Mike Payne Emphasizes Importance of the National Diabetes Prevention Program

CMS' decision to pay for the Diabetes Prevention Program marks a shift in payment models from one that originally only paid for the screening and treatment of diabetes to one that now weighs prevention just as seriously in diabetes care, Mike Payne, MBA, MSci, chief healthcare development officer at Omada Health.

CMS' decision to pay for the Diabetes Prevention Program marks a shift in payment models from one that originally only paid for the screening and treatment of diabetes to one that now weighs prevention just as seriously in diabetes care, Mike Payne, MBA, MSci, chief healthcare development officer at Omada Health.

Transcript (slightly modified)

The National Diabetes Prevention Program is being paid for by Medicare. What impact does this have on a senior’s health?

Oh, I think it’s huge. There are 28 million beneficiaries in Medicare right now who are pre-diabetic, so that’s a huge population that needs this help. And frankly, the National Diabetes Prevention Program is standard of care for people with pre-diabetes and it’s been a bit disappointing, frankly, that for a long time, Medicare would pay to screen for diabetes and to treat full blown diabetes. But if you’re a senior, right now actually still, and you are screened and found to be pre-diabetic, your physician has no financial incentive to treat you. They have an incentive to tell you to come back when you have developed diabetes and that’s a cruel irony when we have an intervention that we know works. And by the way, it’s non-toxic because it’s not a drug.

And so, I think that this is, it’s really a landmark for a bunch of seniors but it is also a big win for preventative medicine. And I think it will, I hope that it will engender a kind of a national discussion around the value of prevention versus treatment, especially given the fact that there’s data that this is a cost-effective and effective intervention. It’s not just public health for public health’s sake.

What message is CMS sending by deciding to pay for the National Diabetes Prevention Program?

It’s sending a huge message. It’s the first time that Health and Human Services, CMS, has basically covered a large scale prevention service beyond screening. And the traditional idea that screening in and of itself is prevention has largely been proven not to be true. You need to know that you have risk for disease and then you need to do something about it. And this is the first time that CMS at scale has reimbursed for the ‘doing something about it’ part.

So, I think it’s a landmark for that. I do think it’s a big win for innovation in healthcare. This is driven out of the Center for Medicare and Medicaid Innovation that was established by the Affordable Care Act and they have a model where they test out a bunch of different things across payment and actual interventions and then the ones that work, they’re supposed to scale nationally. And this is one of the first ones that they’ve scaled nationally. And so, I think for those who feel like we need incubators and innovation models in healthcare, this is a big win.