BALTIMORE — The current diabetes epidemic demands a united and concerted effort to prevent future diagnoses and complications, and both the National and Medicare Diabetes Prevention Programs offer opportunities to “turn the tide” and create an impact at the population level, according to two speakers here.
“This is the time — now more than ever — when it is really imperative that we do not grow faint of heart,” Ann Albright, PhD, RN, director of the division of diabetes translation for the CDC, said during a presentation at the American Association of Diabetes Educators annual meeting. “Our team, along with incredible stakeholders, have joined forces to unite, for the first time, an infrastructure for lifestyle intervention for our country. We really all do need to join forces, because it is going to take all of us. That is the beauty of the national DPP, because it really unites all of us and brings us together.”
The heart of the National Diabetes Prevention Program is a CDC-approved curriculum that relies on public-private partnerships with community organizations, private and public insurers, employers, health care organizations, faith-based organizations and government agencies, Albright said.
“You need to have a common set of metrics, you need to have a common agenda, and that is what the national DPP affords us,” Albright said.
The national DPP has four strategic goals, Albright said: increasing the supply of quality, CDC-recognized programs; increasing coverage among public and private payers; increasing referrals from health care providers; and increasing demand for the program among people at risk for the disease. CDC-recognized programs, Albright said, have several advantages: Public and private payers reimbursing for the NDPP program are requiring CDC recognition, Albright said, and CDC-recognized programs have access to technical assistance, training and resources. CDC recognition can also be an effective marketing tool to increase referrals to your practice, Albright said. As of July, more than 1,787 national DPP suppliers have become CDC recognized across the U.S., enrolling more than 221,000 people with prediabetes, Albright said.
“If you’re not with us, come and join us,” Albright said. “Our whole mode has to be problem solving. So, lets problem solve. Let’s join forces, because we cannot allow the trajectory we are on to continue.”
Approximately 25% of Americans aged 65 years and older are living with type 2 diabetes with health care costs of about $104 billion yearly, and those numbers are continuing to rise, Nina Brown-Ashford, MPH, CHES, deputy director for the Prevention and Population Health Group at the Center for Medicare and Medicaid Innovation at CMS in Baltimore, said during a presentation. The Medicare Diabetes Prevention Program, or MDPP, is designed to halt the transition from prediabetes to overt type 2 diabetes by promoting healthier behaviors, thereby decreasing Medicare costs for patients with diabetes.
MDPP is available only for Medicare part B and part C beneficiaries, and there is no copay for eligible patients, Brown-Ashford said. To be eligible, patients must have BMI at least 25 kg/m² (at least 23 kg/m² if self-identified as Asian), and have either HbA1c between 5.7% and 6.4%, fasting plasma glucose between 110 and 125 mg/dL or 2-hour oral glucose tolerance test (OGTT) measurement between 140 and 199 mg/dL, as well as no previous diabetes diagnosis (apart from gestational diabetes).
The Medicare benefit, Brown-Ashford said, covers up to 2 years of MDPP sessions for eligible beneficiaries, including 16 weekly sessions for the first 6 months regardless of weight loss, followed by monthly core maintenance sessions for the second 6 months, also regardless of weight loss. If the participant meets a weight-loss goal, he or she is eligible for the second year of the program, which includes 12 monthly maintenance sessions and are unique to MDPP and not required for CDC program recognition, Brown-Ashford said. Performance-based payments are made based on beneficiary attendance and weight loss, with a maximum payment of $670 per eligible patient who attends all sessions and meets weight-loss goals.
“CMS is really responsible for the MDPP suppliers and making sure they are compliant with the payment requirements,” Brown-Ashford said. “CDC is really the quality-assurance arm, making sure all individuals with diabetes are seen in a quality program. Suppliers have to maintain that CDC recognition.”
There are several ways diabetes educators can help promote the MDPP program, Brown-Ashford said — starting with screenings and referrals.
“If you are unable to become an MDPP supplier yourself, but you are working with beneficiaries who could benefit from this program, refer them,” Brown-Ashford said. “Screen and test your at-risk Medicare beneficiaries, and refer them to a nearby MDPP supplier.”
CDEs can also work to increase the awareness about the MDPP program and increase supplier capacity, Brown-Ashford said.
“Encourage CDC-recognized delivery organizations to enroll as an MDPP supplier,” Brown-Ashford said. “Say to them, ‘Hey, have you guys thought about enrolling and gaining reimbursement for MDPP?’”
“We understand the task of enrolling in Medicare can seem quite large ... we want to work to help provide support for organizations as they work on that enrollment process. If you work for an organization that is not CDC-recognized, encourage them to get that recognition,” Brown-Ashford said. – by Regina Schaffer
For more information on the MDPP, visit:
For more information on the CDC NDPP, visit:
Albright A, et al. Delaying type 2 diabetes: perspectives from NIH, CDC and CMS on progress and goals. Presented at: American Association of Diabetes Educators; Aug. 17-20, 2018; Baltimore.
Disclosures: Albright and Brown-Ashford report no relevant financial disclosures.