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Diabetes Prevention Programs get the nod from Medicare, now it’s our turn to act

February 19th, 2018

According to the CDC website, many health plans and employer groups offer diabetes prevention programs (DPP) because scientific research shows that they work. The federal government must read its own webpages (eventually) because effective April 1, 2018, Medicare and Medicare Advantage programs will begin reimbursing for DPP services as well. It’s long overdue, but now that it’s on the horizon, we need to take action as a healthcare community and encourage the full use of these programs to raise awareness of the high incidence of Type 2 diabetes and halt its devastating impact on overall health and quality of life. Some quick facts:

Eighty-six million adults in the United States have prediabetes, with nine out of ten people not knowing they have it. The risk for prediabetes and diabetes is higher if the person is:

  • Overweight or obese
  • Has a family history of the disease
  • Aged 45 or older
  • Not physically active
  • Had diabetes while pregnant
  • Is African American, American Indian, Hispanic, Asian American or Pacific Islander

Full disclosure – my organization was the first independent physician organization in Michigan to be fully accredited by the CDC for our DPP. The Medicare reimbursement won’t incentivize us though; we were incentivized years ago when we saw a patient population suffering the avoidable co-morbidities of Type 2 diabetes, from diabetic retinopathy and renal failure to loss of toes and limbs. That being said, I think the reimbursement will influence physician practices (and employer and community groups) to take a more aggressive approach to discussing Type 2 diabetes and the services available to patients (often at no charge) to learn about prevention. That’s where formal DPP programs come into play.

With prescription pad in hand, physicians can encourage incremental changes in diet and activity level and direct patients at risk of developing Type 2 diabetes to lifestyle coaches, exercise specialists and registered dietitians accessible through accredited DPPs. Even better? In a PCMH environment, physicians can offer DPP services in their office through a traveling DPP; that’s because the nature of the training makes these programs portable and community-driven.

Primary care physicians or members of their care team should now feel emboldened to urge (or should I say “prescribe”?) patients to participate in this potentially lifesaving program, just as they would do for cardiac rehab after heart surgery or physical therapy after a hip replacement. The conversation shouldn’t be limited to the Medicare population, of course. The Medicare covered benefit is just another reason to bring up the topic of diabetes prevention to the entire practice population. Physician organizations (POs) can help by providing signage, offering or facilitating DPP programs at convenient times and locations – including at the physician’s office or in community centers or places of worship – and ensuring that DPP activities are being billed correctly.

We can’t lose hope on quelling the Type 2 diabetes epidemic. Just as the vaccination rate has increased impressively in Michigan following legislation, public awareness campaigns and vaccination advocacy group action, so to can we put forth a collective effort to halt this disease. As we might say to patients on the subject, let’s get moving!

Ewa Matuszewski is the CEO and co-founder of MedNetOne Health Solutions.

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