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Could an mHealth Program Help Cut Billions in Chronic Care Costs?

A Humana program using Omada Health's digital health diabetes platform helped overweight seniors lose an average of 13 to 14 pounds in a year. It could be a model for Medicare's efforts to reduce chronic care costs through mHealth.

Source: ThinkStock

- A digital health program launched by Humana has proven successful in getting overweight seniors to lose weight – and could help Medicare shed billions of dollars in chronic care management costs.

The Louisville, Ky.-based insurer’s Diabetes Prevention Program, launched in 2015, uses Omada Health’s digital platform, which features an online support group, digital tracking tools, a weekly behavior change curriculum and health coaches who monitored each participant and reached out to offer support and guidance when needed.

According to a study recently published in The Journal of Aging and Health, an analysis of some 500 people in Humana’s Medicare Advantage program lost an average of 13 to 14 pounds during 2015; they also saw improvements in cholesterol levels, blood-glucose levels and even moods and self-care.

The study’s authors – a team of researchers from Humana and San Francisco-based Omada Health – concluded that a digital health platform directed at overweight seniors could help cut more than $3 billion in Medicare expenditures over 10 years. Those savings would come from a reduction in healthcare services for chronic issues like diabetes, high blood pressure and heart issues.

“Diabetes and obesity are an epidemic among the senior population and, if left unchallenged, threaten to seriously impact quality of life,” Cynthia Castro Sweet, PhD, director of medical affairs at Omada Health and the study’s lead author, said in a press release. “The results of our research show we now have the tools to fight this epidemic.”

“This study demonstrates that digital tools and personalized coaching can help people reduce their risk of developing diabetes,” added Laura E. Happe, PharmD, MPH, director of research and publications at Humana and a co-author of the study. “(I)t shows that seniors can be highly engaged in electronic media, which has the potential to greatly expand the number of people these types of programs can help.”

Omada’s platform, modeled after the National Diabetes Prevention Program (NDPP) that is proposed to become a Medicare-covered benefit in 2018, resulted in weight loss totals that exceed the benchmark set by the Centers for Disease Control and Prevention’s National DPP program (5 percent reduction in weight at six and 12 months) and are equal to results seen in high-cost, face-to-face programs. The Omada program reported weight loss averages of 8 percent over 6 months and 7.5 percent over 12 months.

Just as importantly, researchers said, the program showed other successes – improvement in glucose control, a key indicator of type 2 diabetes, and overall well-being and mental health – that prove the value of a program that targets weight loss.

“These indirect benefits of program participation are highly relevant to successful aging, as well-being and psychological health have a profound impact on older adults,” the study reports. “Positive improvements in well-being and psychological health for older adults are important for preserving overall health and preventing the onset of disease as people age.”

“The findings of positive improvements in self-care activities among the respondents of the survey suggest that the program successfully modified the targeted health behaviors as intended: improving eating and physical activity patterns,” the study added. “The program increased both the number of days of healthful eating and regular physical activity, and reduced the frequency of consumption of high fat foods.”

The study offers proof that a program combining mHealth and personalized coaching could make an impact on a population that’s growing – and one that will continue to stress the nation’s healthcare system.

National studies indicate obesity rates are at 35 percent for men and 40 percent for women, while the number of Americans aged 65 or older will rise from 40 million in 2010 to more than 88 million by 2050. Of that population, at least 66 percent are overweight, and more than half are at risk for type 2 diabetes.

This isn’t the first time an mHealth-enabled platform has been held up as a model for weight loss and chronic disease management. Just last September, a study published in the British Medical Journal reported success with a Northeast-based insurance company that had offered overweight members access to Noom Health, a free app that provides online education and access to coaching.

The study’s authors said it “addresses the major barriers facing the widespread translation of the NDPP in the community setting; including high fixed overhead, fixed locations, and lower levels of engagement and weight loss.”

“Our findings support the effectiveness of a uniquely mobile prediabetes intervention, producing weight loss comparable to studies with high engagement, with potential for scalable population health management,” they concluded.

St Jude Children’s Research Hospital, meanwhile, launched a program last December in which clinicians are using an online platform and wireless mHealth devices to coach children with weight management issues at home.

That platform – Fruit Street – is also being used in a pediatric telemedicine weight management program at the University of Michigan and in a binge-eating disorder study at the University of North Florida (which added the Apple Watch to its platform).

The pilot NDPP, launched in 2013 with an $11.8 million CMS Health Care Innovation Award to the National Council of Young Men’s Christian Associations of the United States of America (Y-USA), invited eligible Medicare beneficiaries at high risk of developing type 2 diabetes to attend weekly meetings with a lifestyle coach, who trained the participants on diet, exercise and healthy lifestyle. Those weekly sessions eventually became monthly sessions.

According to federal officials, about 6,000 people participated in the 15-month program, with 25 percent attending more than 17 sessions, 37.5 percent attending nine to 16 sessions, 37 percent attending less than nine sessions and more than 80 percent attending at least four sessions. Those attending at least four sessions lost an average of 4.73 percent of body weight, while those attending at least nine sessions lost an average of 5.17 percent of body weight.

The Department of Health and Human Services estimated that the program saved $2,650 in Medicaid costs per enrollee.

Humana and Omada Health researchers say their study proves that an NDPP-modeled program with a digital health platform can make an even bigger impact.

“These remotely delivered programs retain the essential elements of behavioral counseling, including a high level of interaction with a remotely accessible health coach, group-oriented support, paced educational components, and skill building for health behavior change,” they noted in the study. “At the same time, technology-enabled programs can be delivered asynchronously and on demand, providing flexibility and increased accessibility for those whom fixed, location-based services are impractical. The remote access to a live health coach is an especially important component, as programs without access to a live coach have been deemed to have insufficient evidence to support their widespread use.”

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