Retaining seniors in the Diabetes Prevention Program will be important for community groups offering it through Medicare, because the proposal calls for payment to be based on performance.
Evidence shows that the National Diabetes Prevention Program (DPP) can keep 58% of people with prediabetes from progressing to type 2 diabetes (T2D).1 But the program won’t work if people don’t stay enrolled, and that’s the rub: DPP is a yearlong commitment that starts with 16 weekly sessions, and if people miss 2 classes they are unlikely to come back.
Solera Health, an integrator that offers management support for community DPP providers, has worked with the technology company HealthSlate to create a mobile app to fill this gap. Called SoleraONE, the app allows DPP participants to make up missed sessions and complete their nutrition logs—tasks that now consume up to 6 hours a week for health coaches when participants miss class. SoleraONE will be an exclusive offering for Solera Health’s clients, according to Brenda Schmidt, founder and CEO, who discussed the app with The American Journal of Managed Care®.
The app could be crucial to the success of community providers offering the DPP through Medicare, which is planning to pay for diabetes prevention starting in January 1, 2018. While CMS has finalized some aspects of the program, details on reimbursement and how Medicare will integrate digital providers won’t be finalized until 2017.2 In the interview, Schmidt said CMS will have to answer questions such as how often participants can use the app to replace an in-person class, but she’s optimistic these details can be resolved.
Schmidt sees the future of diabetes prevention as a “hybrid” experience, in which participants who choose a community-based, in-person program may welcome access to the app, but that doesn’t mean they’ll want to use it all the time. “I truly believe in consumer access and consumer choice, in which the digital provider serves a role in the Medicare ecosystem," she said.
Dan Sheeran, CEO of HealthSlate, said the app creates efficiencies for community providers and improves the DPP experience for those in the program. In working with hospitals and other groups that offer diabetes prevention, Sheeran said, the paperwork and “back office” aspects present challenges, especially if health coaches have to track down people who miss a session.
“With digital tools, all of that can be done in a much more efficient and enjoyable way,” he said. The app also offers an additional benefit—it allows DPP participants to contact coaches and each other in between sessions for support. Seniors benefit from the social experience online, Sheeran added.
Keeping enrollees connected and engaged is important to the providers, because CMS’ original proposal called for reimbursement to be tied to performance. Community providers who already operate on slim margins would face financial challenges If they lose money because too many people failed to complete the program. Schmidt said the app addresses a need among Medicare beneficiaries, who may have a hard time showing up 16 weeks in a row.
“They might have transportation issues," she said. "They might be caring for a sick partner. If they can make up their DPP class, they’re much less likely to drop out.”
And, Schmidt points out, it’s important to finish, because in Medicare, benefits are “one and done.” At least for now, beneficiaries cannot start the class over.
Sheeran sees the app having applications elsewhere in diabetes care, the most obvious being in diabetes self-management education. Enrollment for those diagnosed with type 2 diabetes is dismal: first-year rates are only 6.8% for those in commercial plans and 4% in Medicare.3,4
Schmidt said the market is migrating, and that diabetes education needs to move to the hybrid model that serves people in different places, depending on their need. “We have to meet people where they are.
1. 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.
2. Fact Sheet. Medicare Diabetes Prevention Program (MDPP) Expanded Model. CMS website. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-11-02-2.html. Published November 2, 2016. Accessed November 3, 2016.
3. Li R, Shrestha SS, Lipman R, Burrows NR, Kolb LE, Rutledge S; Centers for Disease Control and Prevention (CDC). Diabetes self-management education and training among privately insured persons with newly diag­nosed diabetes—United States, 2011-2012. MMWR Morb Mortal Wkly Rep. 2014;63(46):1045-1049.
4. Duncan I, Birkmeyer C, Coughlin S, Li QE, Sherr D, Boren S. Assessing the value of diabetes education. Diabetes Educ. 2009;35(5):752-760. doi: 10.1177/0145721709343609.