Medicare to offer reimbursements for Diabetes Prevention Programs

Omada Health

Medicare will cover the Diabetes Prevention Program (DPP), including digital versions like Omada Health’s, marking the first time a preventative model from a CMS Innovation Center has been expanded into the Medicare program.

“This program has been shown to reduce health care costs and help prevent diabetes, and is one that Medicare, employers and private insurers can use to help 86 million Americans live healthier,” HHS Secretary Sylvia Burwell said in a statement. “The Affordable Care Act gave Medicare the tools to support this groundbreaking effort and to expand this program more broadly. Today’s announcement is a milestone for prevention and America’s health.”

Based on pilot studies, participants in the program lost an average of 5 percent of their body weight, while 80 percent attended at least four weekly sessions. Also, compared to Medicare beneficiaries outside the program, the DPP would save about $2,650 per enrollee.

Omada is the largest CDC-recognized DPP provider that works with 45,000 individuals via employers, health plans, and health systems. In a recent study, conducted six months after starting the program called Prevent, 84 percent of participants, with an average age of 69, remained engaged and lost an average of 7.8 percent of their body weight.

So far, Omada has worked with Medicare and Medicaid populations but on a smaller scale — with Medicare they’ve only worked in Medicare Advantage populations, and with Medicaid they’ve done some small trials.

“I think what we’ve felt from HHS is a really strong level of support for technology across the board, which I think is a beautiful thing,” Omada Health CEO Sean Duffy told MobiHealthNews. “I hope this sets the stage for ‘Are their other programs with clinical proof and published evidence that show they can impact that population positively?'”