Across the country, 86 million – or one in three Americans – have prediabetes. Within three years, 30% of these people will progress to Type 2 diabetes. People with prediabetes are those who are beginning to show signs of being unable to regulate their blood sugars, but have not crossed over into a full diabetes diagnosis. Prediabetes is tightly correlated with being overweight and obese, and the condition is more prevalent in older and low-income adults.
To address this growing issue, the Centers for Medicare & Medicaid Services established the National Diabetes Prevention Program (DPP), an initiative that reflects a remarkable 15-year journey of translating clinical research into practice. The program stemmed from National Institutes of Health (NIH)-sponsored research that demonstrated a nearly 60% reduction in diabetes diagnoses for people with prediabetes who were assigned to a structured lifestyle intervention focusing on physical activity and healthy eating. With these results, the Centers for Disease Control and Prevention (CDC) recognized the importance that this intervention could have in slowing and reversing the diabetes epidemic, and subsequently created the National DPP. The CDC now oversees administration of the National DPP and ensures that organizations delivering the intervention adhere to a curriculum and measure key progress metrics, and that peer coaches are adequately trained. The National DPP is constantly evolving, including the integration of food banks and food pantries in its program. The most recent step forward has been the coverage of the National DPP by health insurers as a clinical preventive service – like an influenza vaccine.
In the beginning, it was employers that sought this kind of group-counseling program for their employees and insisted that the program be included as part of their health insurance. Then, Medicare announced that they would cover the DPP for all Medicare beneficiaries. Medicare coverage began only a few months ago, on April 1, 2018 and many organizations that had been delivering the National DPP are now stepping up to the increased requirements to become a Medicare DPP supplier.
Hunger relief professionals are aware of the broad prevalence of food insecurity for older adults, people with disabilities and the working poor. The recent development in DPP coverage may be most relevant to our community – coverage by Medicaid. Medicaid is the largest health insurance program in the country serving more than 70 million low-income Americans. California and New Jersey are in the process of offering DPPs as a Medicaid-covered service. Health insurance coverage provides a predictable and sustainable source of third party payment for a program that previously relied on grants, donations or self-pay. Making DPP available to Medicaid beneficiaries will improve health equity by making the benefit accessible to our most vulnerable populations.
Medicaid health plans and professionals aiming to build community DPP capacity are recognizing that food banks and their affiliated food pantries can play a vitally important role not only in screening and referring eligible clients, but also in serving as class sites for the coaching sessions. Furthermore, since DPP coaches do not need to be licensed health care professionals there is an economic development opportunity for residents of lower-income neighborhoods to become paid DPP coaches.
As the DPP becomes a covered Medicaid benefit, providers will need to address barriers to access and participation that may exist for people living in low-income communities. This is an opportunity for the food banks to offer valuable guidance to health plans on community engagement for health promotion programs. Solera Health’s early work with Alameda County in California has pointed out the critical importance of community engagement. Taking into consideration convenient class times, warm hand-offs from the food bank to DPP program staff to build trust as new people are introduced, and minimizing the repetitive number of times clients have to provide identifying information have all contributed to strengthening the local program. As the health insurance and social supports and services worlds move closer together, it is important to not jump into a contractual frame of mind, but to allow time for joint exploration and problem solving.
Dr. Sandeep Wadhwa is the Chief Health Officer and Senior Vice President, Market Innovation at Solera Health. Dr. Wadhwa is a geriatrician and served as the State Medicaid Director for Colorado. He also worked for 3M and McKesson where he led their population health services. Sandeep serves on the Board of Reinvestment Fund, a $1 billion community development bank. He received his undergrad from Wesleyan, medical degree from Cornell, business degree from Wharton and continues to see patients at the Seniors Clinic of the University of Colorado Hospital.