If the Affordable Care Act is repealed, providers of the Diabetes Prevention Program will need to replace the path to Medicare reimbursement that were covered in the law.
The Council for Diabetes Prevention, created 4 months ago to promote the success of the National Diabetes Prevention Program (DPP), has elected its first board of directors. The council, a non-profit group consistently mostly of providers, was formed to promote access, program quality, and sustainability of the DPP, which will be covered by Medicare for the first time in January 2018.
“We need all stakeholders to come together to solve the diabetes epidemic in America,” Anne Woodbury, executive director of the Council for Diabetes Prevention, said in a statement. “I’m looking forward to working with the diverse members of our board, who each bring their unique expertise, leadership and vision to help realize the mission of making the National DPP accessible to all Americans who need it.”
The council’s agenda shifted with the election of Donald J. Trump, whose vow to repeal the Affordable Care Act (ACA) could upend Medicare’s plans to pay for DPP. Educating members of Congress about this “unintended consequence” is on the council’s immediate agenda, Woodbury said.
Directors, who will serve an initial term of 1 year, are:
When it formed in September 2016, council members voiced the need to work together to ensure the long-term viability of the DPP, which has more than 1400 providers with CDC recognition. At the time, Schmidt said it was clear that providers needed an entity to share information and best practices. In the group’s first statement, Schmidt described the Council as a “big-tent forum,” that would allow members to stay current on government policy.
At the time, CMS was taking comments on the rules that will govern Medicare’s launch of DPP. The agency has since set eligibility criteria but is still working on rules for reimbursement, including how to work with digital providers like Canary Health. In an interview Wednesday with The American Journal of Managed Care® (AJMC®), Woodbury explained that until recently, digital providers were barred from obtaining CDC recognition, which can take several years.
As it stands, Medicare wants to require CDC recognition for reimbursement, but that could exclude digital providers who have not had time to achieve recognition. Without them, she said, “You’re going to have a lot of frustrated seniors—and, more importantly, seniors who should get the benefit.”
Said Woodbury, “It is going to be pivotal to have digital providers in the mix to scale this program.” The importance of scalability was explained by an Omada Health executive last spring in Evidence-Based Diabetes Management.
A new challenge is ensuring that Medicare can still pay for DPP, even if the ACA is repealed. HHS Sylvia Mathews Burwell authorized reimbursement through a provision that allowed Medicare to fund programs after a successful pilot within the Center for Medicare and Medicaid Innovation. If that path to reimbursement goes away, Congress must allow a new one, Woodbury said.
The National DPP is based on research funded by the National Institutes of Health; the initial study showed that participants with prediabetes reduced their risk of developing type 2 disease by 58%. A 10-year follow-up study published in AJMC® found that long-term risk reduction among adherence participants was nearly 50%, and these people incurred fewer medical costs than those who took metformin to prevent diabetes.