The Importance of Adding the Diabetes Prevention Program to Medicare

Brenda Schmidt is CEO of Solera Health, an integrator that serves as the “back office” for both community-based and digital providers of the Diabetes Prevention Program (DPP), an evidence-based program that has been shown to reduce incidence of people with prediabetes progressing to type 2 diabetes. In April, Medicare will take the historic step of launching the DPP for beneficiaries, and Solera has been at the forefront of helping providers navigate the policy and technical hurdles to serve clients who will take part in the DPP.

Transcript

Can you describe the historic importance of adding the Diabetes Prevention Program to Medicare?

Prevention matters, and our older Americans matter. The inclusion of the Diabetes Prevention Program (DPP) as a Medicare benefit is both historic and significant for a few reasons. The first is, it’s the first preventive service coming out of CMS Innovation Center that meets the statutory requirements for expansion, and what that means is that it was demonstrated to both reduce net spending and also improve or maintain patient care.

The second is, it’s delivered by non-clinical community organizations, and that’s a first. So now you have hyperlocal, non-clinical community organizations, who were traditionally funded by grant funding, now being able to pay through medical claims. The third is just the realization that our older Americans matter, and that they can make healthy lifestyle changes that can improve their health and prevent diabetes. So, inclusion of DPP as a Medicare benefit is not only important for seniors, it’s really just important for the population of America.

What are the key features of the final rule that are important to consumers?

What consumers should know about the Medicare Diabetes Prevention benefit is it is a required Medicare benefit for all Medicare beneficiaries, original Medicare fee-for-service, or Medicare Advantage plans and Med sup plans members at no cost-sharing. So this is a free benefit for all Medicare beneficiaries as of April 1, 2018.

The second is it’s delivered in community organizations; where people live, play, pray, and shop. And the third is, the goal of the program is to make long-term healthy lifestyle changes to lose a minimum of 5% of their body weight by attending these classes for up to a 2-year time period.

Can you discuss how the final rule affects Medicare Advantage plans and what these plans need to do to be ready to meet their clients’ needs by April?

There was a lot of confusion among the Medicare Advantage plans for whether, when, and how the finale rule would impact Medicare Advantage plans, but CMS is clear that Medicare Advantage plans have to offer the Diabetes Prevention Program as a preventive service effective April 1, 2018. There’s a couple of ways they can do that. The first way is for the plan to actually deliver the Diabetes Prevention Program themselves as a community provider. The second is to contract with community providers who meet the minimum Centers for Disease Control standards for being a Medicare DPP supplier.

At this point if a Medicare Advantage plan has not already implemented the DPP program, it’s way too late to implement April 1, so Solera has integrated those community providers and has broad contracts now with Medicare Advantage plans to allow them to access a really broad, highly fragmented network of these community and person DPP programs.