Focus on Prevention

Diabetes prevention matters for older Americans

One hospital’s experience in expanding the National Diabetes Prevention Program as a Medicare diabetes prevention program supplier

Diabetes and prediabetes have become a pressing concern for the Centers for Medicare and Medicaid Services (CMS), due to the rising costs of diabetes care in the United States. Nationally, rates of diabetes and prediabetes are high, with Medicare spending an estimated $45 billion each year in diabetes services.

Prevention matters, especially for older Americans. Research shows that when people age 65 and older attain 5% weight loss, it can lead to a 71% decrease in their risk of developing type 2 diabetes. The CDC’s National Diabetes Statistics Report found that more than 23.1 million adults age 65 and older have prediabetes, many of whom are Medicare beneficiaries.

Diabetes Prevention | UnidosUS

As of April 1, 2018, Medicare covers the National Diabetes Prevention Program (National DPP) for Medicare beneficiaries. Any organization that has been providing the National DPP and has obtained preliminary or full CDC-recognition, is eligible to apply for reimbursement under the Centers for Medicare and Medicaid Services (CMS) Medicare Diabetes Prevention Program (MDPP) expanded model.

The MDPP expanded model includes an evidence-based set of services aimed to help prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. Coverage includes 12 months of core sessions for beneficiaries with an indication of prediabetes, and an additional 12 months of on-going maintenance sessions for participants who meet weight loss and attendance goals. The sessions are provided by a trained lifestyle coach, who delivers a CDC-approved curriculum to promote dietary change, increased physical activity, and weight loss strategies.

National Diabetes Prevention Program | UnidosUS

Although a referral from a physician is not required for beneficiaries to participate in MDPP services, it is highly encouraged and proven to be effective. In fact, UCHealth Poudre Valley Hospital (PVH) in Fort Collins, Colorado, found that since offering the National DPP at their site they have strengthened their relationships with local physicians and in return created a robust referral system for their diabetes prevention program. One way that PVH has marketed its program is by going directly to physicians and physician groups that can evaluate their patients’ health information and write them a referral to the program.

“Physicians are excited about the program, but you need to have some contact with them to explain the National DPP because it’s fairly new to them,” Linda Schoon, a registered dietitian, certified diabetes educator, and program coordinator at PVH, explains.

She notes that her team visits physicians’ offices, gives physicians qualifying criteria, and encourages them to screen their patients for prediabetes. From there, physicians can refer patients to the hospital’s National DPP program either electronically or via fax. She underscores the importance of—at the bare minimum—spending time with care managers and informing physicians’ offices of the benefits of the service in order to try to reach eligible patients who may benefit from it.

Schoon and her team have also collaborated with other hospital departments to expand the reach of their diabetes prevention program.

“We have worked with the UCHealth Community Health Improvement department to service their underserved populations,” Schoon says. She adds that she has high hopes of expanding their work—particularly in the Latino, Spanish-dominant community in Fort Collins and surrounding communities—in the future.

Since the expansion of the MDPP, Schoon explains that PVH is also getting requests from other hospitals systems for information on how their diabetes prevention program works and how they became MDPP suppliers.

Schoon’s story is important for organizations interested in becoming a site for the National DPP. For more information about the value of the National DPP, becoming a MDPP supplier, and the partnership between UnidosUS and AADE, visit us here.