1. Intermountain Diabetes Prevention Program: Stepping Back to Move Forward Kim Brunisholz, MST, PhDc Senior Outcomes Analyst; Institute for Healthcare Delivery; Intermountain Healthcare PhD candidate; Division of Public Health; University of Utah

2. 27 million Americans with DM II 79 million Americans with preDM 25% 20 million will develop DM in 3-5 years 3. The Diabetes Disaster 25.8 million Americans have diabetes1 (90-95% DM II) 1.9 million new cases diagnosed in 2010 79 million Americans have prediabetes1 2 out of 3 people with diabetes die from heart disease or stroke2 US spends $174 billion/year on diabetes1 1 CDC (2011). National Diabetes Fact Sheet. Diabetes Myths 3 CMS (2011) Medicare Healthcare Support Ov 1 out of 3 Medicare dollars is spent on diabetes3 194 382 592 2003 2013 2035 DiabetesPatients(Millions) 4. Across the Diabetes Continuum 5. Healthy Lifestyle & Diabetes Prevention Diabetes Prevention Program NEJM 2002 -58% reduction in the incidence of DM in lifestyle group compared to usual care -71% reduction in incidence in participants > 60 yo 6. 10 year Follow-up of the DPP Incidence of diabetes in those randomized to lifestyle intervention reduced by 34% compared to placebo/usual care Incidence of diabetes in those randomized to metformin reduced by 18% compared to usual care Diabetes Care 35:723730, 2012 7. Why DPP Now? Compelling evidence that DPP works Stunning cost figures related to the care of patients with diabetes Increasing risk with the Select Health Medicare Advantage Plans, and managed care Medicaid Completion of the Intermountain Lifestyle and Weight Management CPM Roll-out of the LiVe Well Program 8. ????????? 9. First Steps. - Diabetes Development team charter now includes the prevention and management of diabetic patients - Formed a prediabetes workgroup - Detailed a flow process for clinicians - Leveraged existing Intermountain programs: - Clinical Diabetes Education classes (CDE) - Weigh to Health (W2H) - Medical Nutrition Therapy (MNT) - Tools from Healthy Lifestyle CPM - Created a standardized curriculum - Dieticians across the system created the product - Mapped curriculum of the National Diabetes Prevention Program to W2H. 10. Intermountain DPP Identifies patients who are ready to make a lifestyle change Leverages current lifestyle programs Each step includes oversight from front lines Minimal footprint on traditional clinical staff 11. DPP Workflow: Role of the Primary Care Provider 12. DPP Workflow: Role of Team- based Care 13. Evaluation Framework RE-AIM ELEMENT DEFINITION Reach The proportion of the target population that participated in the intervention. Effectiveness [or Efficacy] The impact of an intervention on important outcomes, including potential negative effects, quality of life, and economic outcomes. Adoption The proportion of settings, practices, and plans that will adopt this intervention Implementation The extent to which the intervention is implemented as intended in the real world. Maintenance The extent to which a program is sustained over time in settings AND in individuals INDIVIDUAL ORGANIZATIONAL INDIVIDUAL & ORGANIZATIONAL 14. Reach: Defining our population 4201 patients identified with prediabetes with Medical Group 327 patients have been invited to participate 287 distinct patients have participated in DPP 199 in Prediabetes 101 class 95 in MNT 49 in W2H 100% of patients can begin participation in DPP ~ Medical Group views first 101 15. Adoption: Program Locations Referring locations: 95 referring Providers 35 referring Clinics Regions Participating: Cache Valley Weber/North Davis North Salt Lake Salt Lake/South Davis Central Salt Lake South Salt Lake Park City/ Heber Valley Utah Valley Southwest Region 16. Implementation: A Secret Shoppers experience Dieticians all had different Teach Back styles Lecture vs. conversation Not all tools were being utilized No projector Not enough time to fill out surveys No referrals to Intensive Lifestyle Program One size DOES NOT fit all Individual vs group sessions Different paths to end result 17. Enrollment in the DPP: The first 9 months Pilot Phase Deploym ent Phase 18. Primary Goal of DPP: Achieve a 5% Weight Loss Out of 287 enrollees, 100 patients have been enrolled for 6 months 41 patients had weight tracked at baseline and 5-9 months later 19/41 patients had decrease in weight 20% (8/41) patients achieved 5% weight loss * According to internal Intermountain Registry 19. .we can do a back of the napkin calculation! So how do we predict what our potential savings could be? 20. Potential Cost Savings: Over 10 years 4201 patients identified with preDM within Intermountain Without intervention, 66% will convert to DM in 10 yrs1 With DPP intervention, 34% reduction in DM incidence at 10 yrs2 Prevention of ~900 patients from converting to Diabetes at 10 years = 2773 patients = 1830 patients 1CDC (2011) Diabetes Fact Sheet 2 Diabetes Care 35:723730, 2012 21. Potential Cost Savings for Intermountain Average cost difference is 2.7 times higher for DM patient compared to those without DM or = $7300 per patient per year* DPP has the potential to save $7300/patient/year (shared by the patient and the healthcare system) Able to prevent ~900 patients from converting to Diabetes at 10 years *www.unitedhealthgroup.com/hrm/UN 5.pdf