Dr Paul Chew Discusses the Importance of Chronic Disease Prevention

With 35% of Americans having prediabetes, prevention is clearly a priority, but many strategies have not bee translated into clinical practice because there is no system for reimbursement yet, explained Paul Chew, MD, chief medical officer of Omada Health

With more than 30 million American with diabetes, prevention clearly needs to be a priority, but there is a lack of provider awareness about available options. How can payers work with providers to build awareness about prevention?
What’s not known is that 12% of Americans have diabetes, and 35% have prediabetes. It’s even more amazing is that 90% of those who have prediabetes don’t know it. The problem we have is that there’s lot of clinical literature which shows that behavioral counseling and dietary management can reduce the incidence of diabetes incidence in those at risk by more than half. The problem we have is not the lack of literature, but the fact that it has not been translated into practice for the benefit of people and to prevent them from becoming patients.

The main reason is that there is a system that has not been reimburse or recognizing the value of prevention. The other issue is that this problem is so massive, with more than 84 million Americans having prediabetes, that it is literally impossible to address it in the old traditional way. So, we need proven digital approaches, one where return on investment and publications can validate these approaches to make this a reality. Finally, one of the bright spots is that CMS will be encouraging predicates testing and prediabetes referrals, so that sort of alignment of the medical need and the incentives and benefits can be brought closer into harmony.

Has the implementation of MACRA increased provider awareness or sped adoption of prevention strategies?
One of the most significant advances for the problem of prediabetes will be the MACRA (Medicare Access and CHIP Reauthorization Act) and MIPS (Merit-Based Incentive Payment System) incentive for referral to programs—validated Diabetes Prevention Programs—as well as testing for prediabetes through the MACRA and MIPS initiatives. People at risk for diabetes live all over the country; some are closer to Diabetes Prevention Programs than others. And so, to reach the more than 80 mi people at risk we need a comb of both face-to-face as well as digital programs. So, face-to-face and digital in the setting of MACRA and MIPS can greatly accelerate the treatment of people with prediabetes.
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