The Successes and Challenges of the Diabetes Prevention Program in California Medi-Cal

A session at the 2021 American Diabetes Association Virtual 81st Scientific Sessions, held from June 25-29, explored the challenges and projected outcomes of the Medi-Cal Diabetes Prevention Program (DPP) enacted in the state of California. The aim of the program is to significantly improve the health of Americans with diabetes and prediabetes in California and provide a roadmap to guide other states in following suit.

The effects of Medicaid coverage on the Diabetes Prevention Program in California were discussed by O. Kenrik Duru, MD, MSHS, from the University of California, Los Angles (UCLA). Gia E. Rutledge MPH of the CDC, and Yvette Roubideaux, MD, MPH, further discussed the strategies needed moving forward, current performance measures across the United States, and the positive outcomes on children with diabetes in Native American communities.¹

JOURNEY FOR MEDI-CAL PATIENTS

Duru underscored the statistics and reality of diabetes in the United States by discussing legislation aimed at fixing this health concern. He said, “As you can see 55% of adults in California have type 2 diabetes or prediabetes. We expect that over 5 years almost 2 Million Californians will be diagnosed with diabetes, but we believe with this program hopefully up to 25,000 people with prediabetes every year will be helped. Those arguments were enough to sway the state who ultimately voted to pass [Senate Bill] 97 and designate 5 million dollars to fund diabetes prevention programs for Medi-Cal patients.”

Duru presented models of a simulation analysis. “I wanted to bring your attention though to a simulation analysis done recently that focused on Medicaid and specifically also on California to give a sense to what we might expect with DPP coverage or Medi-Cal (California Medicaid),” he said. “Twenty percent of Medi-Cal beneficiaries enroll in DPP, at a cost of $800 per person, including identification, screening for prediabetes, enrollment, and delivery of the 12-month program. There would be lower incidence in Medi-Cal diabetes, peaking at the low point with 10 years out, reducing 3.8% [of] incidence cases. In 25 years, it would decrease diabetes.”

Concerns related to Medi-Cal programs were addressed, such as the disconnection and lack of incentives between factions. Duru explained through a mature Medi-Cal Stakeholder diagram that there needs to be more linkage through the organizations that administer Medi-Cal and health plans all the way through DPP suppliers.

He explained that “The 2 most important groups are clinicians and patients.” According to Duru, “Clinicians have been apprehensive to promote these programs and patients have not joined in the numbers that can be seen through implemented strategies moving forward. As of January 2019, Medi-Cal health plans must provide a CDC-recognized DPP to all interested and eligible beneficiaries with prediabetes, [including those who are] 18 years or older, overweight, or obese. Medicare is in person only for DPP; Medi-Cal covers in-person and virtual which we think may be very helpful as we work hard to get people engaged in the program. The ability to offer it going forward with both modalities…it’s a broad inclusion criteria list.”

Organizations and health plans reach out to clinicians and patients to inform them of Diabetes Prevention Programs. However, Duru noted that the reality that very few DPP suppliers have completed the application process may be the reason for the lack of communication from health plans to patients or health plans to clinicians. “We have wound up with relatively few patients enrolling with DPP suppliers. As of last week, only 3 DPP suppliers out of 100 are approved to bill California for Medi-Cal DPP’s (all 3 offer online programs),” Duru said. “Twenty-nine DPP suppliers in LA County report having started the application process. Few California DPP suppliers are currently offering in-person classes. There is work to do. It’s an issue of this being a challenging and extensive process to bill. [COVID-19] has put a wrench in all of this.”

Duru is part of a multi-site research team co-led by Kaiser Permanente and UCLA who will be studying the implementation of Senate Bill 97 over the next 4 years. The study aims to focus on Medi-Cal health plans and suppliers to get a sense of what they are doing and how they are planning to promote and recruit patients. Additionally, the researchers plan to reach out to the Medi-Cal DPP participants and DPP lifestyle coaches to identify what the barriers are, along with a quantitative aim to look at the target population (those with Medi-Cal). Lastly, this effort seeks to determine the effectiveness of mandated Medi-Cal DPP coverage by looking at the target population with Medi-Cal, with a control population with those on the health insurance exchange, and compare body weight, systolic blood pressure, diabetes incidence, and future cost savings.

CLINICAL AND COST OUTCOMES

The study will also aim to determine the effectiveness of mandated Medi-Cal DPP coverage by looking at the target population with Medi-Cal comparatively with a control population of those on the health insurance exchange. The researchers will examine body weight, systolic blood pressure, diabetes incidence, and future cost savings. Patients will be tested 12 months and 22 months after participants enter the cohort. The researchers will evaluate projected cost savings at 5 and 10 years out.

FUTURE PROJECTION

In 4 years, the goal is to have a better understanding of how DPP is working to improve population health and to identify and document weak links in the process, as well as challenges moving forward. Additionally, the researchers hope to identify success stories where DPP suppliers and clinicians are partnering for weight loss to then be publicized throughout the state and others to provide a roadmap for how the program can be implemented in other states.

Reference

Duru OK. Rutledge GE, Roubideaux Y. Diabetes Prevention in Vulnerable Populations. Presented at: American Diabetes Association Virtual 81st Scientific Sessions; June 25-29, 2021; online. Accessed June 25, 2021.