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Commercial Payers See Promise in Diabetes Prevention Program

While offering the Diabetes Prevention Program to beneficiaries comes with some challenges, commercial payers see positive potential for chronic disease management.

The diabetes prevention program shows promise in payer efforts to address diabetes care.

Source: Thinkstock

By Thomas Beaton

- The Diabetes Prevention Program could offer commercial payers an impactful way to prevent chronic disease for beneficiaries, according to a new report from AHIP.  

In 2012, AHIP recruited seven large payers to a pilot program which involved administering the CDC’s DPP to around 8400 beneficiaries.  

Between 2012 and 2017, the insurance companies worked collaboratively to identify best practices and solve implementation issues related to scalability and participant retention.

The CDC estimates that 29.9 million people in the US, about 9.9 percent of the population, have diabetes. In addition, 90 million adults have some form of diagnosed or undiagnosed prediabetes.  

Diabetes leads to high healthcare costs. The CDC calculated that diabetes costs the US an average of $327 billion a year to treat and manage.

Anthem, Cigna, Denver Health, EmblemHealth, Florida Blue, HealthNet, and Molina Healthcare agreed to leverage the DPP in an effort to control those costs and potentially improve outcomes for beneficiaries.

The DPP is designed to promote weight loss, a key factor for controlling blood sugar and preventing long-term complications.  Losing just 5 to 7 percent of body weight can reduce the risk of developing Type 2 diabetes by 71 percent for prediabetics over the age of 60, AHIP noted.

The national program uses group sessions to share strategies for healthy eating, increasing exercise, and adopting other healthy behaviors that can lead to weight loss.

Beneficiaries sign up for a year-long curriculum and are expected to complete 22 classes within that time frame. The first 16 classes are held weekly, but the sessions decrease in frequency over time as participants establish new lifestyle routines.

The payer group reported that enrolling members and keeping participants engaged for the full 12-month period was a challenge for program administrators.

Payers were able to increase DPP enrollment and retention by tailoring class schedules, creating flexible participation options, and targeting communications to certain beneficiary groups.

For example, Florida Blue offered virtual classes to ensure access for beneficiaries who could not attend in-person options, while EmblemHealth held classes in English, Spanish, and Chinese to meet the needs of its diverse member community.

The payers also encountered staffing challenges due to a lack of available lifestyle coaches and CDC-recognized DPP providers to work with members.  Offering staff development options, including competitive compensation and benefits, helped the payers secure talented staff members to administer classes.

AHIP found that the payer participants were pleased with the results and participation rates, and many are planning to continue to offer the program to prediabetic populations. Medicare now offers reimbursement for the DPP, which may accelerate adoption across the industry and incent more payers to participate.

Anthem, Denver Health, and Health Net have committed to offer the DPP to members at zero cost after 2018.

“Health insurance providers have established themselves as leaders in prevention and early intervention efforts for their members,” AHIP said. “Experiences from the DPP can be applied to new and more diverse groups of people, as insurance providers work with their members to improve their health.”

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