We Can Prevent Diabetes Study Results and DHS Updates: Collective Impact Meeting September 13, 2016 Jeff Schiff, MD, MBA MHCP Medical Director Department of Human Services
Disclosure Funding Support The We Can Prevent Diabetes Study was supported by Funding Opportunity Number 1BCMS330901 from the Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Services or any of its agencies.
Background Medicaid Incentives for Prevention of Chronic Diseases (2010 Affordable Care Act) 10 participating states Diabetes prevention, diabetes management, smoking cessation, weight management, blood pressure control, lipid control Diabetes Prevention Lifestyle Program (DPP): Minnesota, Montana, New York
Participating Organizations Minnesota Department of Human Services Minnesota Department of Health HealthPartners Institute YMCA of the Greater Twin Cities Diabetes Prevention and Control Alliance (UHG) 13 FQHC s and primary care clinic systems Medicaid beneficiaries
Participating Clinic Systems Axis Medical Center Community University Health Care Center Crown Medical Center HealthPartners St. Paul Clinic HealthEast/Entira Hennepin County Medical Center Neighborhood Health Source Native American Community Clinic Northpoint Health and Wellness Center Open Cities Health Center People s Center Health Services University of Minnesota Physicians Westside Community Health Services
Research Questions Can financial incentives facilitate increase participation by Medicaid beneficiaries in the Diabetes Prevention Program (DPP)? Can financial incentives for the DPP enhance weight loss among Medicaid beneficiaries at high risk for diabetes?
Financial Incentives Study Arms Attention Control: $25 for attendance at week one Individual Incentives Varying incentives for attendance each week Increasing incentives for attaining weight loss goals at 5%, 7% and 10% Group-Individual Incentives Varying incentives for individual attendance each week Individual incentive for 5% weight loss Incentives for group attendance goals and attaining target weight loss
Financial Incentives Study Arms, continued Maximum possible financial incentives: Attention Control: $25 Individual Group: $295 Group-Individual Hybrid: $295
Participant Eligibility: Inclusion Criteria Medicaid Assistance, PMAP, Minnesota Care BMI 25 kg/m 2 18-74 years of age Prediabetes FPG = 100-125 mg/dl IGT = 140-199 mg/dl HbA1c = 5.7 6.4% ICD-9: 790.21, 790.22, 790.29 Hx of GDM: 648.8x, self-report, medical notes
Participant Eligibility: Exclusion Criteria Diabetes diagnosis Pregnant @ enrollment Gastric bypass in next 12 months Alzheimer s or dementia Provider judgment
Recruitment, Enrollment & DPP Identified, recruited using Medicaid data, clinic EMR data, telephone outreach & community outreach 13 primary care clinics (21 clinic sites) DPP delivered by YMCA lifestyle instructors & clinic lifestyle instructors Enrolled & assigned to DPP classes using the MyNetico software package (DPCA) Assignment provided to lifestyle instructor 24 hours prior to the start of the 1 st session and revealed to participants at the 1 st session
Data Collection MyNetico Database: Eligibility criteria Demographics Attendance Weight Physical activity Clinic EHR: blood glucose, blood pressure, smoking status, lipids, weight Medicaid enrollment and claims data
Analyses Linear mixed models to increase the number of sessions attended Two-step model for weight change Weight on log scale; adjust for baseline weight Random intercept and slope for group classes with an autoregressive AR(1) structure for the error term Evaluate the effectiveness using the significance of the interaction term (2 df) and two planned pair-wise contrast (GRP vs AC and InD vs AC) Generalized linear model with binomial distribution Participation rates at 16 weeks and 52 weeks Weight loss goals (5%, 7%, 10%)
Recruitment, Enrollment and Class Assignment Total participants recruited: n = 2,072 Total participants enrolled: n = 1,154 27 participants never assigned to class Class randomization occurred after enrollment 30 Attention Control classes 377 participants, 279 attended one or more classes 33 Individual Incentive classes 392 participants, 309 attended one or more classes 30 Individual-Group Incentive classes 342 participants, 259 attended one or more classes
Attended vs Never Attended Characteristics Attended 1 Session (N=847) Never Attended a Session (N=307) HbA1c 5.7-6.4% 60.2 55.7 ICD-9 790.xx 8.3 12.4 Mean Age (years, SD) 48.3 (11.9) 46.5 (13.0) BMI: 25 <30 kg/m 2 20.5 28.0 BMI: 30 to <35 kg/m 2 25.7 27.0 BMI: 35 or higher kg/m 2 53.6 45.0 White 16.9 13.4 Black/African-American 63.5 58.0 Asian 4.2 7.5 American Indian/Alaska 10.0 12.0 Native Hispanic/Latino 3.9 8.1
Participant Baseline Characteristics: Age, BMI and Gender Age Group (%) IND (N=33; n=309) GRP-IND (N=30; n=259) AC (N=30; n=279) 18-44 years 33.3 35.9 32.3 45-64 years 60.2 60.2 62.4 65+ years 6.5 3.9 5.4 BMI (%) 25 < 30 kg/m 2 25.9 15.8 19.0 30 to <35 kg/m 2 26.9 22.4 27.6 35 or higher kg/m 2 47.2 61.8 53.0 Female (%) 70.9 72.6 70.2
Participant Baseline Characteristics: Language, Race and Ethnicity IND GRP-IND AC Primary Language(%) English 61.2 78.4 79.2 Spanish 2.9 3.5 0.4 Somali 31.7 15.4 14.3 Hmong 3.6 0.8 4.7 Other 0.6 1.9 1.4 Race/Ethnicity (%) White 15.5 25.1 10.8 Black/African-American 70.6 54.0 64.5 Asian 3.9 2.3 6.4 American Indian/Alaska 5.2 10.0 15.4 Native Native Hawaiian/Pacific 0 0 0 Islander Hispanic/Latino 4.2 6.2 1.4 Other or Missing 0.6 2.3 1.4
Study Results Results will be available upon request to the Minnesota Department of Human Services or the Department of Health once the final study results are published.
Medicaid Coverage of the Diabetes Prevention Program Two distinct payment policy changes to support DPP in fee for service Medicaid Community Health Worker payment policy: CHWs are enrolled providers under Medicaid Increased the number of billable units or hours permitted for CHW taught diagnosis-related patient education to 2 hours/day Limited to 12 hours per calendar month per recipient Increased hours support delivery of DPP classes Group size remains limited to 5-8 for CHWs
Medicaid Coverage of the DPP January 2016: DPP-specific payment code authorized in FFS Medicaid program National CPT demonstration code: 0403T Eligible organizations: Must be eligible to enroll as an MHCP provider Full or pending CDC recognition as a Diabetes Prevention Recognition Program (DPRP) Coaches do not need to enroll in MHCP
Medicaid Coverage of the DPP, continued Eligible recipients: Enrolled in FFS Medicaid Age 18 and older Meet DPP eligibility requirements
Questions? Thank you!