- With more than one out of every three Americans living with prediabetes, payers are actively seeking out innovative strategies for preventing progression of the costly and life-changing disease.
Most payers offer clinical benefits to cover the costs of care for members who have progressed into Type 2 diabetes, but getting ahead of the curve requires more than just a reactive stance to the increasingly common metabolic condition.
The Diabetes Prevention Program (DPP), developed by the CDC and now popular across the public and private insurance sectors, offers payers a way to get upstream of rising risks.
The DPP teaches beneficiaries with prediabetes how to engage in healthy behaviors, like losing weight and managing their blood pressure, that could significantly reduce - or eliminate - their chances of progressing past the initial clinical stage.
Between 2012 and 2017, the DPP has helped beneficiaries over 60 years old with prediabetes reduce their risk of developing diabetes by 71 percent if they lost between 5 and 7 percent of their body weight. DPP classes are designed to promote healthy behaviors that are clinically proven to reduce a person’s risk of developing diabetes.
Joan Harvey, Vice President of Consumer Health Engagement and Behavioral Health at Cigna, says that the DPP provides an effective and efficient framework for payers looking to address prediabetes among their members.
“DPP is absolutely the gold standard,” Harvey said. “It’s just critical from a community perspective, and for the greater good, that the healthcare industry is supporting chronic illness prevention with programs that truly deliver results.”
“The DPP provides an opportunity to help employers have healthy and productive employees, and support communities in becoming healthier.”
The program also ties into Cigna’s financial goals around moving towards value-based care, she added.
“We really like the DPP because we believe that we need to continue to move the market to value-based payment,” she said. “Paying for value is critical to Cigna's philosophy.”
The DPP is delivering that value by fostering engagement with patients in need of extra support to make long-term, healthy changes to their lifestyles.
While there are many possible iterations of the DPP that incorporate both in-person classes and digital interactions, Cigna has found that online and mobile strategies resonate the best with its target beneficiary population.
“Models like the DPP lend themselves to digital environments, especially to our consumer base,” Harvey said.
“We are very heavy into commercial clients which means most of them are working and they're doing the DPP classes around their work schedules, or at night, or whenever. A digital platform takes a lot of pressure off of members from a timing perspective,” she continued.
Cigna decided to partner with an established chronic disease prevention vendor to offer the classes, first as part of a pilot program aimed at identifying best practices.
“The execution of the DPP guidelines is important,” Harvey said. “A digital platform needs to be easy to use, but it must also have clinical efficacy.”
“The DPP requires strong clinical foundations that some vendors understood really well. However, there were some vendors that weren't equipped clinically to support our DPP goals.”
Cigna decided that Omada Health offered the digital engagement tools and DPP structure that the payer was looking for, Harvey said. The two companies initially partnered in 2017 on the pilot program, then expanded their collaboration.
Omada’s platform leverages engagement strategies including personal coaching, peer support, stress management, and nutritional assistance, Harvey said.
Participants are also placed into smaller groups, no larger than two dozen people, to create a supportive community and the opportunity to form personal relationships between members.
Beneficiaries can also upload personal health data from Bluetooth scales, wearable fitness monitors, and mobile apps to help supplement their weight loss journeys and monitor their health.
Cigna prioritized impactful patient education tools that are easy to understand.
“It’s so much easier for members see a picture of what a healthy plate looks like then try to describe it,” Harvey said. “The ability for folks to really use those tools when they want to, and through a seamless and simple platform, is important.”
The initial pilot program produced significant positive results in terms of clinical care and spending, Harvey noted.
On average, Cigna’s DPP members experienced sustained weight loss of 3.5 to 5 percent of their body weight after the one-year pilot.
The program also drove health improvements that led to reduced net medical costs of $421 to $972 per DPP beneficiary, when compared to spending for non-DPP members. Harvey said those cost reductions were between 1.5 to 2.1 times greater than what employers spent on DPP sponsorship.
Harvey added that 83 percent of participants would recommend the DPP program to a friend, indicating the potential widespread DPP adoption among beneficiaries.
“The pilot results indicated that the digital DPP was clearly was bringing value to our client,” Harvey said. “The DPP was preventing disease within our communities. And it was a hit in terms of customer satisfaction.”
The DPP may also have the added benefit of reducing risks for other high-cost chronic conditions such as cardiovascular disease, she noted.
“If a payer can help reduce overall metabolic risks, which DPP does, not only do you get the value of it for diabetes, but you also get it for reducing heart disease,” she said.
“There are studies showing that the DPP reduces certain kinds of cancers or the elevation of cancer. The general DPP framework has an overarching value above and beyond diabetes around chronic care.”
The multifaceted benefits of the Diabetes Prevention Program are a strong selling point for other payers to integrate DPP strategies into their chronic disease prevention and management plans.
“We always like to try to simplify complicated solutions,” Harvey said. “We wanted an easy-to-use solution that's very simple for our customers and empowers them to be part of taking charge of their health.”
“We really wanted to focus on creating something that would mean we were paying for value while also delighting the customer, because the customer really has to change behavior and do something for their program to be successful.”