Medicare Invests in Diabetes Prevention, and Health Researchers Seize the Moment
By Jill Pope, Senior Technical Writer & Editor
A new four-year study will evaluate diabetes prevention programs at Kaiser Permanente Northwest.
With recent attempts by Congress to repeal the Affordable Care Act, there’s been a lot of uncertainty about the future of health care. One thing’s for sure, though: for Medicare beneficiaries, it’s going to get easier to lose weight in 2018. That’s when Medicare will begin covering programs that deliver diet and exercise counseling to beneficiaries with prediabetes.
According to the American Diabetes Association, by preventing these beneficiaries from progressing to diabetes, the Medicare program expects to save $1.3 billion in health care costs by 2024.
There is strong evidence that diabetes prevention programs work and are cost-effective. Still, many questions remain about how to deploy these programs on a large scale. What’s the best way to reach eligible people and encourage them to join a program? Will in-person, online, or phone counseling programs work best for Medicare beneficiaries? Which programs will keep participants engaged? Which will be cost-effective?
CHR Investigators Stephanie Fitzpatrick, PhD, and Stephen Fortmann, MD, will co-lead the study.
Looking to the Kaiser Permanente Delivery System for Answers
To answer these questions, the Center for Health Research will conduct a four-year, $1.9 million study, Evaluating the Implementation of the Diabetes Prevention Program in an Integrated Health System. The study will enroll up to 5,000 members of the Kaiser Permanente Northwest health plan. Funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the study will be co-led by CHR Investigator Stephanie Fitzpatrick, PhD, and Senior Investigator Stephen Fortmann, MD.
The new study will follow eligible Medicare beneficiaries who are offered the opportunity to participate in in-person or online Diabetes Prevention Programs.* The study will follow patients for one year, and will assess their weight and hemoglobin A1C data extracted from the electronic health record as well as diet, physical activity, mental health, and quality of life. A cost analysis will determine the program’s return on investment for the health plan.
“This study is a ‘natural experiment’ since KP Northwest has decided to implement diabetes prevention through its Health Engagement and Wellness Services (HEWS), and because of this new grant, we will be able to evaluate the impact for that work,” Dr. Fortmann noted.
The research team includes HEWS Director Dr. Sarah Grall and Kristy Funk, a HEWS program manager who was formerly a research associate at the Center for Health Research.
Making the Most of a Decisive Moment for Medicare
Of all the questions the study will answer, Dr. Fitzpatrick is most interested in understanding who enrolls and stays in the program. “Who do we reach, enroll, and retain in the program, and why? And who do we not reach, enroll, or retain? We will be doing a hundred interviews with people who enroll and do not enroll in a Diabetes Prevention Program to help us understand these reasons.
“I think the health plan will be interested to know whether these programs improve patient health outcomes,” Dr. Fitzpatrick adds. “And, of course, they’ll want to know whether the program will reduce health care service utilization and costs.”
Dr. Fitzpatrick also believes that Medicare’s move to reimburse diabetes prevention—and not just treatment—is a turning point. “It’s a big deal for them to invest in an evidence-based behavioral intervention that has shown to be clinically effective and cost effective,” she says, “and it’s a big deal for behavioral science.” Dr. Fitzpatrick expects that findings from the new study will help the Medicare program and health care providers at KPNW and elsewhere understand how to offer, finance, and sustain these programs.
* Medicare will reimburse organizations that implement the Medicare Diabetes Prevention Program, a 12-month program that uses the Centers for Disease Control and Prevention (CDC)-approved National Diabetes Prevention Program curriculum, in both clinical and non-clinical settings. Centers offering the programs must be CDC-certified. About 25 certified in-person DPP programs are available in Oregon and Southwest Washington. Several are based in YMCAs, but others are sponsored by community health centers and community-based organizations.