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Medicare Diabetes Prevention Program Model Expands Nationwide

CMS is extending its Medicare Diabetes Prevention Program to include both traditional healthcare providers and community-based organizations.

The Medicare Diabetes Prevention Program will expand nationwide

Source: Thinkstock

By Jessica Kent

- The Centers for Medicare and Medicaid (CMS) has expanded its Medicare Diabetes Prevention Program (MDPP) nationwide.  The program will now enroll both traditional healthcare providers and community-based organizations as Medicare suppliers of health behavior change services.

The MDPP is a national performance-based model that offers a new approach to type 2 diabetes prevention in Medicare beneficiaries.

One of the critical innovations in the MDPP is its method of care delivery and the new inclusion of community-based organizations. After achieving preliminary or full recognition through the CDC, community-based organizations can enroll in Medicare to provide evidence-based diabetes prevention services.

“This innovative model promotes patient-centered care and continues to test market-driven reforms to drive quality of care and improve outcomes for America’s seniors, more than a quarter of whom have type 2 diabetes,” CMS Administrator Seema Verma wrote in a blog post.

“CMS recognizes that prevention is a critical part of creating an affordable healthcare system that puts patients first, and we encourage eligible suppliers to partner with us on this shared goal by participating in the national expansion of the MDPP.”

Verma noted that each year, the Medicare program spends more than $104 billion treating patients with the condition.

If current trends continue, the number of adult patients with diabetes will increase approximately twofold by 2050, CMS states on the MDPP website.

The MDPP model aims to change this. The program is the first preventive services model test of the CMS Innovation Center to expand nationally.

Launched in 2012, the model started as a small, voluntary test model at 17 sites across the country as part of a partnership with the YMCA-USA, CDC, and other public and private organizations.

In the initial test, 45 percent of beneficiaries met the five percent weight loss goal, an achievement that can meaningfully reduce the risk of developing type 2 diabetes.

Because of these promising results, CMS will expand this set of services nationwide, offering curriculum-driven coaching and proven behavior change strategies to high-risk beneficiaries.

The MDPP expanded model will also employ trained community health workers and other health professionals will help empower patients to take control of their own health and wellness.

The services consist of a minimum of 16 intensive core sessions over a six-month period. The classroom-style, group-based sessions provide practical training in long-term dietary change and increased physical activity.

After completing the core sessions, participants engage in less intensive monthly follow-up meetings to help ensure that they maintain healthy behaviors.

In addition, as part of a new preventive service for qualifying beneficiaries, MDPP services are now available without a referral or co-payment.

The program will not only benefit patients, but the Medicare program as a whole. Verma wrote that investing in preventive services through performance-based payments will save the Medicare program more than $180 million by avoiding new cases of diabetes and keeping patients healthy.

CMS expects that this new, expanded model will improve health outcomes for Medicare patients and prevent the development of diabetes in high-risk individuals.

“The MDPP is leveraging innovation to bring valuable preventive services to our beneficiaries, and I urge eligible organizations across the country to enroll today in this exciting performance-based payment opportunity,” Verma concluded.

CMS will accept supplier applications on a rolling basis.

Eligible organizations interested in becoming an MDPP Supplier can begin the screening and enrollment process by using the Provider Enrollment Chain and Ownership System (PECOS) or submitting the paper CMS-20134 Form. For more information on the steps to enrollment, click here.

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