Full recognition is key as the provider of the Diabetes Prevention Program awaits rules for Medicare reimbursement. CMS will offer the program to Medicare beneficiaries in 2018.
Noom Inc, a New York City-based digital behavioral health company, on Tuesday received full CDC recognition for its mobile and online applications of the Diabetes Prevention Program (DPP), becoming the first virtual provider to achieve this status.
Artem Petakov, Noom’s president and co-founder, said the company received an e-mail from CDC late Tuesday that it had received full recognition. This comes 4 years after Noom created the program and 2 years after the CDC began accepting applications for recognition from digital providers.
“We know that the program is above the requirements,” Petakov said. The CDC requires that 40% of participants lose 5% of their weight, and Noom demonstrated that 51% achieved 5% weight loss, he said. “It’s been a big team effort.”
DPP is a yearlong, evidence-based lifestyle management intervention for those meeting clinical criteria of prediabetes. The program has been shown to reduce the chances of progressing to type 2 diabetes (T2D) by 58%, and a pilot program offered through the YMCA under the Center for Medicare and Medicaid Innovation (CMMI) showed a savings of $2650 per Medicare beneficiary over 15 months. That prompted Medicare to fund the program starting in January 2018.
Until now, only programs that offered face-to-face instruction had achieved full recognition, a lengthy process that requires following an approved curriculum and submitting 2 years of data on patients’ participation and weight loss. Online programs offer the potential to scale the DPP to the estimated 86 million Americans with prediabetes. Right now, 175 programs listed on the CDC website have partial recognition, which means they are working toward full recognition.
More and more, these providers are publishing studies in academic journals to gain acceptance from payers as a way to prevent chronic disease or slow its march, in an effort to keep diabetes, obesity, and cardiovascular disease from consuming ever larger portions of the healthcare dollar. Already, Medicare accounts for $1 of every $3 spent in Medicare. (Noom published in the most recent issue of Evidence-Based Diabetes Management.)
Noom’s philosophy, “Changing your body by changing your brain,” offers customers a digital health coach and a customized program that aims to reveal—and change—the behaviors that lead to unhealthy eating. The program seeks to change eating habits for the long haul; and for its business clients, it offers outcomes-based pricing.
Having full recognition is key, because Medicare’s first round of rules require programs to have this status to receive reimbursement when it starts paying for DPP next year. The next round of rules, which is expected to cover specifics for digital providers, is set to come out in June. Digital providers are core members of the Council for Diabetes Prevention, which has organized to ensure DPP access and program quality.
While the implications for Medicare reimbursement are important, Petakov said gaining full recognition from the CDC is also key for demonstrating the program’s value to payers, large employers, and individual consumers who are driving the company’s growth. “It’s really a myth that consumers will not pay for their own care,” he said. “They will pay if the product is right, if it is presented not in medical terms but in layman’s terms.”
Consumers, for example, are asking when the Medicare program will be available, and some are asking their doctors about it and whether their health plans cover it, Petakov said.
While Noom boasts that it has served 45 million clients, Petakov said the focus today is on the 3 billion data points it has gathered, which are allowing the company to continually refine its behavioral-driven programs, tailoring directives and reading material to users based on feedback. Petakov said Noom is not only developing data that correlate certain materials with success in certain groups, but it’s reaching the point of developing causal data.
“That’s been keeping us busy,” he said. “There’s a lot of ways to mine the data and shape the program.”
Petakov said Noom appeals to consumers who have tried and failed to lose weight on other diets or through medication. “Customers are smart,” he said. “A lot of these people have tried the pills or the unsustainable solutions, the crash diets—they’ve tried everything in the book and it hasn’t worked. They’re coming to this with full awareness looking for something different.”