Dr Ann Albright CDC Atlanta

Transcription

1 Dr Ann Albright CDC Atlanta

2 BUSINESS PLANNING FOR TYPE 2 DIABETES PREVENTION Ann Albright, PhD, RDN Division of Diabetes Translation

3 RISK STRATIFICATION FOR TYPE 2 DIABETES PREVENTION INTERVENTIONS Risk Level Adult Prevalence (%) 10 Years Diabetes Risk (%) Risk Indicators Intervention Very High ~ 15% >30 High 20% 20 to 30 A1c >5.7% FPG>110 FPG> 100 Natl DPP score 9+ Structured Lifestyle Intervention in Community and Clinical Settings ** Moderate 30% 10 to risk factors Risk Counseling ** Low 35% 0 to risk factors **Build Healthy Communities Gerstein HC et al. Annual incidence and relative risk of diabetes in people with various categories of dysglycemia: a systematic overview and metaanalysis of prospective studies. Diabetes Res Clin Pract Dec;78(3): Zhang X et al. A1C level and future risk of diabetes: a systematic review. Diabetes Care. 2010;33:

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5 OVERVIEW OF THE NATIONAL DPP Core is a CDC-recognized, year-long structured lifestyle change program that offers participants a trained lifestyle coach, a CDCapproved curriculum, and group support. Relies on a variety of public-private partners (community/faith organizations, health care, business, insurers, academia, government, others) to: Build a workforce that can implement the lifestyle change program effectively Ensure quality and standardized reporting Deliver the lifestyle change program through organizations nationwide Increase referrals to & participation in the lifestyle change program

6 ROLE OF DIGITAL TECHNOLOGY IN TYPE 2 DIABETES PREVENTION The National DPP is designed for all American adults at high risk for type 2 diabetes Behavioral and structural factors create barriers to participation - digital technology can help Some participants prefer a digital program Digital tools can enhance program delivery

7 REMOTE MODALITIES: CONTINUUM OF COMPLEXITY ing/ Texting Mobile Technology Phone Conference Video Conference Full Virtual

8 ALL-PAYER MODEL Working with all public and private payers and employers to eliminate cost barriers for participants and sustain program delivery organizations long-term Partners Private Sector Self Insured Employers Commercial Insurers Health Plans Employers Public Sector: State/Local State & Local Health Departments State/Local Employee Benefit Boards Public Sector: Federal CMS: Medicare & Medicaid

9 COMMERCIAL INSURANCE PLAN COVERAGE Many commercial health plans provide some coverage for the National DPP. Examples include: AmeriHealth Caritas Anthem BCBS Florida BS California BCBS Louisiana Denver Health Managed Care: Medicaid, Medicare, Public Employees Emblem Health: NY GEHA Highmark Humana Kaiser: CO & GA LA Care: Medicaid MVP s Medicare Advantage Priority Health: MI United Health Care: National, State, Local, Private, and Public Employees

10 COVERAGE FOR PUBLIC EMPLOYEES Over 3.4 million public employees and dependents in 18 states have the National DPP lifestyle change program as a covered benefit. States with Coverage for State/Public Employees RI California Colorado Connecticut (DOT workers) Delaware Georgia (Kaiser members) Kentucky Louisiana Maine Maryland (partial payment) Minnesota New Hampshire New York Oregon (educators/local government) Rhode Island Tennessee Texas Vermont Washington Demonstrations ongoing in North Dakota, Pennsylvania, South Dakota, and Utah

11 MEDICARE DIABETES PREVENTION PROGRAM PAYMENT STRUCTURE Performance-based payments are based on beneficiary attendance and weight loss MDPP Core Services MDPP Core Services Ongoing Maintenance Sessions Ongoing Maintenance Sessions 1 Core session: $25 4 Core sessions: $50 9 Core sessions: $90 Two $60 payments for core maintenance with weight loss OR Two $15 payments for core maintenance without weight loss 5% weight loss achieved: $160 9% weight loss achieved: $25 Payment per Eligible Beneficiary Four $50 payments for ongoing maintenance sessions with weight loss 9% weight loss achieved: $25 Minimum payment per eligible beneficiary*: $195 Maximum payment per eligible beneficiary: $670 *Assumes the eligible beneficiary completes one year of MDPP sessions but does not achieve 5% weight loss

12 MEDICAID (LOW INCOME) COVERAGE Goal: Achieve sustainable coverage of the National DPP lifestyle change program for Medicaid beneficiaries Result: Remove cost barriers and reduce diabetes health-related disparities for high-risk/burden populations Work with State Health Departments - Funded health departments in all states and DC to partner with their Medicaid sister agencies to make the case for coverage 9 states have full or partial coverage through Medicaid authorities, demonstrations, or pilots Work with National Organizations - Funded 10 national organizations to establish new programs through affiliate sites in underserved areas to reach priority populations Work with Managed Care Organizations (MCOs) - Funded a comprehensive Demonstration Project in 2 states with a focus on implementation and uptake Products/Outcomes Virtual Learning Collaborative with 20 States National DPP Coverage Toolkit: Final Demonstration Project Evaluation Report October 2018 New Tools and Resources for the National DPP Customer Service Center

13 BUSINESS/EMPLOYER INVESTMENTS Many businesses and employers are investing in promoting or offering the National DPP lifestyle change program Examples: Costco Weight Watchers Omada Noom American Medical Association Canary Health Google Real Appeal, Inc. UCLA Latham & Watkins New York City Government General Dynamics Bath Iron Works

14 CDC COOPERATIVE AGREEMENT INVESTMENTS National Organizations ( ) State Health Departments ( ) State & Large City Health Departments ( ) National Diabetes Prevention Program: Preventing Type 2 Diabetes Among People at High Risk: Funded 6 national organizations to: 1) increase number of CDC-recognized organizations offering the National DPP lifestyle change program via multi-state networks, and 2) expand coverage through employers and insurers State Public Health Actions to Prevent and Control Diabetes, Heart Disease, and Obesity and Associated Risk Factors and Promote School Health: Funds all states to raise prediabetes awareness, increase referrals to CDC-recognized orgs., and work with State Employee Benefit Plans and Medicaid to support coverage State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke: Funds 17 states and 4 cities to expand on work above with emphasis on enrolling vulnerable, high-risk populations National Organizations ( ) Scaling the National Diabetes Prevention Program in Underserved Areas: Funds 10 national organizations to establish new programs in underserved areas and enroll populations currently underrepresented in the program relative to their disease burden and risk factors

15 Estimated Average Monthly Salary and Training Costs for Lifestyle Coaches and Program Coordinators 1 Lifestyle Coaches Program Coordinators $4,882 $4,512 $4,744 $5,088 $751 $751 $699 $699 Average Monthly Salary Average Training Costs Average Monthly Salary Average Training Costs Y3 Y4 Source: Data from program delivery organizations participating in CDC cooperative agreement DP from 10/01/14 09/30/16. 1 Data on lifestyle coach and program coordinator salary were collected in Year 3 (N=37 for lifestyle coaches and N=25 for program coordinators) and Year 4 (N=46 for lifestyle coaches and N=26 for program coordinators) of DP

16 Average Participant Enrollment Fee Charged by Type of Site 1 $475 $450 $450 $429 $455 $429 $423 Government Educational Non-profit or Community Y3 Y4 Health Care Source: Data from program delivery organizations participating in CDC cooperative agreement DP from 10/01/14 09/30/16 1 Data on participant fees collected in Years 3 (N=57) and 4 (N=94) of DP

17 36.6% Percentage of Sites Reporting How Participant Enrollment Costs are Covered Financially % 23.8% 20.1% 14.0% 6.1% 2.4% Participant Fee Waiver/Grant funded/scholarship Insurance coverage benefit Insurance coverage Employer coverage via pay-forperformance benefit model Local YMCA Scholarship Other Employer sponsored delivery Note: Sites may report more than one type of coverage option per year so total percentage is greater than 100%. 1 Source: Data from program delivery organizations participating in CDC cooperative agreement DP from 10/01/12 09/30/16 17

18 IN SUMMARY To scale-up type 2 diabetes prevention efforts nationwide, investment is needed across multiple sectors (business, healthcare, community-based organizations, government, technology, others). A variety of program delivery options are needed to meet the needs of all people at risk. Cost/pricing will vary across these options. A national framework/supporting infrastructure can play a critical role in: ensuring quality across program delivery organizations securing coverage by public and private payers to decrease cost barriers raising public awareness/creating demand linking resources and sharing best practices serving as a neutral convener to bring diverse partners to the table