Medicare Diabetes Prevention Program Research Articles

Case Report: Medicare Diabetes Prevention Program in an Academic Medical Center

Case Report: Medicare Diabetes Prevention Program in an Academic Medical Center

Digital Divide Among Medicare Beneficiaries and the Diabetes Prevention Program

IntroductionSuccessful delivery of the virtual Medicare Diabetes Prevention Program (MDPP) is influenced by a beneficiary's access to a computer and use of the Internet. MethodsUsing the 2020 nationally representative Medicare Current Beneficiary Survey, a three-level categorical dependent variable was created: (1) has a computer AND uses Internet, (2) has a computer OR uses Internet, and (3) has no access to either (reference group). A survey-weighted multinomial logit model was performed to examine associations between socio-demographics, comorbidities, and computer access and Internet use in 2023. ResultsOf study beneficiaries aged ≥65 years with BMI ≥25 kg/m2 and no history of diabetes (n=3,875), 70.8% had a computer AND used Internet; 14.3% had a computer OR used Internet; and 14.9% had no computer AND did not use Internet. Hispanics and non-Hispanic Blacks were less likely (OR=0.28, 95%CI [0.17-0.43]) than non-Hispanic Whites to have a computer AND use Internet. Beneficiaries with less education (<high school) were less likely to have a computer AND use Internet (OR=0.04, [0.03-0.06]) or have a computer OR use Internet (OR=0.21, [0.14-0.33]) than those with more than a high school education. Beneficiaries with lower incomes (<$25,000) were less likely to have a computer AND use Internet (OR=0.27, [0.20-0.35]) or have a computer OR use Internet (OR=0.58, [0.41-0.80]) than those with higher incomes (≥$25,000). ConclusionsApproximately 30% of potentially MDPP-eligible beneficiaries (representing ∼6 million beneficiaries) lacked full digital access. Efforts to encourage enrollment in the virtual MDPP must address digital disparities for beneficiaries at-risk for type 2 diabetes.

Enhancing access and impact of the Medicare Diabetes Prevention Program using telehealth: a narrative review.

Over 26 million older adults in the United States (US) have prediabetes, which is often a precursor to type 2 diabetes. The Medicare Diabetes Prevention Program (MDPP) is an evidence-based, lifestyle program for older-adult Medicare beneficiaries to prevent progression to diabetes. However, the MDPP has been drastically underutilized. Telehealth delivery may be a promising strategy to increase the reach and impact of the MDPP, including for underserved populations. The objective of this narrative review is to explore the role of telehealth on the accessibility and effectiveness of diabetes prevention programs (DPPs) for older adults. We searched the online databases of MEDLINE, APA PsycInfo, CINAHL, and Academic Search Elite for studies that used telehealth to deliver DPPs to older adults through distance learning, i.e., live program delivery where participants join via phone- or video-conferencing. Relevant information from policy documents and related publications was also included. Three themes emerged from the literature on telehealth delivery of DPPs for older adults (I) clinical effectiveness for weight loss, (II) feasibility and acceptability of this format; and (III) policy considerations to support greater public health impact. There is a growing body of recent evidence to suggest that older adults achieve a clinically meaningful amount of weight loss from participation in telehealth DPPs. The literature suggests that telehealth program delivery is feasible, and older adults find it acceptable, with some specific accommodations. Effectiveness and acceptability of telehealth interventions were also noted for older adults from rural, ethnically-diverse, and low-income groups. Policy considerations include adjustments in rulemaking by the Centers for Medicare and Medicaid Services (CMS) to allow MDPP delivery via telehealth using distance learning, along with sufficient reimbursement rates. The evidence indicates that delivery of the MDPP via telehealth is beneficial for increasing program reach and impact, including among underserved groups, as well as providing social support for older participants. Scalable delivery of the MDPP via telehealth is essential to make a national, population-level impact for older adults with prediabetes who receive Medicare benefits.

68-OR: Digital Divide and Medicare Diabetes Prevention Program of Beneficiaries with Elevated BMI

The Medicare Diabetes Prevention Program (MDPP) encourages beneficiaries with prediabetes to build healthy lifestyle behaviors that reduce the risk of diabetes. Limited supply of in-person MDPP and telehealth growth, support virtual delivery of MDPP. Success of virtual MDPP is impacted by access to digital devices and the Internet. A survey-weighted multinomial logit model was performed to examine associations between socio-demographics, comorbidities, and computer access and internet usage among beneficiaries. Using the 2020 nationally representative Medicare Current Beneficiary Survey PUF, a three-level categorical dependent variable was created: (1) has a computer AND uses internet, (2) has a computer OR uses internet, and (3) has no access to either (reference group). Of beneficiaries reporting BMI ≥ 25 kg/m2 and no diabetes history (n=3,912), 70.6% had a computer AND used internet; 14.2% had a computer OR used internet; and 15.2% lacked a computer and did not use internet. Hispanics, Non-Hispanic Blacks (NHB), and Others were less likely to have a computer AND use internet than non-Hispanic Whites (NHB, OR=0.27; p&amp;lt;0.001). Beneficiaries with lower educational attainment (&amp;lt;high school (HS) and HS) were less likely to have a computer AND use internet (&amp;lt;HS, OR=0.04; p&amp;lt;0.001) or have a computer OR use internet (&amp;lt;HS, OR=0.21; p&amp;lt;0.001) than those with college education. Beneficiaries with lower incomes (&amp;lt;$25,000) were less likely to have a computer AND use internet (OR=0.24; p&amp;lt;0.001) or have a computer OR use internet (OR=0.58; p&amp;lt;0.001) than those with higher incomes. This study found that ~30% of beneficiaries likely eligible for MDPP (potentially representing 6 million beneficiaries) lack digital tools for virtual MDPP. Digital divides by race/ethnicity, income, and education were observed. Efforts to improve access and enrollment in MDPP using virtual delivery must consider digital access to avoid technological disparities among populations with heightened type 2 diabetes risk. Disclosure B.Ng: None. J.B.Lamanna: None. M.Massey: None. G.T.Hawkins: None. C.Park: None.

14-OR: Lifetime Medical Spending for Diabetes among Medicare Beneficiaries in the United States

Information on lifetime medical cost of type 2 diabetes mellitus (DM) among Medicare beneficiaries is needed to assess potential economic benefits of the Medicare Diabetes Prevention Program (MDPP). We estimated lifetime incremental spending for DM by age of diagnosis and sex among Medicare beneficiaries using the 2001-2019 100% Medicare fee-for-service (FFS) claims database. We identified a cohort of persons with newly diagnosed DM in 2001 using International Classification of Diseases codes (E10 and E11), used a propensity score method to construct a non-DM comparison cohort, and then followed the two cohorts until death, discontinuation of plan coverage, or end of 2019. Lifetime medical expenditures for each cohort were estimated by aggregating the expected annual medical expenditures from age at DM diagnosis to death. Annual medical costs by age at diagnosis and sex before 2019 were derived from actual spending and those after 2019 were extrapolated using age and sex-specific expenditures from 2019. The survival rate was modeled by smoothing the annual survival rate using polynomial regression. Life-years lived with and lost to DM and lifetime excess medical expenditures of DM modeled from FFS claims cost overall and by sex are presented in the table. Despite a shorter lifespan, persons with DM had higher medical costs in their lifetime. MDPP may reduce this expenditure by helping beneficiaries prevent or delay DM. Disclosure Y.Wang: None. Y.Shao: Employee; Biogen. G.Imperatore: None. E.Luman: None. C.S.Holliday: None. P.Zhang: None.

745-P: The Impact of COVID-19 and the Public Health Emergency on the Medicare Diabetes Prevention Program

Background: The MDPP has been significantly affected by the COVID-19 public health emergency (PHE). Prior to the PHE, the MDPP was designed as an in-person program delivered to participants in community settings. The Centers for Medicare &amp; Medicaid Services (CMS) moved quickly in March 2020 to waive the in-person requirement for MDPP sessions and allow classes to continue on a virtual basis. CMS also permitted beneficiaries to temporarily pause participation. Purpose: To examine the impact of the COVID-19 PHE on MDPP suppliers and on beneficiary participation, attendance, and weight loss. Methods: We analyzed data collected as part of the MDPP evaluation and Medicare claims from April 2018 to December 2021. Results: In the 6 months following the start of the PHE, new enrollment fell to 11 beneficiaries per month, a decrease of 236% from the same period in 2019. In addition, 32% of suppliers had more than half of the MDPP beneficiaries drop out, and 22% of suppliers had more than half of their MDPP beneficiaries pause for at least 30 days. In comparison, in 2019, only 2% of suppliers had more than half of their MDPP beneficiaries drop out, and 8% of suppliers had more than half of their beneficiaries pause. For participants who continued or returned after a pause, the share of virtual sessions increased from &amp;lt;1% prior to March 2020 to 92% in April 2020. Thereafter, the percentage of virtual sessions declined, but the overall percentage still exceeded 50% through December 2021. Among beneficiaries who started in January or February and continued in the program without dropping out or pausing, weight loss is very similar between those that participated in 2019 (6.4%; n=245) compared to those in 2020 (6.5%; n=188). Conclusions: Although the PHE altered the way MDPP sessions were delivered and substantially reduced new enrollment in the program, changes in session delivery mode (e.g., in-person to virtual) did not appear to impact overall weight loss among continuing beneficiaries. Disclosure S.Jacobs: None. T.J.Hoerger: Research Support; Gilead Sciences, Inc. B.T.Allaire: None. P.Amico: None. P.Markovich: None. M.Romaire: None. Funding Centers for Medicare &amp; Medicaid Services (HHSM-500-2014-0037I/75FCMC18F0003)

Stakeholder analysis: Medicare Diabetes Prevention Program awareness and implementation.

The Medicare Diabetes Prevention Program (MDPP) provides unprecedented coverage of a behavior change program for older adult Medicare beneficiaries, but uptake has been extremely limited; only 1.5 sites deliver the program per 100,000 beneficiaries nationwide. Inadequate reach and utilization of the MDPP threaten its long-term success; thus, the purpose of this project was to determine facilitators and barriers to MDPP implementation and use in western Pennsylvania. We conducted a qualitative stakeholder analysis project with suppliers of the MDPP and health care providers. Using an implementation science framework, we conducted individual interviews with 5 program suppliers and 3 health care providers (N = 8) to determine their perspectives on positive aspects of the program and reasons for MDPP unavailability and lack of use. Data were analyzed using Thorne and colleagues' approach of interpretive description. Three main themes emerged: (1) facilitators and attributes of the MDPP, (2) barriers to MDPP implementation, and (3) suggestions for improvement. Facilitators of the program included technical support and webinars from Medicare to assist with the application process. Barriers such as financial reimbursement constraints and a lack of a systematic referral process were noted. Stakeholders suggested refinements to participant eligibility and performance-based payments, a seamless method of flagging and referring patients through the electronic health record, and ongoing virtual program delivery options. Findings from this project can be used to improve implementation of the MDPP in western Pennsylvania, support Medicare policy refinement, and inform implementation research to promote broader adoption of the MDPP across the United States.

IDF2022-1237 A Stakeholder Analysis of Awareness and Implementation of the Medicare Diabetes Prevention Program in the United States

IDF2022-1237 A Stakeholder Analysis of Awareness and Implementation of the Medicare Diabetes Prevention Program in the United States

The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs to Prevent Diabetes in People With Prediabetes.

Individuals with an elevated fasting glucose level, elevated glucose level after glucose challenge, or elevated hemoglobin A1c level below the diagnostic threshold for diabetes (collectively termed prediabetes) are at increased risk for type 2 diabetes. More than one-third of U.S. adults have prediabetes but fewer than one in five are aware of the diagnosis. Rigorous scientific research has demonstrated the efficacy of both intensive lifestyle interventions and metformin in delaying or preventing progression from prediabetes to type 2 diabetes. The National Clinical Care Commission (NCCC) was a federal advisory committee charged with evaluating and making recommendations to improve federal programs related to the prevention of diabetes and its complications. In this article, we describe the recommendations of an NCCC subcommittee that focused primarily on prevention of type 2 diabetes in people with prediabetes. These recommendations aim to improve current federal diabetes prevention activities by 1) increasing awareness of and diagnosis of prediabetes on a population basis; 2) increasing the availability of, referral to, and insurance coverage for the National Diabetes Prevention Program and the Medicare Diabetes Prevention Program; 3) facilitating Food and Drug Administration review and approval of metformin for diabetes prevention; and 4) supporting research to enhance the effectiveness of diabetes prevention. Cognizant of the burden of type 1 diabetes, the recommendations also highlight the importance of research to advance our understanding of the etiology of and opportunities for prevention of type 1 diabetes.

491-P: Ten Years of the National Diabetes Prevention Program: Scaling the Lifestyle Change Program across the United States

The National Diabetes Prevention Program (National DPP) is a public-private partnership to build a nationwide delivery system for an evidence-based lifestyle change program (LCP) proven to prevent or delay the onset of type 2 diabetes in adults with prediabetes. Using data collected through the Diabetes Prevention Recognition Program (DPRP) , which certifies programs as official National DPP sites since 2012, this study shows how programmatic milestones have impacted enrollment trends over the past years. At the end of 2012, only 13 states had enrolled participants, with the highest number reported by MT (269) . By 2013, the number of states with programs increased to 41, with the highest number of enrollees reported by OH (931) and FL (840) . In 2015, online delivery modes were introduced, this allowed participants to enroll in programs located outside of their current states of residence and led, to an increase in enrollment across 50 states and DC. Notable increases were then seen in IL (13 to 670) , KS (9 to 786) , and LA (59 to 1362) . In January 2018, the Medicare Diabetes Prevention Program (MDPP) was launched, which allowed eligible Medicare beneficiaries to enroll in the LCP as a covered service. By the end of 2018, in-person (IP) enrollment sharply increased in organizations approved as MDPP suppliers, and large increases in IP enrollment from 2017 to 2018 were seen in AL, MO, NJ, and NV. The ongoing COVID-pandemic significantly impacted National DPP enrollment trends. Most states’ online enrollment increased by at least 20% from March 2020 to March 2021, with NC, CO, and NY showing large increases of 176%, 243%, and 590%, respectively. In contrast, CA, DE, and MS had decreases in online enrollment of 7%, 8%, and 26%, respectively. Enrollment trends have proven to be important reflections of milestones in the evolution of the National DPP. Expanding the number of organizations offering the MDPP, as well as those offering virtual delivery, allows the Program to continue to scale. Disclosure A.Chappell: None. E.Ely: None.

49-OR: Ten Years of the National Diabetes Prevention Program: Ten Years of Impactful Changes

In 2010, Congress authorized the creation of the National Diabetes Prevention Program to build a nationwide delivery system for a lifestyle change program (LCP) proven to prevent or delay the onset of type 2 diabetes. In 2012, the Diabetes Prevention Recognition Program (DPRP) approved its first CDC-recognized organization. Over the last years, CDC has recognized ∼4000 organizations to deliver the LCP to 500,000+ participants. This analysis looks at the impact of changes to the DPRP national quality standards on participant outcomes. The initial version of the DPRP Standards covered the period 1/1/12-12/31/14. Later versions were released on 1/1/15, 3/1/18, and 5/1/21. Data for participants who entered the LCP during each version were analyzed with respect to enrollment, starting body mass index (BMI) , and % weight change. Enrollment during version 1 climbed to 24,614 based on in-person delivery. Version 2 introduced virtual delivery and enrollment reached 227,329. Version 3 reflected changes to accommodate the Medicare Diabetes Prevention Program. In-person enrollment increased 36% from 2018 to 2019, while online enrollment decreased over that period. Version 3 saw the public health emergency that caused most in-person enrollment to halt while organizations shifted to virtual platforms. In-person enrollment during 2020 ranged from a low of 763 in April to almost normal numbers of 2000+/month by September. Mean BMI was highest for those who started the LCP in 2012 (version 1) and 2021 (version 4) at 36.2 and 36, respectively. Those enrolled in organizations using combination (in-person + virtual) delivery had the highest mean BMI, regardless of version. Mean % weight loss for those who completed 9+ months of the LCP was highest during version 1 (6.3) . Version 3 produced the lowest at 5.2, which was also the mean % in 2020. The DPRP has endured program changes, as well as external factors. The evidence-based LCP continues to enroll participants looking to reduce their risk of developing type 2 diabetes. Disclosure E.Ely: None.

Challenges with implementing the Diabetes Prevention Program for Medicare beneficiaries in an integrated health system.

In April 2018, CMS began reimbursing both clinical and community settings for providing the CDC-recognized Diabetes Prevention Program (DPP) to eligible Medicare beneficiaries. To better understand the process of offering the program to Medicare beneficiaries, we interviewed relevant stakeholders in a large, integrated health care delivery system. Qualitative interview study. We conducted semistructured interviews with 12 delivery system stakeholders. Data were analyzed following a thematic analysis approach. Stakeholders described systemic challenges to the implementation of Medicare DPP (MDPP), including inadequate reimbursement for the health care system, low awareness of MDPP among patients and providers, and challenges with utilizing third-party vendors to connect patients to CDC-recognized MDPPs. Although the reimbursement of DPP for Medicare beneficiaries was a landmark decision, the current structure and requirements make it difficult for health systems and community-based providers to implement and promote this benefit. This study highlights the challenges that even integrated health systems are facing to implement MDPP, as well as potential strategies to overcome these barriers and expand the reach of the program. Medicare should seek ways to increase the financial incentives and decrease the barriers associated with implementing MDPP.

Accessibility of Medicare Diabetes Prevention Programs and Variation by State, Race, and Ethnicity

This cross-sectional study examines the accessibility of the Medicare Diabetes Prevention Program and investigates whether there are disparities in access among racial and ethnic minority beneficiaries at the state level.

Estimated number of eligible Part B beneficiaries for the medicare diabetes prevention program at the county level and by urban-rural classification.

IntroductionDiabetes imposes large health and financial burdens on Medicare beneficiaries. Type 2 diabetes can be prevented or delayed through lifestyle modification programs. In 2018, Medicare began to offer the Medicare Diabetes Prevention Program (MDPP), a lifestyle intervention, to eligible beneficiaries nationwide. The number of MDPP-eligible beneficiaries is not known, but this information is essential in efforts to expand the program and increase enrollment. This study aimed to estimate the number and spatial variation of MDPP-eligible Part B beneficiaries at the county level and by urban–rural classification.MethodsData from 2011–2016 National Health and Nutrition Examination Surveys and a survey-weighted logistic regression model were used to estimate proportions of prediabetes in the United States by sex, age, and race/ethnicity based on the MDPP eligibility criteria. The results from the predictive model were applied to 2015 Medicare Part B beneficiaries to estimate the number of MDPP-eligible beneficiaries. The National Center for Health Statistics’ Urban–Rural Classification Scheme for Counties from 2013 were used to define urban and rural categories.ResultsAn estimated 5.2 million (95% CI = 3.5–7.0 million) Part B beneficiaries were eligible for the MDPP. By state, estimates ranged from 13,000 (95% CI = 8,500–18,000) in Alaska to 469,000 (95% CI = 296,000–641,000) in California. There were 2,149 counties with ≤1,000 eligible beneficiaries and 11 with >25,000. Consistent with demographic patterns, urban counties had more eligible beneficiaries than rural counties.ConclusionsThese estimates could be used to plan locations for new MDPPs and reach eligible Part B beneficiaries for enrollment.

Medicare Diabetes Prevention Program: where are the suppliers?

The Medicare Diabetes Prevention Program (MDPP) launched in April 2018, offering an unprecedented opportunity to reach the estimated 48.3% of older adults with prediabetes. Success of the innovative policy is likely to depend on adequate supplier availability. We examined supplier data from CMS to assess beneficiaries' potential access to MDPP services. We conducted a descriptive analysis of MDPP suppliers using data extracted from the CMS registry of suppliers as of July 2019 and data about beneficiary populations. Identifying the location, type, and number of MDPP suppliers and their respective sites, including within states, US territories, and the District of Columbia (hereafter, states), we mapped geographic coverage of MDPP access. There are 126 unique supplier organizations that offer the MDPP across 601 sites, equating to only 1 site per 100,000 Medicare beneficiaries. Seventy-five percent of states have no MDPP sites, fewer than 1 site per 100,000 beneficiaries, and/or availability limited to a single municipality. Although only 10.3% of MDPP suppliers are community-based organizations, they represent more than half (55.7%) of sites where beneficiaries can access the program. Findings show inadequate MDPP access, with relatively few suppliers and locations where beneficiaries can receive services. Insufficient reimbursement relative to costs for suppliers may largely account for limited availability. Strategies to facilitate access are urgently needed, which may include partnering with large organizations for greater per capita reach and rural organizations for broader geographic coverage, along with setting fiscally sustainable rates based on refined program implementation and cost analysis.

Update on Behavioral Weight Loss Treatments to Reduce Obesity and Lower Cardiometabolic Risks

Obesity is an intractable clinical and public health problem that is associated with morbidity and mortality. This review provides an update on current and emerging behavioral weight loss interventions (BWLIs). Because lifestyle behaviors are primary determinants of weight loss success, BWLIs are front-line treatments in the clinical management of obesity. BWLIs provide guidance in dietary restriction, increased physical activity, and decreased sedentary behavior to achieve reductions in body weight. Intensive in-person comprehensive BWLIs providing 14 or more sessions over 6 months are effective in producing weight losses of 5–10% and are recommended by clinical guidelines. High-intensity BWLIs providing frequent contacts during the first 2 years have been shown to be more effective in preventing weight regain than lower intensity programs. The Medicare Diabetes Prevention Program (MDPP) is an evidence-based, federally supported translational community-based BWLI program that is being made available to communities across the US. Mindfulness-based interventions, acceptance-based interventions, and motivational interviewing are evidence-based modalities that have been recently translated into BWLIs. Current evidence suggests they can provide short-term weight loss similar to established BWLIs, but further research is needed to evaluate their effectiveness for long-term weight loss maintenance. Internet-based delivery of BWLIs offers the potential advantages of greater accessibility and reach, user anonymity, and cost-effectiveness for long-term weight loss maintenance. Comprehensive, intensive BWLIs are effective, but long-term weight maintenance is challenging and requires ongoing participant engagement. Newer translational BWLIs and Internet-based BWLIs are being developed to improve weight loss outcomes.

685-P: Insights into Online Delivery of the National Diabetes Prevention Program

The National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations working together to build a nationwide delivery system for a lifestyle change program proven to prevent or delay onset of type 2 diabetes in adults with prediabetes. In 2015, the Diabetes Prevention Recognition Program (DPRP), the quality assurance arm of the National DPP, began recognizing lifestyle change programs delivered through an online platform, meaning participants log into course sessions via a computer, tablet, or smart phone. In November 2018, the total number of participants ever enrolled in the program reached 250,000. Those in online programs have now exceeded the number in in-person programs (144,122 vs. 109,951), despite the fact that online participation is not currently covered as part of the Medicare Diabetes Prevention Program. Among men eligible for participation in the program, more were found to enroll in online programs (65.6%) than in-person programs (34.4%), while among women, the difference was not as great (54.4% online and 45.6% in-person). With respect to age, eligible participants aged 18-44 enrolled in online programs at a rate of 75.5%, while eligible participants 65+ enrolled in in-person programs at a rate of 81.8%, seeming to show that younger participants prefer online, while older participants prefer in-person. Hispanic and white participants enrolled in online at a higher rate than in-person (54.9% and 62.4%), while 51.6% of black participants enrolled in in-person over online. Mean weight loss is used to determine the effectiveness of programs. Participants strive to lose at least 5% of their starting body weight over 12 months. When only eligible participants who were fully engaged for at least 9 of the 12 program months were considered, mean weight loss was found to be 6.3% for in-person programs and 5.4% for online programs. The addition of online programs has allowed the National DPP to reach underserved populations with prediabetes with favorable results. Disclosure E. Ely: None. R. Jabrah: None.

New Medicare Diabetes Prevention Coverage May Limit Beneficiary Access and Widen Health Disparities.

The Centers for Medicare and Medicaid Services recently issued final rules for the Medicare Diabetes Prevention Program (MDPP), offering an unprecedented opportunity to provide lifestyle intervention to Medicare beneficiaries with prediabetes via a pay-for-performance model. The MDPP is based on the widely disseminated, yearlong National Diabetes Prevention Program (NDPP), which has lesser but still beneficial risk-reduction outcomes among minority and low-income participants. We compare projected payments based on outcomes of a diverse sample of Medicare beneficiaries to service delivery costs, and explore resulting implications for MDPP access and sustainability. We delivered NDPP in a safety-net health care system from 2013 to 2017 and conducted an analysis of service cost, beneficiary performance, and projected MDPP reimbursement. Among 1165 total participants, 213 (18.3%) were Medicare beneficiaries. Participating beneficiaries were 40.6% Hispanic, 31.6% non-Hispanic black, and 26.9% non-Hispanic white and 69.5% low-income. Overall beneficiary performance would result in an average reimbursement of $138.52 (interquartile range=162.50). Program delivery costs were $800 per participant, leaving an average gap of $661 per beneficiary. Findings from delivering the NDPP to diverse and undeserved patients show a large gap between service costs and projected reimbursement. Although many MDPP suppliers are needed to reach all Medicare beneficiaries with prediabetes, insufficient reimbursement may be a deterrent. Health disparities may also widen as suppliers serving diverse and low-income populations will likely receive especially low payments, threatening access. Higher payments are supported by strong return-on-investment findings and seem needed to reduce diabetes prevalence and related disparities.

Medicare Diabetes Prevention Program Final Rules May Limit Beneficiary Access and Widen Health Disparities

Introduction: The Centers for Medicare and Medicaid Services recently issued final rules for the Medicare Diabetes Prevention Program (MDPP), offering an unprecedented opportunity to provide lifestyle intervention to the estimated 48.3% of seniors with prediabetes. The MDPP is based on the widely disseminated National Diabetes Prevention Program (NDPP), which has lesser but still beneficial risk-reduction outcomes among racial/ethnic minority participants. We assess the extent to which the MDPP’s pay-for-performance reimbursement model may cover costs of service delivery to diverse Medicare beneficiaries. Methods: Denver Health Medical Center is a safety net healthcare system that provided the yearlong NDPP to 232 diverse Medicare beneficiaries between 2013-2017, primarily through grant funding. Based on their NDPP attendance and weight loss outcomes, we compared projected performance-based-payments (e.g., $160 for ?5% weight loss) to service costs. Results: Participating Medicare beneficiaries were 40.6% Hispanic, 31.6% non-Hispanic black, and 26.9% non-Hispanic white. Only 4.7% of beneficiaries achieved all attendance and weight loss outcomes associated with the maximum $470 payment for services in months 1-12. Overall beneficiary performance would result in an average reimbursement of $138.52 (SD=142.58). Program delivery costs were $800.64 per-participant, leaving an average gap of $662.12 per beneficiary served. Discussion: Numerous MDPP suppliers are needed to reach Medicare beneficiaries with prediabetes, yet insufficient reimbursement is a likely deterrent. Health disparities may also widen as suppliers serving diverse populations will likely receive especially low payments, threatening their MDPP delivery. Higher payments appear needed and are supported by strong return-on-investment findings. A risk-adjusted model that accounts for demographic differences in outcomes is also needed to promote health equity. Disclosure N. Ritchie: None. M. Gritz: None.

Medicare poised to cover diabetes prevention services

Clinicians who know how to help their patients lead a healthy lifestyle have a new opportunity this year to be reimbursed for preventive services for Medicare enrollees who are at high risk for diabetes. The recently launched Medicare Diabetes Prevention Program (DPP) grew from a Centers for Disease Control and Prevention (CDC)–led initiative that now involves more than 1,500 sites nationwide. The DPP model relies on a standard curriculum adopted by health coaches who encourage groups of patients to make lifestyle changes that have been shown to delay or prevent the onset of diabetes. The Centers for Medicare and Medicaid Services (CMS) in late 2016 announced its support for the DPP model and stated that the agency planned to cover DPP services for Medicare beneficiaries. Final details on the Medicare DPP program and its funding structure were published as part of the 2018 physician fee schedule in the November 15, 2017, Federal Register. The enrollment period for new Medicare DPP suppliers started on January 1.