UPDATE: Screening and Coverage for Diabetes and Prediabetes. Karin Gillespie, Changing Diabetes Policy, Novo Nordisk

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1 UPDATE: Screening and Coverage for Diabetes and Prediabetes Karin Gillespie, Changing Diabetes Policy, Novo Nordisk

2 2 USPSTF Diabetes Screening Guideline

3 New USPSTF Abnormal Blood Glucose and Type 2 Diabetes Screening Guideline 3 Experts say: Screen for prediabetes and type 2 diabetes in adults who are at risk 2008 USPSTF risk factors 2015 USPSTF risk factors High blood pressure & overweight/obese Family history GDM or PCOS Ethnic/racial minority

4 4 New USPSTF Guideline Details and Coverage Implications 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

5 New USPSTF guideline Millions More Could Get Screened Number screened UDM detected UPDM detected 2015 USPSTF ADA 2008 USPSTF Source: Analysis by Tim Dall for NNI, IHS Global insights, November 2014, Based on study published in American Journal of Preventive Medicine

6 Kentucky: Estimated Diabetes Status of Adults: Undiagnosed prediabetes 1,081,000 33% Normoglycemia 1,604,000 49% Diagnosed prediabetes 132,000 4% Undiagnosed diabetes 112,000 3% Diagnosed diabetes 376,000 11% 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

7 7 Kentucky: USPSTF Screening Adults without diagnosed diabetes 2,929,000 Meet USPSTF screening criteria 2,359, % adults w/o DDM Normoglycemia 1,178,000 Diagnosed prediabetes 132,000 Undiagnosed diabetes 102, % of UDM Undiagnosed prediabetes 947, % of UPDM Do not meet USPSTF screening criteria Undiagnosed diabetes 10, % of UDM Undiagnosed prediabetes 134, % of UPDM Screened: Diabetes newly detected 23.1 Screened: Prediabetes newly detected 2.5

8 8 8 Kentucky: Meet USPSTF Screening Criteria Insurance Type UDM UPDM Total Screened Commercial 36, ,000 1,231,000 Medicare * 43, , ,000 Medicaid * 10, , ,000 Uninsured 13, , ,000 Total 102, ,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 dualeligible, Indian Health Services).

9 9 9 Kentucky: 805,000 Candidates for DPP Lifestyle Intervention Criteria Overweight or obese and Previously diagnosed prediabetes, or undiagnosed prediabetes but meets USPSTF screening criteria Medicaid (public assistance, age <65) 100,000 12% Medicare (public assistance, age 65+) 166,000 21% Uninsured 141,000 18% Commercial 398,000 49%

10 If 805,000 Candidates Achieved Average Outcomes of Diabetes Prevention Program Trials 10 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, , Quality adjusted life years 105, ,

11 11 If 805,000 Candidates Achieved Average Outcomes of 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 $13,854 Increased years of employment 46, ,200 Reduced missed work days 22,000 1,355,000 Absenteeism productivity gain ($ 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

12 Medicare Coverage for the National DPP

13 13 Medicare Announcement on National DPP 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.

14 14 Medicare Coverage of National DPP DAA met with CMS/CMMI officials in May 2016 to discuss implementation of 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 of 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

15 15 Medicaid Coverage of National DPP

16 16 State Health Plan Coverage of National DPP 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

17 Next Steps

18 18 Next Steps 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

19 Key Takeaways

20 20 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

21 Thank you! 21