This post has been updated with additional comments from Dreamit Ventures Managing Director of Health Dr. Phil Christian and Joslin Diabetes Center Chief Medical Officer Dr. Robert A. Gabbay.
Several digital health companies stand to reap the benefits of Health and Human Services Secretary Sylvia Burwell’s move to provide reimbursement for Medicare patients taking part in Diabetes Prevention Programs. It is expected to go into effect next year. It seems fitting that the announcement coincided with the sixth anniversary of the Affordable Care Act which emphasizes preventive care.
An estimated 30 million people in the U.S. have diabetes and another 86 million are at risk for developing the chronic condition, according to data from HHS.
A statement on the website for HHS highlighted the gains from a CMS funded study by the National Council of the YMCA of Medicare beneficiaries at high risk for diabetes. Participants had weekly meetings with a lifestyle coach to learn strategies for long-term dietary change, increase physical activity, and behavior changes to control their weight and reduce their risk of Type 2 diabetes. It sought to achieve 5 percent body weight loss among participants.
According to data from CMS, 6,874 beneficiaries had attended at least one session, as of March 2015. Of these, 5,696 attended at least four sessions. Over 60 percent of the participants are between the ages of 65 and 75. Although many lost 4.75 percent of their body weight, participants who attended at least nine weekly sessions lost an average of 5.17 percent of their body weight. Estimated savings from the program are $2,650 after 15 months
A statement on the website for the HHS said CMS is considering how to expand this model broadly across Medicare and would reveal more details about the program this summer. That could be interpreted to mean that prevention programs for other chronic conditions could also be reimbursed, such as congestive heart failure.
Another diabetes prevention program is also being rolled out in the UK, according to Medscape. Healthier You: The National Health Service Diabetes Prevention Programme (NHS DPP) will start later this year seeking 20,000 participants.
A Deep-dive Into Specialty Pharma
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Here were some of the reactions to Burwell’s announcement.
Omada Health CEO and Co-founder Sean Duffy
“By elevating evidence-based diabetes prevention as the reimbursed standard of care, Secretary Burwell has acknowledged the urgency of addressing what has become a national epidemic.”
Solera Health CEO Brenda Schmidt
“We are excited to be part of the solution as we know that seniors have unique requirements and that certain DPPs have proved to be more successful in serving the needs of this population.”
American Diabetes Association CEO Kevin Hagan
“The Association has spent the last eight years diligently advocating for Medicare coverage of the National DPP, and today’s announcement is a powerful endorsement of the value of preventive health care for people who are at risk of developing type 2 diabetes.”
Joslin Diabetes Center Chief Medical Officer Dr. Robert A. Gabbay
“We are certainly supportive of the new coverage, and we believe that reimbursement for this is a big step forward. The role of digital companies in this will be interesting to follow.”
Dreamit Ventures Managing Director of Health Dr. Phil Christian
“There are thousands of programs designed to address pre-diabetes and diabetes prevention, but the lack of adequate reimbursement mechanisms have served to disincentivize the maintenance of those programs or the development of viable alternatives.
“The DHHS decision to expand reimbursement to cover such prevention services, will not only support existing efforts, but will also incentivize the development and use of digital health and behavior modification strategies and technologies that will leverage the experience of big data bases to assist patients in their disease prevention efforts, AND provide the compensation for providers to successfully design and manage these programs.
“The truth is that the programs and strategies we’ve used for years, as designed, will only yield limited results (5 percent-10 percent reduction in conversion from pre-diabetes to type 2 diabetes). And while we applaud Secretary Burwell’s decision to establish reimbursement for these much needed programs, the next frontier for achieving significant population-based benefits around diabetes control and prevention, is the development of digital health technologies that provide individualized, real-time, evidence-based, actionable data to all stakeholders…each of whom is incentivized to strive for the best possible outcomes.”
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