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Diabetes prevention program could be boom to health IT

By Arthur Allen

12/29/14 8:44 AM EST

Alarmed by the growth and cost of diabetes, which now affects 1 in 10 Americans, the federal government has given the go-ahead to digital diabetes-prevention programs that could be a boon to health IT companies seeking private insurance and Medicare payments.

The CDC last week released new standards for the programs that for the first time allow the use of virtual tools to enroll, track and coach people with “pre-diabetes,” which is diagnosed based on measures of weight, waistline and certain blood tests.

Some 29 million Americans have diabetes; its treatment accounts for $176 billion in direct medical costs and a quarter of Medicare payments. Another 87 million people are at risk for diabetes but only about 8 million of them know it.

Diabetes leads to heart attack, limb amputation, and eye and kidney disease. Pre-diabetics are also at risk for heart attack and stroke. Nipping the disease in the bud will make people healthier and save the health care system money.

“The increase in people developing diabetes in recent years is very serious,” said Ann Albright, director of the Division of Diabetes Translation at CDC. A major research study led by the National Institutes of Health showed<http://www.ncbi.nlm.nih.gov/pubmed/22442395> that a lifestyle-change program reduced diabetes conversions by 58 percent, compared with a placebo over three years — and by 71 percent in those over 60.

“Fortunately these programs can be delivered by health pros and trained lay people, which can make them more widely available,” Albright said.

Currently some 527 organizations are delivering the CDC-approved intervention, which aims at a 5-7 percent weight loss. The program may be less expensive when non-medical staff are employed as coaches; YMCA for example charges insurers or employers $429 for a yearlong program.

From a society-wide perspective, “it’s cheaper to pay for the intervention than for multiple pills and glucose strips, and amputations and kidney failure,” Albright said. “If you intervene before people get to Medicare, far fewer seniors will need to be treated for diabetes. They’ll have better lives.”

“This is the next huge challenge for the U.S. health care system,” says Sean Duffy, CEO of Omada Health, a San Francisco startup that got $23 million in venture capital funding in April, a sign of investor confidence in the growth of the prevention programs.

The new virtual standards will enable companies like Omada to start enrolling thousands. The company plans to contract with doctors, insurers and employers who will send it to patients at risk for diabetes.

Its plan, which worked in a trial<http://tde.sagepub.com/content/40/4/435.long> of 220 patients, is to enroll the pre-diabetics in virtual communities where they get nutrition and exercise advice, compare notes and have 24-hour access to a nutrition and fitness coach. Omada mails the patients scales equipped with chips that send out emails when they weigh themselves.

The CDC guidance is part of a government effort to expand diabetes-prevention programs. In August, a task force created by the Agency for Healthcare Research and Quality gave the programs<http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/healthy-diet-and-physical-activity-counseling-adults-with-high-risk-of-cvd> a positive evaluation, which means private insurers will have to cover them.

CDC first released its diabetes-prevention program standards in 2011. Companies, local governments and nonprofits that offer prevention conforming with the standards are listed on CDC’s website<http://www.cdc.gov/diabetes/prevention/> and, increasingly, are likely to be covered by insurance.

A bill reintroduced<http://www.franken.senate.gov/?p=issue&id=138> in 2012 by Sen. Al Franken (D-Minn.) would require Medicare to reimburse diabetes prevention.

“Right now, CMS will reimburse for diabetic retinopathy or limb removal because of diabetes, but it won’t pay a dime for prevention,” said Mike Payne, Omada Health’s chief operating officer.

In the YMCA’s prevention program, which has enrolled more than 28,000 people over the past three years, officials record a person’s weight each time they come in for a counseling session. The YMCA objected to a part of the new CDC rules that allows people to self-report weight.

“If you ask someone how much they weigh, they tend to underestimate,” said Matt Longjohn, the YMCA’s national health officer and an MD. “Some of the virtual providers [like Omada] are using Bluetooth-enabled scales and such, but I don’t think every virtual provider has an answer yet for how they will fully document weight loss.”

This concern pales in comparison to the need to expand the program by delivering it with new technology, Albright believes. The program works but it needs to be scaled up massively, she said. Ultimately, insurers and employers will decide whether it is worth paying for — and the biggest obstacle is stimulating interest among the unwell.

“People don’t flock to these programs,” said Albright. “We wish they would.”