UPDATE: Screening and Coverage for Diabetes and Prediabetes Karin - - PowerPoint PPT Presentation

UPDATE: Screening and Coverage for Diabetes and Prediabetes

Karin Gillespie, Changing Diabetes Policy, Novo Nordisk

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USPSTF Diabetes Screening Guideline

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New USPSTF Abnormal Blood Glucose and Type 2 Diabetes Screening Guideline

2008 USPSTF risk factors

High blood pressure

2015 USPSTF risk factors 40-70 & overweight/obese Family history GDM or PCOS Ethnic/racial minority

Experts say: Screen for prediabetes and type 2 diabetes in adults who are at risk

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• Private health plans must cover screening test with no co-pay
• USPSTF guideline more closely aligned with ADA
• A1c is now recognized as a valid screening test
• For the first time ever, USPSTF recommends screening for

prediabetes and referral to diabetes prevention program

• Clinicians should offer or refer patients with prediabetes to lifestyle

intervention, such as National DPP, at no-cost for the prevention of type 2 diabetes

New USPSTF Guideline Details and Coverage Implications

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170 7.6 69.1 138.7 7.3 62.8 61.2 4.5 30.2 20 40 60 80 100 120 140 160 180 Number screened UDM detected UPDM detected 2015 USPSTF ADA 2008 USPSTF

New USPSTF guideline Millions More Could Get Screened

Source: Analysis by Tim Dall for NNI, IHS Global insights, November 2014, Based on study published in American Journal of Preventive Medicine

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Kentucky: Estimated Diabetes Status of Adults: 2015

Sources: Analysis of 2011 & 2013 Behavioral Risk Factor Surveillance System, 2013 American Community Survey, 2004 National Nursing Home Survey, and Census Bureau 2015 Population

• Projections. Projection by IHS Global for Novo Nordisk; data on file with Novo Nordisk

Normoglycemia 1,604,000 49% Diagnosed diabetes 376,000 11% Undiagnosed diabetes 112,000 3% Diagnosed prediabetes 132,000 4% Undiagnosed prediabetes 1,081,000 33%

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Kentucky: USPSTF Screening

Adults without diagnosed diabetes 2,929,000 Meet USPSTF screening criteria 2,359,000 80.5% adults w/o DDM Normoglycemia 1,178,000 Diagnosed prediabetes 132,000 Undiagnosed diabetes 102,000 91.1% of UDM Undiagnosed prediabetes 947,000 87.6% of UPDM Do not meet USPSTF screening criteria Undiagnosed diabetes 10,000 8.9% of UDM Undiagnosed prediabetes 134,000 12.4% of UPDM Screened: Diabetes newly detected 23.1 Screened: Prediabetes newly detected 2.5

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Kentucky: Meet USPSTF Screening Criteria

Insurance Type UDM UPDM Total Screened Commercial 36,000 439,000 1,231,000 Medicare * 43,000 222,000 439,000 Medicaid * 10,000 118,000 269,000 Uninsured 13,000 167,000 420,000 Total 102,000 946,000 2,359,000

Notes: Numbers might not sum to totals because of rounding. * ‘Medicare’ category includes all adults age 65+ covered under a public insurance program; ‘Medicaid’ includes all adults under age 65 covered under a public insurance program (e.g., Medicare dual- eligible, Indian Health Services).

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Kentucky: 805,000 Candidates for DPP Lifestyle Intervention

• Criteria
• Overweight or
• bese
• and
• Previously

diagnosed prediabetes, or undiagnosed prediabetes but meets USPSTF screening criteria

Commercial 398,000 49% Medicare (public assistance, age 65+) 166,000 21% Medicaid (public assistance, age <65) 100,000 12% Uninsured 141,000 18%

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If 805,000 Candidates Achieved Average Outcomes

• f Diabetes Prevention Program Trials

5 years 10 years 5 years 10 years New cases prevented Diabetes (141,000) (222,000)

• 62%
• 60%

Ischemic heart disease (10,000) (23,000)

• 21%
• 23%

Congestive heart failure (18,000) (6,000)

• 28%
• 35%

Stroke (12,400) (30,000)

• 30%
• 36%

Heart attack (7,000) (20,000)

• 27%
• 35%

Renal failure (4,900) (7,100)

• 7%
• 6%

Diabetic amputation (500) (2,000)

• 76%
• 81%

Diabetic retinopathy (2,700) (8,700)

• 64%
• 63%

Mortality (22,000) (66,000)

• 20%
• 25%

Additional years of life 52,000 292,000 0.1 0.4 Quality adjusted life years 105,700 370,500 0.1 0.5

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If 805,000 Candidates Achieved Average Outcomes

• f Diabetes Prevention Program Trials

5 years 10 years Reduced medical expenditures ($ millions) $3,419 $8,686 Non-medical economic benefits ($ millions) $4,368 $13,927 Higher household income ($ millions) $4,424 $13,854 Increased years of employment 46,700 167,200 Reduced missed work days 22,000 1,355,000 Absenteeism productivity gain ($ millions) $4 $209 Reduced long term disability ($ millions) $61 $136 Total economic benefits ($ millions) $7,786 $22,613

Note: Estimates take into account differences between state and national prices for medical care and wages

Medicare Coverage for the National DPP

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• In March 2016, the Department of Health and Human Services

announced a proposal for Medicare to begin covering diabetes prevention programs for seniors with prediabetes.

• The announcement was based on a successful demonstration project

by the YMCA of the USA, funded through the Centers for Medicare and Medicaid Innovation.

• The 3 year project delivered the National DPP to nearly 8,000

beneficiaries in 17 communities.

• The demonstration found seniors who participated in the YMCA’s

Diabetes Prevention Program reduced their risk of developing diabetes and saved $2,650 over 15 months in reduced health care expenditures.

Medicare Announcement on National DPP

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• DAA met with CMS/CMMI officials in May 2016 to discuss implementation
• f the benefit
• CMMI in the drivers seat and confirmed A1c will be used as a test for

prediabetes screening and determination of eligibility

• Inferred CDC DPRP recognition would be a requirement to be a provider
• f DPP
• Payment will be structured around attainment of goals (e.g. # of

sessions attended, weight loss, maintenance)

• Coverage expected beginning January 2018 at no-cost to patients
• Additional information about implementation of this new Medicare benefit

is expected in June 2016 as part of the annual Physician Fee Schedule rule released by the Centers for Medicare and Medicaid Services

Medicare Coverage of National DPP

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Medicaid Coverage of National DPP

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• The Affordable Care Act provides states a 1 percentage point increase

in their federal Medicaid match rate for preventive services if they cover all adult preventive services without cost-sharing recommended by USPSTF and the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) for newly eligible Medicaid beneficiaries.

• A handful of states have submitted state plan amendments (SPAs) to

receive the increase and thus beginning in 2017 will be required to cover participation in diabetes prevention programs for the Medicaid expansion population.

• States that have submitted SPAs include CA, DE, KY, MN, NH, NJ, NY,

NV, OK, OR, PA, WV

State Health Plan Coverage of National DPP

Next Steps

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• Diabetes Advocacy Alliance (DAA)

collaborating on FAQ re: new USPSTF screening guideline with Tri-Departments (HHS, Labor & Treasury)

• Understanding how physicians screen-research
• Education about and promotion of the

USPSTF guideline

• Engaging with CMS/CMMI on Medicare

coverage of DPP regulation

Next Steps

Key Takeaways

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Key Takeaways

• When combined and fully implemented, the USPSTF

recommendation and the Medicare coverage proposal will result in most Americans having access and insurance coverage to diabetes prevention programs at no cost.

• Novo Nordisk Inc. provides support to the National DPP through

advocacy and action

• Health care providers, health systems, health plans, and the

community can help increase access to the National DPP

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Thank you!