Advocacy for Diabetes Prevention as a Covered Health Benefit

Submission Date: September 2014

Entry Type: Case Study

State/Territory Submitted on the Behalf of: West Virginia

States/Territories Involved: West Virginia

Funding Source: NACDD

Other Funding:

NACDD funding

Domain Addressed:

Environmental Approaches

Public Health Issue:

In WV, the diabetes prevalence is 13% and the prediabetes prevalence is 8.6%. Without lifestyle changes to improve their health, 15 – 30% of people with prediabetes will develop type 2 diabetes within five years.

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 increase the number of state government employees targeted for the purpose of offering the evidence-based lfiestyle change program as a covered benefit for employees from 0-1.

Program Action:

The state’s public employee insurer, West Virginia Public Employees Insurance Agency (WV PEIA), had expressed interest in the evidence-based lifestyle change program and engaged the West Virginia Diabetes Prevention and Control Program (DPCP) in conversations prior to this project. The DPCP organized a meeting of insurers to discuss prediabetes and the benefits of the lifestyle change program. The DPCP distributed a diabetes prevention fact sheet and the CDC risk assessment tool. Following this meeting, additional quarterly meetings were scheduled. Early in the project, WV PEIA participated in the Department of Health and Human Resources Secretary’s wellness committee, which drafted a wellness program proposal for the agency. While the state insurer identified many barriers to covering the program under both benefit design and wellness programs, they seemed willing to work with the DPCP to overcome those barriers. WV PEIA entered into a Memorandum of Understanding with an evidence-based lifestyle change program provider to conduct a pilot program. Throughout the project, the DPCP acted as a resource to WV PEIA by sharing information and determining answers to questions related to barriers. The National Association of Chronic Disease Directors (NACDD) and MedWorks USA also provided direct support in this effort, including brokering conversations between the DPCP and insurers.

“Funding is the largest barrier to implementing the National Diabetes Prevention Program (National DPP). Offering the National DPP as a covered health benefit will facilitate implementation of the evidence-based lifestyle change program.” -Denise Ryan, Berkley County Health Department

State Health Department Roles

• Advocated for diabetes prevention coverage at the state level
• Organized meetings and engaged key insurance stakeholders to discuss prediabetes and the benefits of the evidence-based lifestyle change program
• Created educational materials to distribute at meetings with insurers
• Facilitated expert consultation and provided technical assistance to insurers to examine ways to overcome barriers to reimbursement

Partners

• Department of Health and Human Resources
• West Virginia Offices of the Insurance Commissioner
• West Virginia Bureau for Public Health Commissioner
• West Virginia Public Employees Insurance Agency
• National Association of Chronic Disease Directors
• MedWorks USA

Impact/Accomplishments:

1 State government employer educated about the evidence-based lifestyle change program and the value of offering it as a covered benefit

2 Meetings/presentations with government employer

65,000 State government employees working in this state government

Challenges/Lessons Learned:

Factors Supporting Success

• Dedicated Funding: $15,000
• Engaged in conversations about the evidence-based lifestyle change program with WV PEIA for two years
• Many insurers attended a Diabetes Prevention Roundtable Meeting to discuss provisions under the Affordable Care Act
• Key state government leaders supported diabetes prevention initiatives
• NACDD and MedWorks USA brokered conversations between the DPCP and insurers

Challenges and Solutions
Challenges with no solution yet identified: WV PEIA did not see the benefits of the evidence-based lifestyle change program as superior to the benefits of lifestyle change programs that were already reimbursable; at the present time in West Virginia, medical claims cannot be used to pay for the evidence-based lifestyle change program as there are no codes to cover services implemented by lay providers

Challenge:The DPCP lacked experience working with insurers prior to the project, and it was difficult to gather insurers for a meeting about the evidence-based lifestyle change program
Solutions: The West Virginia Bureau for Public Health Commissioner issued the invitation to the meeting, which gave credibility; representatives from NACDD and MedWorks USA assisted the DPCP in conversations with WV PEIA and other insurers.

Challenge: Senior state leaders with decision making power or influence who had supported diabetes prevention initiatives left their positions during the project time frame
Solution: The DPCP had to take time to establish relationships with new leaders

Next Steps:

The WV Division of Health Promotion & Chronic Disease will be bringing together diabetes prevention stakeholders to assess progress and determine WV’s next steps.

Program Areas:

Diabetes

State Contact Information:

WV
Jessica Wright and Tony Leach (Tony.M.Leach@wv.gov)
West Virginia Diabetes Prevention and Control Program
304-356-4193
Jessica.G.Wright@wv.gov

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