Diabetes Prevention Covered as a Health Benefit

Submission Date: August 2014

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Kentucky

States/Territories Involved: Kentucky

Other Funding:

NACDD funding

Domain Addressed:

Environmental Approaches

Public Health Issue:

• In Kentucky, 233,000 adults have been diagnosed with prediabetes. Without lifestyle changes to improve their health, 15 to 30% of people with prediabetes will develop type 2 diabetes within five years.
• Ninty-six of Kentucky’s 120 counties had rates of diagnosed diabetes at 11.2% or above, ranking them in the top 20% in the nation (2010).
• The Diabetes Prevention Program research study showed that making modest behavior changes helped participants lose 5 – 7% of their body weight and reduced the risk of developing type 2 diabetes by 58% in people with prediabetes.
• Few employers, including state and local government, offer the National Diabetes Prevention Program’s (National DPP) evidence-based lifestyle change program as a covered health benefit for employees. One strategy to promote increased use of the lifestyle change program is to partner with state and local government agencies to adopt diabetes prevention as a covered benefit.

Project Objectives:

To foster collaboration between the Kentucky Diabetes Prevention and Control Program and at least one state government agency to define options for improving access to/support of the evidence-based lifestyle change program for public employees to prevent or delay type 2 diabetes.

Program Action:

As required by legislation, four state agencies in the Kentucky (KY) Cabinet for Health and Family Services created a biennial KY Diabetes Report. The Kentucky Diabetes Prevention and Control Program (KY DPCP) led this effort. The KY DPCP capitalized on the opportunity to educate key officials by connecting discussions about the evidence-based lifestyle change program to the diabetes prevention recommendation in the KY diabetes legislative report. The DPCP also garnered support from the Department for Public Health’s Deputy Commissioner of Clinical Affairs by arranging for her to be a state diabetes prevention spokesperson, presenting at numerous conferences. This relationship resulted in the state DPCP attending high level meetings focused on Medicaid and state employee coverage. The DPCP came to these meetings fully prepared to share content expertise and examples of other states’ experiences. They contacted Montana, where the evidence-based lifestyle program is covered by Medicaid, to gain a better understanding of their processes and protocols. The DPCP also spoke with Washington staff about coverage for state employees. Additionally, the DPCP used CDC leadership, Dr. Ann Albright, to conduct a presentation by phone followed by a face-to-face open dialogue meeting with the KY Medicaid MCOs.

Three outcomes resulting from the production of this report generated state momentum to support health benefit coverage:
1) Critical relationships between the state entities were established as they wrote the report.
2) The report, presented to the legislature in 2013, included coverage of diabetes prevention as a key recommendation.
3) The KY DPCP formed a Prediabetes/Diabetes Prevention Program (DPP) steering committee including staff from the Personnel Cabinet, Office of the Secretary, and the Department for Public Health. Committee members met with crucial stakeholders to increase their prediabetes awareness, inform them about current diabetes prevention work in KY, and share ideas about demonstration programs regarding DPP coverage through Medicaid and state employee health plans.
In 2013, diabetes prevention was integrated into the state employee health plan, and as of January 1, 2014, became a covered benefit.

“Passion…. Perseverance…. AND Patience —- Three needed virtues for DPCP staff.”     – Janice Haile

State Health Department Roles

• Educated and established ongoing communications with key government officials about the evidence-based lifestyle change program and its potential to reverse KY diabetes trends
• Recommended diabetes prevention initiatives be included in the 2013 KY Diabetes Report to the legislature
• Led the formation of a state DPP steering committee that helped to connect staff from key state entities with KY providers of the evidence-based lifestyle change program
• Provided prediabetes content expertise and resources for government leaders and decision-makers
• Shared experiences and materials from other states that had achieved success in securing diabetes prevention coverage for state employees or Medicaid members
• Created diabetes prevention educational and awareness materials
• Facilitated meeting with KY Medicaid Managed Care Organization (MCO) Medical Directors to present the evidence-based lifestyle change program

Partners

• Cabinet for Health and Family Services — Secretary and Senior Policy Advisor
• Department for Public Health — Commissioner and Deputy Commissioner of Clinical Affairs
• Personnel Cabinet – Commissioner, Department of Employee Insurance Staff, and third party administrator – Humana
• Medicaid – Commissioner, Chief Medical Officer (CMO), and staff
• Medicaid Managed Care Organizations
• YMCA (Louisville, Lexington, Northern Kentucky)
• AADE funded evidence-based lifestyle change program providers (Louisville, Lexington, Ashland)
• Local Health Departments (Louisville, Lexington, Northern KY)

Impact/Accomplishments:

• Coverage of the evidence-based lifestyle change program for state employees began in 2014
• 48,000 State employees now have the evidence-based lifestyle change program as a covered benefit
• Participation in the evidence-based lifestyle change program included as part of the state employee incentive points program in 2013
• 2 Payers/Government Employers educated about the evidence-based lifestyle change program and its value [Medicaid and the State Department of Employee Insurance]
• 6 Meetings with government employers and insurers

Challenges/Lessons Learned:

Factors Supporting Success

• Dedicated Funding: $13,600
• Experienced DPCP staff
• Diabetes prevention prioritized by the State
• Access to diabetes prevention experts and trained lifestyle coaches
• Acted as a neutral convener of a state steering committee that included all KY evidence-based lifestyle change program providers
• Built strong relationships with government leaders who ultimately became strong program supporters
• Learned from other states’ experiences
• Identified a program champion in the Department for Public Health’s Deputy Commissioner of Clinical Affairs

Challenges and Solutions

Challenge: The Medicaid program lacks funding to support the evidence-based lifestyle change program
Solution: Medicaid MCOs have engaged in active discussions regarding DPP coverage. Department for Medicaid Services CMO has agreed to work with the MCO medical directors to develop alternative support and funding model options.

Challenge: Due to timing issues, coverage for diabetes prevention programs as part of the state employee health plan was not possible for 2013
Solution: Piloted processes to identify and refer high risk state employees to a CDC recognized diabetes prevention program which led to full coverage in 2014

Challenge: KY DPCP staff needed a better understanding of how the evidence-based lifestyle change program could be a covered health benefit
Solution: Used relationships with other state and national experts who have been leading the way in diabetes prevention coverage to learn from their experience

Next Steps:

• Work to get prediabetes/diabetes prevention information and toolkits online (KY site) to increase access
• Continue to meet with steering committee every other month
• The National DPP will be presented again as a hot topic (with AADE presenting their data) at our annual symposium (~300 attendees)
• Continue to work with all our evidence-based lifestyle change program sites; currently have 17 providers serving 32 counties (we have developed sheets with more specific information which have helped insurance work out reimbursement details, etc.)
• Work with AADE and YMCA to do trainings in KY to expand sites and providers
• Plan to meet with Medicaid MCOs regarding coverage
• Coordinated YMCA (out of Lexington) to offer the evidence-based lifestyle change program within CHFS building where the largest number of state employees work (with Frankfort site working to become their own lifestyle change program site ongoing)

Program Areas:

Diabetes

State Contact Information:

KY
Theresa Renn (Theresa.Renn@ky.gov) and Janice Haile (Janice.Haile@ky.gov)
Kentucky Diabetes Prevention and Control Program
Theresa Renn 502-564-7996 X 4442; Janice Haile 270-686-7747 X 3031
Theresa.Renn@ky.gov

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