Dennis P. Scanlon, PhD: Dr Snow, what's the role of payers to try to bring this to populations? Obviously, the clinicians that we have around the table and around the country will deliver the programs. But what’s the role for payers when thinking about the populations that you cover and getting the word out that it is covered and trying to have those populations take advantage of these programs?

Kenneth Snow, MD, MBA: We would love to see these types of programs being taken advantage of, and being utilized. Clearly, there’s the health benefits for members, the cost benefits for both members and for the payer, and, just in general, a healthier world, which is one of our goals.

We know, from past experience, that even when there is solid coverage, such as for diabetes education for folks with diabetes, that many folks do not take advantage of this (either because the patient doesn’t take advantage of the benefit or physicians don’t refer). And, regardless of why it doesn’t occur, it doesn’t occur, and that’s to the detriment of our members. Fortunately, diabetes is one of those items that plays a significant role in quality metrics and measuring quality programs and contracts that exist because of quality care that’s being provided. So, there’s an incentive for physicians to be making sure that their members, or their patients, are getting the care that they should. And hopefully, we will be able to facilitate getting the word out there that “this is a covered benefit” and that folks should take advantage of it.

Neal Kaufman, MD: The real secret sauce is, how do you get people to sign up and show up? Once you get them to the program, we can almost predict (for the 1000 people, 10,000 people going) what’s going to happen. But how do you get the right person to the right program at the right time to engage them, to activate them, and to get them to see that there is a benefit from that program? That’s the secret sauce.

Kenneth Snow, MD, MBA: To really identify what it is that either identifies a patient who is likely to be engaged if you offer them the opportunity (they’re the one that will show up). Or, what is the behavior that, whether it’s a payer or provider, they can add to take somebody who is less engaged and turn them into somebody who is?

Robert Gabbay, MD, PhD, FACP: Another piece that I know we started to talk about a little bit is offering different modalities. In-person things are going to work well. Going to the YMCA is going to work well for certain people. But digital solutions are going to work well for another group of people. So, we need to tailor the approach and engagement to what a patient would be most likely to do.
Dennis P. Scanlon, PhD: This is a perfect segue, because earlier we talked about technology and I want to get into different modalities (different types of coaches, educators, different types of technology, digital technology, a lot of different ways) in which these preventions, programs, can be delivered. Can somebody talk about this?

Mary Ann Hodorowicz, RDN, MBA, CDE: I would love to jump in here. I’ve got some notes in front of me, so, if you don’t mind, I’m looking down. I have 2 sons who are in the millennial generation and if you don’t deliver messages to them on the smartphone or online, the message gets lost. The digital platforms—online of course, through the computer for diabetes prevention and smartphone apps, text messaging on smartphones, interactive voice response on telephones, and telephone conference calls, and emails—there’s like 6 great digital platforms especially to address that younger population who relies on digital to enroll in programs, get their messages, and know about behavior change. I think it’s critical.

Dennis P. Scanlon, PhD: What about other populations? Does that work for the Medicare population, or for those who are older?

Neal Kaufman, MD: Yes, it certainly does. I think we have to distinguish between 2 kinds of digital approaches: one that I would call tools and the other, the interventions. So, a text message to remind you to do something—it’s a tool.

An intervention says there’s a beginning, a middle, perhaps an end. There’s a theory behind it. There’s been proven evidence that it works. There’s a coherent set of activities, protocol, curriculum, etcetera.

And tools enable people to do things. But, in most cases, it’s the people who are ready to do it anyway.

An intervention has to be designed so that it can take someone who’s thinking about it, get them to overcome their barriers, become active, and have them do the things that they want and need to do to improve their health.

So, yes, those tools are important, but if they’re not in the context of an intervention that’s been thought through, my prediction is they will only work for those who don’t really need it as much.

Dennis P. Scanlon, PhD: I’m thinking in terms of the interventions. There are things like behavior change. But also, on the tool side, it’s sharing data as well, right? It’s about collecting information and being able to share that.

Bob, from your perspective as a clinician with patients who might participate in these programs, do these help you?

Robert Gabbay, MD, PhD, FACP: Absolutely. One of the things I like to do with my patients, is ask them if they have a smartphone and if they carry it with them all the time. And, depending on what they have, I say, “How much do you walk?” And they say, “Oh, I walk a lot.” And I’m like, “Do you mind? Can we check to see on your phone? It probably tracks how much you’re walking.” And typically, they’re very surprised that they’re walking far less than they thought. I say, “Here’s a goal. What do you think you can do?”

That’s a very simple example of a common digital tool, that is pretty ubiquitous, that can be very effective. That, as Neal says, is only a tool. And really, if you want to do something to prevent diabetes, you need a whole intervention based not only on counting steps but also dietary changes and other behavior change approaches.

Kenneth Snow, MD, MBA: Also, in the population, it’s very easy to accept that the millennial population and the millennial age lives and dies by technology. But that does not mean that older folks aren’t very accepting of technology, and for, particularly, folks in the Medicare population where getting to their physician may be a real challenge because of other health issues or transportation issues. So, in that population, it may be even more important than the millennial population. They have alternatives that an older population may not.

Mary Ann Hodorowicz, RDN, MBA, CDE: It could be by telephone.

Kenneth Snow, MD, MBA: That’s right.

Mary Ann Hodorowicz, RDN, MBA, CDE: I have a 97-year-old mother who wouldn’t know a computer from a dishwasher, but she knows how to use a telephone. And that’s part of the digital platforming.

Kenneth Snow, MD, MBA: That’s right.

Diabetes: Role of Payers Versus Role of Technology

Robert Gabbay, MD, PhD, FACP; Mary Ann Hodorowicz, RDN, MBA, CDE; Neal Kaufman, MD; Dennis P. Scanlon, PhD; and Kenneth Snow, MD, MBA, suggest that technology can help bring the Diabetes Prevention Program to new populations; and smartphones, in particular, can help make diabetes prevention highly accessible.
Published Online: June 02, 2017


Dennis P. Scanlon, PhD: Dr Snow, what's the role of payers to try to bring this to populations? Obviously, the clinicians that we have around the table and around the country will deliver the programs. But what’s the role for payers when thinking about the populations that you cover and getting the word out that it is covered and trying to have those populations take advantage of these programs?

Kenneth Snow, MD, MBA: We would love to see these types of programs being taken advantage of, and being utilized. Clearly, there’s the health benefits for members, the cost benefits for both members and for the payer, and, just in general, a healthier world, which is one of our goals.

We know, from past experience, that even when there is solid coverage, such as for diabetes education for folks with diabetes, that many folks do not take advantage of this (either because the patient doesn’t take advantage of the benefit or physicians don’t refer). And, regardless of why it doesn’t occur, it doesn’t occur, and that’s to the detriment of our members. Fortunately, diabetes is one of those items that plays a significant role in quality metrics and measuring quality programs and contracts that exist because of quality care that’s being provided. So, there’s an incentive for physicians to be making sure that their members, or their patients, are getting the care that they should. And hopefully, we will be able to facilitate getting the word out there that “this is a covered benefit” and that folks should take advantage of it.

Neal Kaufman, MD: The real secret sauce is, how do you get people to sign up and show up? Once you get them to the program, we can almost predict (for the 1000 people, 10,000 people going) what’s going to happen. But how do you get the right person to the right program at the right time to engage them, to activate them, and to get them to see that there is a benefit from that program? That’s the secret sauce.

Kenneth Snow, MD, MBA: To really identify what it is that either identifies a patient who is likely to be engaged if you offer them the opportunity (they’re the one that will show up). Or, what is the behavior that, whether it’s a payer or provider, they can add to take somebody who is less engaged and turn them into somebody who is?

Robert Gabbay, MD, PhD, FACP: Another piece that I know we started to talk about a little bit is offering different modalities. In-person things are going to work well. Going to the YMCA is going to work well for certain people. But digital solutions are going to work well for another group of people. So, we need to tailor the approach and engagement to what a patient would be most likely to do.
Dennis P. Scanlon, PhD: This is a perfect segue, because earlier we talked about technology and I want to get into different modalities (different types of coaches, educators, different types of technology, digital technology, a lot of different ways) in which these preventions, programs, can be delivered. Can somebody talk about this?

Mary Ann Hodorowicz, RDN, MBA, CDE: I would love to jump in here. I’ve got some notes in front of me, so, if you don’t mind, I’m looking down. I have 2 sons who are in the millennial generation and if you don’t deliver messages to them on the smartphone or online, the message gets lost. The digital platforms—online of course, through the computer for diabetes prevention and smartphone apps, text messaging on smartphones, interactive voice response on telephones, and telephone conference calls, and emails—there’s like 6 great digital platforms especially to address that younger population who relies on digital to enroll in programs, get their messages, and know about behavior change. I think it’s critical.

Dennis P. Scanlon, PhD: What about other populations? Does that work for the Medicare population, or for those who are older?

Neal Kaufman, MD: Yes, it certainly does. I think we have to distinguish between 2 kinds of digital approaches: one that I would call tools and the other, the interventions. So, a text message to remind you to do something—it’s a tool.

An intervention says there’s a beginning, a middle, perhaps an end. There’s a theory behind it. There’s been proven evidence that it works. There’s a coherent set of activities, protocol, curriculum, etcetera.

And tools enable people to do things. But, in most cases, it’s the people who are ready to do it anyway.

An intervention has to be designed so that it can take someone who’s thinking about it, get them to overcome their barriers, become active, and have them do the things that they want and need to do to improve their health.

So, yes, those tools are important, but if they’re not in the context of an intervention that’s been thought through, my prediction is they will only work for those who don’t really need it as much.

Dennis P. Scanlon, PhD: I’m thinking in terms of the interventions. There are things like behavior change. But also, on the tool side, it’s sharing data as well, right? It’s about collecting information and being able to share that.

Bob, from your perspective as a clinician with patients who might participate in these programs, do these help you?

Robert Gabbay, MD, PhD, FACP: Absolutely. One of the things I like to do with my patients, is ask them if they have a smartphone and if they carry it with them all the time. And, depending on what they have, I say, “How much do you walk?” And they say, “Oh, I walk a lot.” And I’m like, “Do you mind? Can we check to see on your phone? It probably tracks how much you’re walking.” And typically, they’re very surprised that they’re walking far less than they thought. I say, “Here’s a goal. What do you think you can do?”

That’s a very simple example of a common digital tool, that is pretty ubiquitous, that can be very effective. That, as Neal says, is only a tool. And really, if you want to do something to prevent diabetes, you need a whole intervention based not only on counting steps but also dietary changes and other behavior change approaches.

Kenneth Snow, MD, MBA: Also, in the population, it’s very easy to accept that the millennial population and the millennial age lives and dies by technology. But that does not mean that older folks aren’t very accepting of technology, and for, particularly, folks in the Medicare population where getting to their physician may be a real challenge because of other health issues or transportation issues. So, in that population, it may be even more important than the millennial population. They have alternatives that an older population may not.

Mary Ann Hodorowicz, RDN, MBA, CDE: It could be by telephone.

Kenneth Snow, MD, MBA: That’s right.

Mary Ann Hodorowicz, RDN, MBA, CDE: I have a 97-year-old mother who wouldn’t know a computer from a dishwasher, but she knows how to use a telephone. And that’s part of the digital platforming.

Kenneth Snow, MD, MBA: That’s right.
View More From This Discussion
Episode 1 Intervention for Diabetes Prevention
Episode 2 The Challenges of Diabetes Prevention Programs
Episode 3 Diabetes: Role of Payers Versus Role of Technology
Episode 4 Clinical Rationale for CGM in Diabetes
Episode 5 Using Technology to Help Data Make Sense in Diabetes
Episode 6 Which Technology Merits Payment in Diabetes Care?
Episode 7 Evaluating Factors for FDA Approval of Diabetes Devices
Episode 8 The Change in the Device Coverage Landscape
Episode 9 The Future of Diabetes Prevention and Management
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