The National DPP Coverage Toolkit: Timely Tools for Payers Addressing Prediabetes

More than 86 million American adults have prediabetes. That number alone is astounding, but perhaps what is even more concerning is that 9 out of 10 people with prediabetes don’t know they have it.  Considering that, in the absence of any health intervention, 15‒30 percent of people with prediabetes will develop type 2 diabetes within five years, effective preventive measures are needed to mitigate a serious public health crisis. The Centers for Disease Control and Prevention (CDC) is proactively responding to this potential problem by developing and promoting the National Diabetes Prevention Program (National DPP) lifestyle change program.

The National DPP Lifestyle Change Program

The National DPP lifestyle change program is an evidence-based program that can be provided through an in-person classroom-like setting, a virtual platform, or a combined approach. To receive reimbursement, the site facilitating the program must obtain CDC recognition. A few states currently cover the program for Medicaid beneficiaries, several states cover the program for state employees, and many employers cover the program as an employee benefit. Medicare coverage of the program will become effective in 2018.

As interest in covering the National DPP lifestyle change program has grown, so has the need for a tool that can help organizations navigate the potential complexities of covering the program. The result is the National DPP Coverage Toolkit.

The National DPP Coverage Toolkit

The National DPP Coverage Toolkit is a web-based resource developed in partnership by the National Association of Chronic Disease Directors (NACDD), Leavitt Partners, and the CDC. The online toolkit provides specific resources and information on important topics for payers interested in covering the National DPP lifestyle change program. It also links to CDC and other existing resources surrounding the National DPP lifestyle change program, making the toolkit a “one-stop-shop” for finding information about the program. Sections of the toolkit are tailored to different groups, including: state Medicaid agencies, Medicaid managed care organizations, commercial health plans and employers interested in covering the program, as well as Medicare Advantage plans.

The toolkit covers the topics listed below and are personalized to provide the distinct payers with the best information for their situation. The toolkit’s webpages are also regularly reviewed and updated to reflect the latest developments.

  • Program delivery. Provides information about steps that should be considered for delivering the National DPP lifestyle change program, including screening and identifying potential participants, enrollment and retention, and options for program delivery.
  • Contracting. Provides information about contracting with CDC recognized organizations and provides information on cost and reimbursement.
  • Coding and billing. Provides information on the steps and considerations associated with billing for the National DPP lifestyle change program.
  • Data and reporting requirements. Provides information on the type of data that needs to be reported to the CDC’s Diabetes Prevention Recognition Program, as well as other data reporting standards.

Visitors to the site can submit feedback, propose changes, and notify the site if they have joined the growing number of payers and employers currently covering the program. The site currently names numerous states, health plans, and self-insured employers who have elected to cover the program for their beneficiaries.

The toolkit was officially launched on June 22, 2017. Several-hundred people tuned-in to a launch webinar. Since its public release, more than 1,300 unique visitors have visited the site. State and local health departments continue to share the toolkit and have provided links to the toolkit’s URL on their websites as a potential resource for interested individuals. The toolkit has also received positive feedback from visitors. Many of the graphics and explanatory representations that were created for the toolkit have been used in discussions and presentations by state, local, and national-level partners.

What’s next

The release of the website raises the question: Where do we go from here? The most timely answer to this question is to move in step with regulatory and policy updates. Recently, CMS announced the proposed rule regarding Medicare coverage of the in-person Medicare Diabetes Prevention Program as a covered benefit for eligible participants beginning in 2018. This is an important milestone for the National DPP, particularly since the return on investment for the National DPP lifestyle change program is highest for the population over age 65. As rules around Medicare coverage become final, the site will feature additional information about Medicare coverage and its intersection with Medicare Advantage plans.

Medicare’s coverage of the National DPP lifestyle change program will likely drive other payers to cover the program as well. We believe the toolkit will be a valuable resource for these groups as they look to cover this program as a benefit for their customers and improve the current health trajectory for millions of Americans.

**Editor’s Note** The link for the National DPP Coverage Toolkit was updated on February 23, 2018 after the toolkit was moved to a new domain.