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National Diabetes Prevention Program
Ann Albright, PhD, RD
Director, Division of Diabetes Translation
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation www.cdc.gov/diabetes
The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
26 million
with Diabetes
79 million with Prediabetes
Proportion of U.S. Adults Aged > 20 with Prediabetes Who Are Aware of Their Risk Status
MMWR, 2013
Current Projections of Cases of Diabetes in the United States by 2030
0
10
20
30
40
50
60
70
2007 2010 2015 2020 2025 2030
mill
ion
s
Very
High Risk
(A1c > 5.7%;
IGT; GDM)
Moderate Risk
Low Risk
High Risk (FPG > 100);
Central Obesity; HTN, age
Risk Stratification Pyramid for Diabetes Prevention
10-year risk (%)
>30 %
>20 %
>10%
>0%
Prevalence (%)
~10 %
~25 %
~65%
Evidence for National Diabetes Prevention Program
• The DPP research study showed that structured lifestyle change program achieved modest weight loss of 5-7 percent and 150 min PA/wk reduced type 2 diabetes by 58% (71% in those over age 60) in those at high risk for type 2 diabetes – True for all participating ethnic groups and for both men and
women – Blood pressure and lipids improved – 10-year f/u shows continued reduction in new cases of type
2 diabetes
• Translational studies demonstrate trained lay health workers are as effective in delivering the lifestyle change program as health professionals
• National DPP is 1/3 of the cost of DPP research study and demonstrates similar lifestyle change results
Cost Effectiveness
• Diabetes prevention lifestyle change programs have been shown to be cost effective and can be cost saving
• Influenced by target population, delivery format and personnel, time horizon
• Some modeled data from an insurer has shown a three year cumulative ROI of 3:1 when using a pay-for-performance approach
BASIC SCIENCE
EFFICACY
EFFECTIVENESS
EFFICIENCY
AVAILABILITY
DISTRIBUTION
Molecular/
physiological
Ideal
settings
Real world
settings
Biggest effect on
most people
Supply
Diffusion of
interventions
Adapted from information in Sinclair JC, et al. N Engl J Med. 1981;305:489–494. and Detsky AS, et al. Ann Intern Med. 1990;113:147-154.
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation www.cdc.gov/diabetes
Albright A, Gregg EW. Am J Prev Med. 2013;44(4S4):S346-S351.
Increase Workforce
• Trained lifestyle coaches attached to delivery organization
• Lay coaches and health professional coaches can both effectively deliver the program
• Use organizations that train to a CDC-approved curriculum
• > 1200 coaches trained
Quality Assurance
CDC Diabetes Prevention Recognition Program:
• Assure program quality and fidelity to scientific evidence
• Maintain a registry of recognized organizations
• Provide technical assistance to programs to assist staff in delivery and problem-solving to achieve and maintain recognition
• > 500 sites in recognition program
www.cdc.gov/diabetes/prevention/recognition
Deliver Program
• Link health care and community sectors
• Effective business model for program scalability and sustainability
• Programs in 48 states and DC to date – need many more
• Exploring methods to deliver program more widely
• Attendance matters
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation www.cdc.gov/diabetes
National Diabetes Prevention Program Sites
June 6, 2013
Support Program Uptake
• 89% with no diagnosis and no symptoms requires aggressive awareness and testing efforts
• Engage multiple channels: employers, insurers, providers and directly to consumers
Summary
– Evidence for prevention through lifestyle change is strong
– Lifestyle change program is cost effective
– A coordinated approach, as provided by the National DPP, is critical to achieve scale
– Quality assurance and evaluation are part of National DPP
– Need to act now and think BIG
Implementing the National Diabetes Prevention Program
Brenda Schmidt MS MBA President and CEO
Marissa Hudson Executive Vice President of Public/Private Partnerships
Core Program Elements
Challenge – 79 million Americans have prediabetes (35% of U.S. population)
Opportunity – Prediabetes can be reversible with lifestyle intervention
Delivery – Outcomes-based, pay-for-performance model
Goal – Weight loss; behavior modification; lasting lifestyle changes
Outcomes – Reduce diabetes conversion among prediabetes; substantial ROI
PROVEN, EVIDENCE-BASED OUTCOMES: Prediabetics who lose 5-7% of their weight may reduce conversion to diabetes by 58%; 70% for those age 60+.
Drivers – Obesity and inactivity
My Weigh 2 Prevent Diabetes
• High value – No cost to individual to
participate; big return on improved health
• Innovative – Leverages Health Coaching
model, group influence, social support (in-person & virtual)
• Accessible
– Offered at convenient locations (worksites, central community locations, urban and rural areas)
© Viridian Health Management, LLC. All Rights Reserved.
• Group class led by a trained lifestyle coach
• 16 weekly, in-person core sessions • Group based class session • Individual feedback regarding
nutritional logs • Weight / Minutes of brisk physical
activity recorded weekly • Make up sessions
• 6 monthly post-core sessions • Social support • Pay for performance model
Core Diabetes Prevention Program Elements
ASO: Administrative Services Organization DPRP: Centers for Disease Prevention and Control (CDC) Diabetes Program Recognition Partner
Viridian Diabetes Prevention Network
(Coordinated National Network)
Training
• Master Training
• Motivational Interviewing
• Lifestyle Coach Training
• Coach Support / Quality / Fidelity
Program Delivery
• National Delivery Network
• Flexible Intervention Sites
Network of DPRP Program Delivery Partners
ASO / TPA
• Consumer website and social network
• Participant Identification and Engagement
• Material Fulfillment
• Data Collection and Reporting
• Claims Processing
Viridian Coordinated National Network
Viridian Flexible Delivery Models
Full service provider of National DPP (Viridian) • Health Plans
• Employers - Coordination with existing health management programs
Partner model (Training / ASO / Maestro™) • Large employers with internal staff to deliver program
• Retail grocery / pharmacy
• Health plans
• Health delivery networks - internal and external
• Community based organizations
Training only • Active National DPP providers building program delivery capacity
Benefits for Delivery Partners
Employers Payers Healthcare Providers
Healthier employees / lower overall healthcare costs
Reduced benefits claims due to healthier members
Healthier patients
Reduction in worker compensation and disability costs
Ability to maintain quality coverage
Supports comprehensive patient care programs
Lower replacement costs for ill or injured workers who are absent as well as costs for recruiting and training new workers
Maintaining quality while reducing costs results in competitive advantage
Implements population health management approach and principles
Healthy employees are more productive; less absenteeism than unhealthy counterparts
Reduces likelihood of comorbidities associated with diabetes and prediabetes
Supports success in pay-for-performance/shared risk delivery and payment model environments
Viridian Payment Model
• Pay-for-Performance Model • Model allows employer/payer to assume less risk • Payment based on outcomes • Participant fee charged at milestones
Payment Milestone
Administrative Fee At program enrollment
Milestone Payment # 1 Completion of 4th class
Milestone Payment # 2
Completion of 9th class
Milestone Payment # 3
Minimum 5% weight loss
Viridian is one of four national training organizations for National DPP Lifestyle Coaches and Master Trainers Training is interactive in design and focuses on a problem based learning
Motivational Interviewing, Group Facilitation, National DPP Lifestyle Curriculum
Ongoing support through 1:1 mentor sessions, monthly webinars and fidelity monitoring
National DPP Lifestyle Coach Training
Population Health Management Platform
Employer added to Maestro™
Data Import
- Biometrics, Claims, Questionnaire, Labs,
Other sources
Participant ID & Outreach
- Data mining & ID - Multi-channel mktg - Participant opt-in
National Provider Network
- Community classes - Coach data
Aggregate Reporting & Reporting to
DPRP
Viridian proprietary model for DPP identification, outreach and administration
Summary Billing (@ Milestones)
- Classes 4 & 9 - 5-7% weight loss
National DPP Toolkit and Maestro™ Demonstration