

Are the medicines and supplies from foreign countries?

We use the same FDA approved suppliers as any use pharmacy would use. Though it is legal for individual patients to buy up to 90 days of medicine from out of the country (like you can do at pharmacychecker.com), it is not legal for us to purchase medications that are not approved by the FDA. This is all legit.

Who are your doctors and nurses?

Adam Wheeler M.D. is the attending physician, who designs the programs and oversees several assistant physicians. Helena Galstian M.D., Megan Ellis R.N., and Noe Rusaya help patients apply the care pathways. Though this is a new idea, our team has coordinated care for thousands of people in many complex and diverse environments.

What if, after talking to the doctor and nurse, I don’t want to follow one of the care pathways? What if they don’t think they are appropriate for me?

There is no charge.

Why are glucose test meters not included in the level 1 and level 2 plans?

Most experts agree that patients on only oral medications do not need to test their blood sugar at home.

What about medicines like Jardiance that claim to improve my heart health too? Why don’t you use those medications in your programs?

Medicines like Jardiance are excellent medications, and though expensive, are the right medicine for some. All newer medicines for diabetes are required to be tested to see if they improve heart health. Older medicines were often not tested. Thus all newer, and thus still expensive, medications for diabetes can make a claim to improve heart health, whereas older, generic medications cannot make such a claim.

How long do I have to commit to the program?

We mail you a month of medication at a time. You can cancel any time.

What if I want to do other medications?

Our regular program, Big Tree Medical Home, has the ability to prescribe other medications. This program was designed to optimally integrate both state-of-the-art medical care and sensitivity to price. Other, newer medications have a role in the care of diabetes, especially if price is not an important consideration. For those patients for who price is keeping them from getting care, we believe this program is optimal.