CMS Finalizes Proposal to Implement the Medicare Diabetes Prevention Program Expanded Model Beginning January 1, 2018

by | Nov 3, 2016

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued a proposal for reimbursement of the Diabetes Prevention Program. Yesterday, the CMS finalized the proposal to implement the Medicare Diabetes Prevention Program (MDPP) expanded model beginning January 1, 2018.

Typically, a proposal for Medicare coverage takes several years to be passed. Despite opposition from The Pharmaceutical Research and Manufacturers of America (PhRMA), the CMS has decided to expand the program to the entire medicare population due to the success of the YMCA’s demonstration project. The Department of Health and Human Services estimated that expanding coverage of the Diabetes Prevention Program (DPP) will result in over $2,650 in medicaid costs per enrollee during a 15-month period.

The decision to expand the program to the entire medicare population is a huge stride forward in the world of chronic disease prevention, as it is this is first preventative service model to be approved for expansion out of the CMS Innovation Center.

That being said, there is still work to be done to increase the dissemination of the program. While it is well documented that traditional face-to-face delivery of the DPP like the YMCA’s program is successful in reducing participant’s risk of type 2 diabetes and decreasing incidence of type 2 diabetes in participant populations long-term, the in-person model has faced challenges in access and scalability.

With the continued rise of pre-diabetes, these barriers will only amplify. Due to the scope of the problem, other models that can promote the widespread dissemination of the program need to be considered.

Virtual models, like Noom, have proven equally effective at engaging participants, promoting weight loss, and improving HbA1c levels, while overcoming the barriers of access and scalability. As such, these models that expand the uptake of and access to the program likely will be the most successful at reducing a population’s diabetes risk. Therefore, the reimbursement of other CDC-recognized models like Noom will improve patient care and reduce healthcare cost at scale and reach at-risk individuals such as senior citizens or busy professionals that are excluded due to constraints of attending in-person programs.