The National Diabetes Prevention Program (National DPP) Training Opportunity

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.

1. National Diabetes Prevention Program

Ann Albright, PhD, RD
Director, Division of Diabetes Translation
Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation www.cdc.gov/diabetes
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.

2. 26 million
with Diabetes
79 million
with Prediabetes

3. Proportion of U.S. Adults Aged > 20 with Prediabetes
Who Are Aware of Their Risk Status
MMWR, 2013

4. Current Projections of Cases of Diabetes
in the United States by 2030
0
10
20
30
40
50
60
70
2007 2010 2015 2020 2025 2030
millions

5. Very
High Risk
(A1c > 5.7%;
IGT; GDM)
Moderate Risk

Low Risk
High Risk
(FPG > 100);
Central Obesity; HTN, age
Risk Stratification Pyramid for Diabetes Prevention

10-year risk (%)

>30 %

>20 %


>10%



>0%

Prevalence (%)
~10 %
~25 %
~65%

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. 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. BASIC SCIENCE
EFFICACY
EFFECTIVENESS
EFFICIENCY
AVAILABILITY
DISTRIBUTION
Molecular/
physiological
Ideal
settings
Real world
settings
Biggest effect on
most people
Supply
Diffusion of
interventions
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. National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation www.cdc.gov/diabetes
Albright A, Gregg EW. Am J Prev Med. 2013;44(4S4):S346-S351.

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. 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

www.cdc.gov/diabetes/prevention/recognition

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. National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation www.cdc.gov/diabetes
National Diabetes Prevention Program Sites
June 6, 2013

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. 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. Implementing the National
Diabetes Prevention Program
Brenda Schmidt MS MBA
President and CEO
Marissa Hudson
Executive Vice President of Public/Private Partnerships

17. Core Program Elements

18. Challenge – 79 million Americans have prediabetes (35% of U.S. population)
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+.
Drivers – Obesity and inactivity

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. •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

Core Diabetes Prevention Program Elements

21. ASO: Administrative Services Organization
DPRP: Centers for Disease Prevention and Control (CDC) Diabetes Program Recognition Partner
Viridian Diabetes Prevention Network
(Coordinated National Network)

Training
•Master Training
•Motivational
Interviewing
•Lifestyle Coach
Training
•Coach Support /
Quality / Fidelity


Program Delivery

•National Delivery
Network
•Flexible Intervention
Sites



Network of DPRP Program Delivery Partners
ASO / TPA
•Consumer website
and social network
•Participant
Identification and
Engagement
•Material Fulfillment
•Data Collection and
Reporting
•Claims Processing
Viridian Coordinated National Network

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. 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
comorbidities associated with
diabetes and prediabetes
Supports success in pay-for-
performance/shared risk
delivery and payment model
environments

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 4
th
class
Milestone Payment # 2

Completion of 9
th
class
Milestone Payment # 3

Minimum 5% weight loss

25. 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


National DPP
Lifestyle
Coach
Training

26. Population Health Management Platform
Employer added
to Maestro™
Data Import
- Biometrics, Claims,
Questionnaire, Labs,
Other sources
Participant ID
& Outreach
- Data mining & ID
- Multi-channel mktg
- Participant opt-in
National Provider
Network
- Community classes
- Coach data
Aggregate
Reporting &
Reporting to
DPRP
Viridian proprietary model for DPP
identification, outreach and administration
Summary Billing
(@ Milestones)
- Classes 4 & 9
- 5-7% weight loss

27. National DPP Toolkit and
Maestro™ Demonstration