The National Diabetes Prevention Program (National DPP) Training Opportunity


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The National Diabetes Prevention Program (National DPP) encourages collaboration among federal agencies, community-based organizations, employers, insurers, health care professionals, academia, and other stakeholders to prevent or delay the onset of type 2 diabetes among people with prediabetes in the United States.

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The National Diabetes Prevention Program (National DPP) Training Opportunity

  1. 1. National Diabetes Prevention Program Ann Albright, PhD, RD Director, Division of Diabetes Translation Centers for Disease Control and Prevention 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. National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation
  2. 2. 26 million with Diabetes 79 million with Prediabetes
  3. 3. Proportion of U.S. Adults Aged > 20 with Prediabetes Who Are Aware of Their Risk Status MMWR, 2013
  4. 4. Current Projections of Cases of Diabetes in the United States by 2030 70 millions 60 50 40 30 20 10 0 2007 2010 2015 2020 2025 2030
  5. 5. Risk Stratification Pyramid for Diabetes Prevention Prevalence (%) ~10 % ~25 % ~65% 10-year risk (%) Very High Risk (A1c > 5.7%; IGT; GDM) >30 % High Risk (FPG > 100); Central Obesity; HTN, age Moderate Risk >20 % >10% Low Risk >0%
  6. 6. 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
  7. 7. 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
  8. 8. DISTRIBUTION AVAILABILITY Diffusion of interventions EFFICIENCY Supply EFFECTIVENESS Biggest effect on most people EFFICACY Real world settings BASIC SCIENCE Ideal settings Molecular/ physiological 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.
  9. 9. Albright A, Gregg EW. Am J Prev Med. 2013;44(4S4):S346-S351. National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. National Diabetes Prevention Program Sites June 6, 2013 National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation
  14. 14. 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
  15. 15. 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
  16. 16. Implementing the National Diabetes Prevention Program Brenda Schmidt MS MBA President and CEO Marissa Hudson Executive Vice President of Public/Private Partnerships
  17. 17. Core Program Elements
  18. 18. Challenge – 79 million Americans have prediabetes (35% of U.S. population) Drivers – Obesity and inactivity 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+.
  19. 19. 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.
  20. 20. Core Diabetes Prevention Program Elements • 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
  21. 21. Viridian Coordinated National Network Viridian Diabetes Prevention Network (Coordinated National Network) Program Delivery Training ASO / TPA Master Training • Motivational Interviewing • Lifestyle Coach Training • • Coach Support / Quality / Fidelity • National Delivery Network • Flexible Intervention Sites Consumer website and social network • Participant Identification and Engagement • Material Fulfillment • Data Collection and Reporting • • Claims Processing Network of DPRP Program Delivery Partners ASO: Administrative Services Organization DPRP: Centers for Disease Prevention and Control (CDC) Diabetes Program Recognition Partner
  22. 22. 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
  23. 23. 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 Supports success in pay-forcomorbidities associated with performance/shared risk diabetes and prediabetes delivery and payment model environments
  24. 24. 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
  25. 25. National DPP Lifestyle Coach Training 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
  26. 26. Population Health Management Platform Employer added to Maestro™ Aggregate Reporting & Reporting to DPRP Data Import - Biometrics, Claims, Questionnaire, Labs, Other sources Viridian proprietary model for DPP identification, outreach and administration Participant ID & Outreach Summary Billing (@ Milestones) - Classes 4 & 9 - 5-7% weight loss - Data mining & ID - Multi-channel mktg - Participant opt-in National Provider Network - Community classes - Coach data
  27. 27. National DPP Toolkit and Maestro™ Demonstration