- The American Medical Association is once again lobbying for more telehealth in the Diabetes Prevention Program, arguing that digital health access to coaching and health and wellness resources could help roughly 84 million Americans avoid diabetes.
In a story on the AMA’s website and a study published in the American Diabetes Association’s Diabetes Spectrum newsletter, the organization pushes for more acceptance of telehealth and mHealth in the program, which has been recognized by the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS).
Most DPP programs focus on in-person classes and one-on-one coaching, though a growing number are looking at online classes and connected health portals to reach more people.
“Although the DPP lifestyle change program has strong evidence to support its effectiveness in preventing type 2 diabetes, many of the 84 million patients with prediabetes aren’t able to participate in an in-person program,” the AMA article states. “Some patients may not have the time or resources to attend weekly or monthly classes, or they may prefer an on-demand interaction at their convenience. Digital health, and specifically virtual diabetes prevention LCPs (lifestyle change programs), offer a way to overcome those barriers and connect more patients with programs to improve their health.”
Some 70 healthcare providers are listed on the CDC’s DPP website, though only 11 have been recognized as offering proof that their online programs reach recognized benchmarks for activity and weight loss.
In addition, CMS currently does not reimburse healthcare providers for using DPPs that feature telehealth or mHealth technology. The agency has said it will continue to study the advantages of using connected health technology, but it hasn’t yet moved to cover those services.
The Diabetes Spectrum paper, written by Kate Kirley, MD, the AMA’s director of chronic disease prevention, and Neha Sachdev, MD, the organization’s director of health systems relationships, points out that “there is fair- to good-quality evidence that these programs are effective in achieving clinically significant weight loss and often have high engagement rates.”
Kirley and Sachdey note that the largest analysis so far of the DPP model found that it reduced one’s chances of developing type 2 diabetes by 58 percent over three years. In addition, digital health programs offered by Omada Health and Noom – two CDC-recognized vendors – show significant improvements in activity and weight loss among participants, resulting in improved health and wellness and a reduced risk of developing type 2 diabetes.
“As the United States strives to reduce the burden of type 2 diabetes, digital health-supported LCPs can innovatively bridge the clinical and community settings and are an important addition to our national type 2 diabetes prevention strategy,” Kirley and Sachdey wrote.
The AMA has been advocating for more telehealth for several years. In 2016, the organization adopted a policy to encourage private and public health plans to include the DPP as a covered benefit for their beneficiaries.
“We have a proven way to help these people make necessary lifestyle changes that can help them avoid developing the disease, but health coverage for these programs is limited and varies by location and insurer,” then-incoming AMA President Andrew W. Gurman, MD, said following the AMA’s annual meeting. “We urge both private and public health care payers to offer the diabetes prevention program under their health plans to give more people access to these proven programs.”
In addition, the AMA announced a partnership with Intermountain Healthcare and Omada Health in 2016 to support digital health platforms in DPPs.
“Research shows that participation in evidence-based diabetes prevention programs can cut the risk of developing type 2 diabetes by nearly 60 percent,” Gurman said at that time. “Online technology such as Omada’s program will help Intermountain physicians and care teams stay connected with their patients as they take proactive steps outside of the clinical setting to prevent type 2 diabetes. By bridging this gap, treatment touch-points with patients over the course of their time in the online program can be more meaningful and impactful, which we believe is a win for both patients and their providers.”
But CMS has yet to be convinced of the value in a digital program. When the agency announced in late 2017 that virtual coaching would not be reimbursed in DPP models for Medicare recipients, proponents lamented that CMS is shutting out a significant population that these types of programs should be serving.
“Without the inclusion of virtual providers in the benefit, millions of clinically eligible Medicare beneficiaries will not have viable options to access a service which could improve their lives based solely on the zip code in which they reside,” Adam Brickman, a spokesman for Omada Health, said shortly after the announcement.