Diabetes is a devastating disease. In addition to the long-lasting health effects, such as blindness and cardiovascular disease, the total economic cost of diabetes is a whopping $245 billion a year, accounting for one out of every 10 American healthcare dollars spent, according to a 2013 study in Diabetes Care.
These costs, driven by the mushrooming prevalence of type 2 diabetes, prompted the CDC to expand the evidence-based National Diabetes Prevention Program (DPP) to reach a large population. The program targets the estimated 86 million Americans—one in every three adults—with prediabetes, up to 30% of whom will develop diabetes within five years without intervention.
Engaging people with prediabetes to modify their behavior is challenging, but the National DPP demonstrates that efficient, effective programs can change the lives of people at risk.
What are National Diabetes Prevention Programs (National DPPs)?
National DPPs are programs that are recognized by CDC. They implement the intensive lifestyle change program that features a trained coach leading a group of people with prediabetes who meet regularly in person, online, or via telehealth during a 12-month period.
While the lifestyle coach facilitates the CDC-approved curriculum and provides resources to help people set goals and overcome barriers, the vital ingredient is the camaraderie the meetings foster in a support-group environment. Participants who attend the program reduce their risk of development, or delay type 2 diabetes significantly.
In 2012, six organizations were chosen to work in a cooperative agreement with the CDC to expand the National DPP using various models, with a goal of sustainability.
The NIH randomized DPP studies found people who participate in these programs lose 5% to 7% of their body weight by eating healthier and being more active (the goal is 150 minutes of physical activity per week).
After attending a program, there was a 58% reduction in risk overall, and a 71% reduction in the older-than-60 group. Most telling is there is still a 27% risk reduction after 15 years.
That’s huge. Even delaying the onset of diabetes improves health and saves costs.
Recognizing the benefits to participants and savings in healthcare spending, beginning January 1, 2018, approved programs can bill Medicare to implement the National DPP to eligible recipients.
Benefits for plans, health systems
Further, an increasing number of private payers are reimbursing for DPPs. Many payers such as large employer groups and state employee health plans cover the National DPP for their beneficiaries, realizing they receive a return on investment for covering the program.
The CDC recently created an impact toolkit, into which employers can plug in their own data to see the likely impact of covering the National DPP.
For health systems, there are other benefits of becoming a National DPP provider, as this can be a revenue-generating program. Program participants may be more likely to consider seeking other services, such as surgery, within a system they know and trust.
Creating an efficient, effective DPP
As one of the six organizations chosen to work with the CDC, the American Association of Diabetes Educators (AADE) began a special focus on the National DPP more than five years ago.
All AADE DPP sites were established in accredited or recognized diabetes self-management education and support (DSMES) programs at a variety of urban and rural settings and locations, including hospitals and health systems, physician practices, pharmacies and other entities.
With the cooperative agreement phasing out and the AADE DPP model a proven success, the AADE Prevention Network is being offered nationwide to DSMES programs as well as other interested entities, from community centers to health departments.
The prevention network is helps organizations set up a sustainable National DPP by providing billing guidance, webinars, templates, and most importantly, a database system that allows organizations to readily collect participant data and perform analytics as well as prepare programs to submit required data to CDC to receive CDC recognition (required for reimbursement).
Joanna Craver DiBenedetto, BS, MNM, is director of prevention, American Association of Diabetes Educators.