Currently Viewing:
The American Journal of Managed Care June 2020
Effect of High-Deductible Insurance on Health Care Use in Bipolar Disorder
J. Frank Wharam, MD, MPH; Alisa B. Busch, MD, MS; Jeanne Madden, PhD; Fang Zhang, PhD; Matthew Callahan, MS; Robert F. LeCates, MA; Phyllis Foxworth, BS; Stephen Soumerai, ScD; Dennis Ross-Degnan, ScD; and Christine Y. Lu, PhD
Tests, Surgical Masks, Hospital Beds, and Ventilators: Add Big Data to the List of Tools to Fight the Coronavirus That Are in Short Supply
Dennis P. Scanlon, PhD, MA; and Mark B. Stephens, MD, MS
What We Talk About When We Talk About Care Management
Leah M. Marcotte, MD; and Joshua M. Liao, MD, MSc
Hopes, Worries for US Health Care in Wake of COVID-19: A Q&A With Donald M. Berwick, MD, MPP
Interview by Allison Inserro
Strategies for Implementing Best Practices in Independent Physician Associations
Jennifer N. Dunphy, DrPH, MBA, MPH; Morris Weinberger, PhD; and Pam Silberman, JD, DrPH
Measures of ED Utilization in a National Cohort of Children
Annie Lintzenich Andrews, MD, MSCR; Jessica Bettenhausen, MD; Erik Hoefgen, MD, MS; Troy Richardson, PhD; Michelle L. Macy, MD, MS; Bonnie T. Zima, MD, MPH; Jeffrey Colvin, MD, JD; Matt Hall, PhD; Samir S. Shah, MD, MSCE; John M. Neff, MD; and Katherine A. Auger, MD, MSc
General Medical Claims for Behavioral Health Patients in Japan
Yasuhiro Kishi, MD, PhD; Roger G. Kathol, MD; and Yasuyuki Okumura, PhD
Health Care Resource Utilization Among Patients With T2D and Cardiovascular-, Heart Failure–, or Renal-Related Hospitalizations
Srinivas Annavarapu, MBBS, PhD; Sabyasachi Ghosh, MS; Yong Li, PhD; Chad Moretz, ScD, MS; Sharashchandra Shetty, PhD; and Todd Prewitt, MD
FASStR: A Framework for Ensuring High-Quality Operational Metrics in Health Care
Elham Torabi, PhD, MSIE; Tugba Cayirli, PhD; Craig M. Froehle, PhD; Kenneth J. Klassen, PhD; Michael Magazine, PhD; Denise L. White, PhD, MBA; and Michael J. Ward, MD, PhD, MBA
Value-Based Insurance Design in Louisiana: Blue Cross Blue Shield’s Zero Dollar Co-pay Program
Xiaojing Yuan, MPH; Janet Chaisson, BS; Dawn Cantrell, BA; Brice L. Mohundro, PharmD, BCACP; Mollie Carby, PharmD, MBA; Milam Ford, MPH; Miao Liu, MS; Jason Ouyang, MD; Yuan Zhang, PhD; Heath C. Williams, MBA; Benjamin V. Vicidomina, BS; Vindell Washington, MD, MS; and Somesh C. Nigam, PhD
Standardization Improves Postoperative Patient Handoff Experience for Junior Clinicians
Amit Prasad, MD; Theodore J. Cios, MD, MPH; Whitney Staub-Juergens, MSN, RN, CCRN; Carol Dziedzina, BSN, RN, CCRN; Srikantha Rao, MBBS, MS; and Kai Singbartl, MD, MPH
Claims Identification of Patients With Severe Cancer-Related Symptoms
Richard W. DeClue, PhD, MPH; Dana Drzayich Antol, MS; Adrianne W. Casebeer, PhD, MS, MPP; Todd Michael, PharmD, RPh; Marina Sehman, PharmD; Andrew Renda, MD, MPH; Sarika Ogale, PhD; Stephen Stemkowski, PhD, MHA; and Bryan Loy, MD
Currently Reading
Medicare Diabetes Prevention Program: Where Are the Suppliers?
Natalie D. Ritchie, PhD; Katherine Ann Sauder, PhD; and R. Mark Gritz, PhD

Medicare Diabetes Prevention Program: Where Are the Suppliers?

Natalie D. Ritchie, PhD; Katherine Ann Sauder, PhD; and R. Mark Gritz, PhD
Despite the Medicare Diabetes Prevention Program now being a covered benefit, there is inadequate availability of suppliers to reach Medicare beneficiaries with prediabetes.
ABSTRACT

Objectives: The Medicare Diabetes Prevention Program (MDPP) launched in April 2018, offering an unprecedented opportunity to reach the estimated 48.3% of older adults with prediabetes. Success of the innovative policy is likely to depend on adequate supplier availability. We examined supplier data from CMS to assess beneficiaries’ potential access to MDPP services.

Study Design: We conducted a descriptive analysis of MDPP suppliers using data extracted from the CMS registry of suppliers as of July 2019 and data about beneficiary populations.

Methods: Identifying the location, type, and number of MDPP suppliers and their respective sites, including within states, US territories, and the District of Columbia (hereafter, states), we mapped geographic coverage of MDPP access.

Results: There are 126 unique supplier organizations that offer the MDPP across 601 sites, equating to only 1 site per 100,000 Medicare beneficiaries. Seventy-five percent of states have no MDPP sites, fewer than 1 site per 100,000 beneficiaries, and/or availability limited to a single municipality. Although only 10.3% of MDPP suppliers are community-based organizations, they represent more than half (55.7%) of sites where beneficiaries can access the program.

Conclusions: Findings show inadequate MDPP access, with relatively few suppliers and locations where beneficiaries can receive services. Insufficient reimbursement relative to costs for suppliers may largely account for limited availability. Strategies to facilitate access are urgently needed, which may include partnering with large organizations for greater per capita reach and rural organizations for broader geographic coverage, along with setting fiscally sustainable rates based on refined program implementation and cost analysis.

Am J Manag Care. 2020;26(6):e198-e201. https://doi.org/10.37765/ajmc.2020.43496
Takeaway Points
  • Despite the Medicare Diabetes Prevention Program (MDPP) now being a covered benefit, there is inadequate supplier availability to reach the estimated 29.5 million Medicare beneficiaries with prediabetes.
  • Severe shortages of MDPP providers in US states/territories with the largest populations of racial/ethnic minority beneficiaries merit particular attention to address health disparities.
  • Insufficient reimbursement relative to costs for suppliers may largely account for limited availability. Setting fiscally sustainable rates amid further cost analysis may be needed to attract more suppliers.
  • Innovation to allow community-based organizations to serve as MDPP suppliers appears to be beneficial.
CMS enacted Medicare coverage of the Medicare Diabetes Prevention Program (MDPP) in April 2018,1 offering an unprecedented opportunity to reach the estimated 48.3% of older adults with prediabetes.2 The MDPP is a structured group class promoting lifestyle change for weight loss1; it closely follows the evidence-based National Diabetes Prevention Program (NDPP) that has been disseminated by the CDC since 2012.3 Success of the MDPP is critical to diabetes prevention efforts and will likely influence Medicaid and private-payer coverage, as well as determination of other preventive benefits. Initial success may largely depend on having adequate suppliers to ensure beneficiary access. Becoming a designated MDPP supplier is fairly straightforward: MDPP suppliers must participate in the CDC’s Diabetes Prevention Recognition Program4 to ensure fidelity and pay the standard Medicare Enrollment Application Fee with their application to CMS. To facilitate availability, trained laypersons can provide MDPP services, and suppliers may include community-based organizations and other nontraditional settings.1

Numerous MDPP suppliers are needed nationwide to serve the estimated 29.5 million Medicare beneficiaries with prediabetes. Inadequate provider payment has been identified as a potential deterrent to increasing the number of suppliers.5-7 Using the MDPP’s pay-for-performance reimbursement schedule, which is based on attendance and weight loss outcomes,8 estimates show that less than a quarter of service delivery costs may be reimbursed by CMS.5,6 Performance-based payments may especially deter suppliers serving racial/ethnic minority populations, who have low attendance and weight loss in the NDPP3,9 yet disparately high diabetes prevalence.2 Little is known about early uptake of the MDPP in practice. In this study, we evaluate MDPP access after the first 15 months of the benefit’s coverage.

METHODS

We conducted a descriptive analysis of MDPP access using data extracted from the CMS registry of MDPP suppliers as of July 2019,10 more than a year after CMS enacted the covered benefit.1 We examined the number of MDPP suppliers and their respective site locations. Because a single supplier can offer the MDPP at multiple sites, site availability was a primary indicator of access. We measured access by the number of MDPP sites per 100,000 Medicare beneficiaries (nearly half of whom may be MDPP eligible based on having prediabetes2) within states, US territories, and the District of Columbia (hereafter, states). To assess the most critical gaps in MDPP access, we identified states as having (1) no MDPP sites, (2) fewer than 1 MDPP site per 100,000 beneficiaries, or (3) MDPP site(s) limited to a single municipal area. To assess potential reach to racial/ethnic minority populations, we determined the frequency of these critical MDPP shortages in states with the largest populations of Hispanic, African American, and Native American/Alaska Native beneficiaries. Based on frequency measures and site locations, we mapped geographic coverage of MDPP access. We also examined supplier type (eg, health care system, community-based organization) and their number of respective sites to better understand early patterns in MDPP supply. Finally, we calculated the percentage of organizations as of July 2019 that offer the in-person NDPP and are listed in the CDC’s recognition program,11 a prerequisite to MDPP designation.1

RESULTS

There are 126 unique supplier organizations that offer the MDPP across 601 sites. With an estimated 61 million Medicare beneficiaries in 2019,12 this equates to 1 site per 100,000 Medicare beneficiaries nationwide. The Figure10,13 shows geographic and population-based availability of the MDPP. Thirty-nine states (69.6% of the United States) have at least 1 MDPP site, and more than half (22) of these have fewer than 1 site per 100,000 Medicare beneficiaries. There are no sites in 11 states (Alabama, Connecticut, Louisiana, Nebraska, Nevada, New Jersey, New Mexico, Rhode Island, South Dakota, Vermont, Wyoming) and no sites in DC or US territories. Only 5 states (Colorado, Delaware, Idaho, Michigan, Washington) have more than 3 sites per 100,000 Medicare beneficiaries, together averaging 5.5 sites per 100,000 beneficiaries. Geographic coverage is limited such that many beneficiaries appear to lack MDPP access even if their states have sites available. Specifically, sites in 11 states (Alaska, Arizona, Arkansas, Georgia, North Dakota, Missouri, Mississippi, Tennessee, Texas, Virginia, Wisconsin) are all located within a single municipality. For example, Texas, the second largest state and with the third most Medicare beneficiaries,13 has only 4 sites clustered in a single municipal area. In total, 75% of the United States has no MDPP sites, fewer than 1 site per 100,000 beneficiaries, and/or availability limited to a single municipality. Regarding gaps in potential to reach racial/ethnic minority populations, 90% of the 10 states with the largest population of Hispanic, African American, or Native American beneficiaries13 have severe MDPP shortages.

The Table10 shows the number and frequency of MDPP suppliers and their respective sites by type of supplier. Notably, although only 10.3% of MDPP suppliers are community-based organizations, they represent more than half (55.7%) of sites where beneficiaries can access the program. Nationwide, the Young Men’s Christian Association (YMCA) is the largest supplier with 147 MDPP sites, including 53 of 58 Ohio sites and 34 of 40 Florida sites. The YMCA’s participation in the original CMS demonstration project14 may have facilitated its participation in the MDPP. Michigan has the most MDPP sites in the United States, nearly all of which (141 of 145) are operated by the National Kidney Foundation of Michigan. Otherwise, only 10% of organizations that offer an in-person NDPP and are currently listed in the CDC’s recognition program11 appear to have become MDPP suppliers.


 
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