Coverage from Patient-Centered Diabetes Care, April 7-8, 2016. Presented by The American Journal of Managed Care and Joslin Diabetes Center.
When HHS Secretary Sylvia Mathews Burwell announced March 23, 2016, that Medicare would soon pay for the National Diabetes Prevention Program (NDPP),1 leaders from digital behavioral health company, Omada Health, were on hand to share the news.
It was a milestone long in the making—starting with the 2002 publication of the National Institutes of Health study on the effectiveness of the NDPP, which was shown to produce a 58% risk reduction for diabetes over 3 years.2 It continued with the passage of the Affordable Care Act, which made diabetes prevention a priority, with guidance from the US Preventive Services Task Force,3,4 and the creation of the Center for Medicare & Medicaid Innovation, which funded the pilot project that showed the NDPP could save Medicare $2650 per person over 15 months.1
However, reaching the 86 million Americans who have prediabetes, before some of them join the 29 million who have the disease,5 will require moving beyond the face-to-face model first conceived. As Mike Payne, MBA, MSci, chief commercial officer and head of medical affairs at Omada Health, told the attendees at Patient- Centered Diabetes Care, only 1% of those who could benefit from the NDPP have gone through the program, despite its proven effectiveness. A technology-driven solution that removes barriers like transportation costs and scheduling problems was needed, Payne explained.
Payer coverage in Medicare for NDPP could grow that 1% very quickly. “The fact that CMS has taken this step is really encouraging,” he said. Reaching the masses with technology, however, requires looking to the behavioral sciences for guidance, even inspiration. Behavioral health programs, Payne explained, teach and offer social support, but “Also, you let them make mistakes and support them with cognitive coping skills in the community.”
Omada Health’s product is not telemedicine in the classic sense, he said, explaining, “It is an immersive experience for the patient, bringing clinical psychology in a group-based setting to your pocket, your computer, to your home, wherever you are.” He played videos showing the audience a sample of what the participant sees and feels— despite being online, the atmosphere seems intensely personal. A huge priority is placed on design, to create a user experience that promotes not only adherence and engagement, but also allows the participant to enjoy the ride.
So far, the results show the approach is working. Omada Health started in 2011 with a commitment to clinical investment and peer-reviewed research on par with a pharmaceutical company, Payne said, because its leaders believed that would ultimately be required. That wasn’t easy, because traditional clinical guidelines are not created with digital delivery in mind.
created with digital delivery in mind. Not only is the company producing studies with the Veterans’ Administration showing the program’s value, and a paper on its long-term economic impact, but today, Payne said, “We have the biggest behavioral science data set in the world. And we’ve got quantitative data like weight, activity, and food.” Beyond that, he said, there is plenty of “unstructured data,” the texts of online conservations that can be mined for insights on why some individuals stay on track and others don’t.
Already, Payne said, Omada has been able to draw a sharp line between 2 types of mindsets: those who come to the program with a “growth mindset,” which embraces change, see a 10% weight loss over 4 months; by contrast, those with the “fixed mindset” have limited success.
The next question, Payne said, is how to treat the “fixed mindset” group differently to produce better results? “That’s what we’re tackling how,” he said. And when asked, Payne said, Omada Health is working on programs to treat those who already have type 2 diabetes.
Omada’s approach addresses an issue that is coming up more and more in diabetes care— what happens to the patient between visits to the doctor or the diabetes educator matters just as much, if not more, than the face-to-face visit with the clinician. There’s nothing wrong with inperson support, Payne said, but this approach by itself isn’t practical to reach the multitudes at risk for diabetes. Digital behavioral health, by contrast, “is going to allow you to multiply your impact by millions.” 1. Independent experts confirm diabetes prevention model supported by Affordable Care Act saves money [press release]. Washington, DC: HHS newsroom; March 23, 2016. http://www.hhs.gov/about/news/2016/03/23/independent- experts-confirm-diabetes-prevention-model-supported-affordable-care-actsaves- money.html. Accessed May 4, 2016.
2. Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
3. US Preventive Services Task Force Bulletin. US Preventive Services Task Force recommends behavioral counseling to prevent cardiovascular disease in at-risk adults. http://www.uspreventiveservicestaskforce.org/Page/Document/ UpdateSummaryFinal/healthy-diet-and-physical-activity-counseling-adults-withhigh- risk-of-cvd. Published August 26, 2014. Accessed May 27, 2016.
4. US Preventive Services Task Force website. Final recommendation statement: abnormal blood glucose and type 2 diabetes mellitus: screening. USPSTF website. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/ screening-for-abnormal-blood-glucose-and-type- 2-diabetes. Published October 27, 2015. Accessed May 27, 2016.
5. National Diabetes Statistics Report, 2014: estimates of diabetes and its burden in the United States. CDC website. http://www.cdc.gov/diabetes/pubs/ statsreport14/national-diabetes-report-web.pdf. Published 2014. Accessed May 4, 2016.