Amid increasing evidence that healthcare researchers have figured out how to prevent diabetes among those most at risk, public and private payers are showing an inclination to pay for that kind of preventive counseling and assistance.
Research also indicates that technology may be able to provide cost-effective assistance in implementing what has become the gold standard for diabetes prevention—the Diabetes Prevention Program.
Much of the activity enrolling high-risk people into the program is driven by three large organizations: HHS' Centers for Disease Control and Prevention, the not-for-profit YMCA of the USA and a division of for-profit UnitedHealth Group.
The groups' efforts, much of it in cooperation with one another, could be the beginning of a steep increase in the number and type of disease-prevention programs should Medicare give or get the green light to reimburse for the counseling, and as more insurers begin reimbursing for the counseling.
“There are huge health implications and there are huge cost-savings implications,” said Tim Koehler, president of UnitedHealth's Diabetes Prevention and Control Alliance.
The CDC's primary role has been to act as the official overseer of a government-endorsed national version of the program, taking on such tasks as certifying groups to be providers to ensure the program is being properly implemented. That two-year process is attracting a lot of interest based in part on growing evidence that the program works. “This is the most proven intervention for those at high risk for diabetes,” said Ann Albright, director of the CDC's Division of Diabetes Translation.
The CDC calculates that 20.9 million people were diagnosed with diabetes in 2010, an increase of 28% from 2005. And a February study published in the Journal of the American Medical Association estimated that close to 36% of adults were considered obese. “Obesity is probably the No. 1 public health issue of our time,” said Michael Barry, executive director of the American College of Preventive Medicine.
A study published last week by the Archives of Internal Medicine offered another example of how the Diabetes Prevention Program can be put into practice, Albright said. The study found that human coaching and a DVD-based model, both supported by e-mailed reminders, demonstrated clinical effectiveness as measured by a reduction in mean body mass. The use of telephones, the Internet and mobile devices are envisioned by some as a way to provide diabetes prevention counseling efficiently and at a cheaper cost than traditional face-to-face methods.
“It's an incredible time to be involved in diabetes prevention,” said Sean Duffy, co-founder and CEO of Omada Health, a San Francisco-based company that last week launched an online Diabetes Prevention Program tool.
Technology-based approaches aren't eligible for CDC certification because studies have shown the effectiveness to be mixed, Albright said. The CDC is open to the concept if tech-based models can be shown to be effective, she said. So at least in the near-term, much of the progress in diabetes prevention is likely to be found in face-to-face Diabetes Prevention Programs run by groups such as the YMCA. About 220 organizations are working toward CDC certification, and that number could more than double once the YMCA's more than 300 sites seek certification, Albright said.
The Y's foray into diabetes prevention, which has close to 10,000 enrollees and 75 Ys participating, could prove to be a turning point. “We hope that 20 to 50 years from now people will look at this moment and say that's when the Y got involved in community health,” said Dr. Matt Longjohn, the YMCA's senior director of chronic disease programs. The Y has seen success with the program, getting people enrolled, reducing the weight of enrollees and gaining acceptance from insurers and providers. “The hardest part is getting someone to show up,” and that is an area that a community group such as the Y is good at, he said.
The YMCA's program is run with the back office assistance of UnitedHealth's Diabetes Prevention and Control Alliance. The alliance, a for-profit endeavor, is working to build a line of business that contracts with UnitedHealth's insurance company and outside groups, such as insurers with self-funded employers.
In addition, the Y and UnitedHealth in June were the recipients of a three-year Health Care Innovation Award worth $11.8 million from the CMS' Center for Medicare and Medicaid Innovation to adapt the program for Medicare.
The CMS has indicated it is willing to fund similar counseling, having produced a national coverage decision in 2011 for intensive behavioral therapy for obesity, which attracted support from advocacy groups such as Shape Up and commercial enterprises like Weight Watchers. Moreover, bills have been introduced in the House and Senate that would give Medicare the authority to reimburse for the Diabetes Prevention Program.
The success of the Diabetes Prevention Program comes from its use of customized options adaptable to individual circumstances.
“People really know what they're supposed to do,” which is lose weight by eating better and exercising, said Linda Delahanty, director of nutrition and behavioral research at Massachusetts General Hospital Diabetes Center, Boston. “What they don't have is the know-how to work it into their lifestyle,” she said.