ICER Weighs in on Diabetes Prevention Programs

The report found that in-person coaching and digital formats with human coaching were both effective and delivered value. ICER's review comes as Medicare is creating reimbursement standards to take effect in January 2018.

With Medicare poised to pay for the National Diabetes Prevention Program (NDPP), the question for all payers will be: which ones get the job done?

The Institute for Clinical and Economic Review (ICER), well-known for its value judgments on high-priced therapies, on Monday made recommendations on the different formats now in use for diabetes prevention. Based on the evidence, ICER’s California Technology Assessment Forum (CTAF) found at least some human coaching is needed.

ICER’s evaluation comes as CMS is taking comments on its proposal to start reimbursement for the NDDP beginning January 1, 2018. The proposal, which is part of the 2017 Physician Fee Schedule, would allow a full year for providers to be approved by Medicare.

While some commercial payers and employers already pay for the NDPP, the change is expected to increase access to younger people, especially once Medicare Advantage contractors become familiar with the reimbursement process.

Different methods of diabetes prevention have emerged since the National Institutes of Health published its landmark study on the NDPP in 2002, which found that the program could reduce the risk of progressing to diabetes by 58%. The original DPP was based on in-person coaching; this format was used in a federally financed pilot with the YMCA, which led to CMS' reimbursement decision.

However, a challenge of in-person programs is the ability to scale them to a large health plan or make them available to those who live in remote areas or lack transportation. Thus, CDC has evaluated a variety of formats through its recognition program, and it has endorsed both in-person group and digitally based formats.

"Type 2 diabetes is a major health concern for patients and our healthcare system," said ICER President Steven D. Pearson, MD, MSc. "There are different approaches to designing and implementing programs to prevent diabetes, and we believe the evidence review and policy recommendations in our Final Evidence Report will help guide health systems and other stakeholders in figuring out how to move forward based on the strongest evidence of effectiveness and overall value."

The CTAF panel voted on each of the key formats now offered and found:

· In-person, group coaching was unanimously approved as offering superior benefits. It found using weight loss (typically 5% to 7%) is an appropriate way to gauge if a program works.

· Digital formats with human coaching gained support from a majority of CTAF members, with most finding the programs offered intermediate value. The report noted the need to balance effectiveness with cost, and that digitally based programs were scalable to large populations.

· Digital-only formats did not get CTAF support, due to the lack of evidence that the programs are clinically effective. Potential exists for this format, however.

ICER’s recommendations are based on a full review of evidence and a meeting that took place June 24, 2016. The report encourages payers to cover different formats, use pay-for-performance contracts, and expect CDC recognition. Programs should be culturally appropriate.

The report was well-received by 2 well-known programs that combine digital formats with human coaching: Omada Health’s format, and Canary Health’s Virtual Lifestyle Management format were both endorsed.

Omada Health CEO Sean Duffy announced the results in a blog post, which read in part, “ICER’s report adds to the conclusions of 11 other supportive organizations, including the American Diabetes Association, the American Hospital Association, and the US Preventive Services Task Force: both in-person and digital DPP programs with human coaching deliver value to the healthcare system.”

The next day, Omada announced a new partnership with the American Medical Association and Intermountain Health to reduce incidence of type 2 diabetes. Omada’s statement said the venture would create a “roadmap for large health organizations” to adopt online tools to change behavior for at-risk patients. The AMA has previously partnered with CDC on a prediabetes awareness initiative, and Intermountain Health presented research at the most recent meeting of the American College of Cardiology on the relationships between waist circumference and heart disease.

Canary Health, which recently entered into a partnership with the medical device maker Medtronic, issued a statement: “We are pleased that ICER has concluded, based in part on the published evidence for our digital Diabetes Prevention Program, Virtual Lifestyle Management, which includes both digital delivery and human coaching, that digital DPP programs provide superior health benefits over the usual care and should be offered more broadly,” said Canary Health President and CEO Adam Kaufman.