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