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Medicare Will Cover Diabetes Prevention Program for At-Risk Seniors

HHS Secretary Announces Expansion of Reimbursement for CDC-Recognized

Diabetes Prevention Programs like Omada Health


San Francisco, CA (March 23, 2016) – Acknowledging diabetes as one of the most pressing issues facing the American healthcare system, U.S. Department of Health and Human Services Secretary Sylvia M. Burwell announced today that Medicare will begin reimbursing CDC-recognized providers like Omada Health for administering the Diabetes Prevention Program (DPP) to eligible beneficiaries. On the sixth anniversary of the Affordable Care Act, Secretary Burwell’s announcement underscores Medicare’s commitment to value-based care by extending the agency’s investment in chronic disease prevention.

Today, more than half of all Americans over the age of 65 have prediabetes, and fewer than one in ten are aware they have the condition. Without intervention, one third of those with prediabetes will likely progress to type 2 diabetes in the next three years. In 2014, Medicare spent more than $15,700 per beneficiary with diabetes, and according to the Diabetes Care Project, one of every three dollars spent by Medicare goes to treating individuals with the condition.

“Today’s commitment by HHS quite literally extends a lifeline to 22 million American seniors with prediabetes,” said Omada Health co-founder and CEO Sean Duffy. “We feel fortunate to have the opportunity to work with CMS, Medicare Advantage plans, health systems, and physicians across the country to make a profound impact in these individuals’ lives. By elevating evidence-based diabetes prevention as the reimbursed standard of care, Secretary Burwell has acknowledged the urgency of addressing what has become a national epidemic. We look forward to continuing to provide data, evidence, and implementation insight to the team at HHS to ensure that the diabetes prevention benefit is implemented effectively, and reaches as many eligible beneficiaries as possible.”

Omada Health is the nation’s largest CDC-recognized DPP provider, working with employers, commercial health plans, and health systems to administer intensive behavioral counseling to more than 45,000 individuals at the tipping point of type 2 diabetes and heart disease. The company has enrolled more than 2,000 participants over the age of 65 in its program. Contrary to the expectations of many, seniors enrolled in the program have been easily able to integrate the technology elements of a digital diabetes prevention program into their daily routines. Six months after starting the program, 84% of participants, with an average age of 69, remained engaged in the program, and lost an average of 7.8% of their body weight. According to the authors of the original DPP trial, this amount of weight loss in participants 60 or older lowered risk of developing diabetes by 71% over three years.

Medicare currently reimburses health care providers to screen for diabetes, and to treat individuals with the condition. But today’s announcement marks the first time the largest healthcare payer in the United States will use expansion authority under the ACA to reimburse for a preventive service. The savings implications for preventing type 2 progression in seniors are enormous. An analysis of the impact of DPP coverage for seniors by Avalere Health estimated that extending a diabetes prevention benefit to Medicare beneficiaries would decrease federal spending on diabetes treatment by $1.3 billion in the first decade, with savings accelerating in the next ten years. In testimony before Congress in 2013, Dr. Kenneth Thorpe, Chairman of the Partnership to Fight Chronic Disease, estimated the savings could be more than twice that amount.

The Secretary’s announcement comes months after the American Diabetes Association, in conjunction with the American Medical Association and the Centers for Disease Control and Prevention, launched a prediabetes public awareness campaign encouraging at-risk individuals to get screened.

For the past three years, the YMCA has operated a demonstration project with the Centers for Medicare and Medicaid Innovation (CMMI) to test the efficacy of the DPP with Medicare seniors. In 17 communities across eight states, local Y’s have delivered evidence-based behavioral counseling to nearly 8,000 Medicare beneficiaries. Federal officials report that Medicare saved $2,650 over 15 months for every beneficiary enrolled in the program.

Omada Health is the leading provider of online DPP. The company’s remotely-delivered intensive behavioral counseling program combines proven behavioral science, the power of professional health coaches and peer groups, cutting-edge technology (including a wireless scale pre-synced to a participant’s account), a proprietary curriculum, and world-class design to deliver clinically-meaningful results. Last year, Omada became one of the first online DPP providers to receive pending recognition from the CDC for meeting the evidence-based standards of the National DPP. Omada also became the first digital health company to publish peer-reviewed results demonstrating that participants in its program maintained clinically-meaningful reductions in body weight and average blood sugar levels two years after starting the program.