Diabetes Prevention Efforts in Delaware Gain Ground Addressing Priority Populations

Submission Date: September 2023

State/Territory Submitted on the Behalf of: Delaware

States/Territories Involved: Delaware, Pennsylvania

Funding Source: CDC

CDC Funding:

Yes

CDC Funding (Specified):

Other CDC Funding

Grant Number:

CDC-RFA-DP18-1815PPHF18

Other Federal Funding:

N/A

Domain Addressed:

Health Promotion

Public Health Issue:

According to the Delaware Behavioral Risk Factor Survey, as of 2021 approximately 12.6% (approximately 100,000 adults) of Delaware’s adults reported being diagnosed with prediabetes, a condition that puts them at greater risk of progressing to type 2 diabetes. Based on national data, one in three adults have prediabetes, with an increased risk for developing type 2 diabetes; about 80% of them do not know it. This suggests more than 211,000 adults in Delaware have prediabetes but are not aware they have it. According to The Impact of Diabetes in Delaware 2023 report, the prevalence of type 2 diabetes is significantly higher among adults ages 55 and older as compared to those under the age of 55. The prevalence of type 2 diabetes is higher among non-Hispanic Black Delaware adults compared to non-Hispanic white adults. While the five-year age-adjusted mortality rate for diabetes continues to decline, there are concerns about disparities by race. The five-year age-adjusted mortality rate for diabetes among non-Hispanic Black adults (34.5 deaths per 100,000 population) is twice that compared to non-Hispanic white adults (17.2 deaths per 100,000 adults).

Project Objectives:

The Delaware Diabetes and Heart Disease Prevention and Control Program (DHDPCP), housed within the Delaware Department of Health and Social Services (DHSS) Division of Public Health, is a public health program that supports evidence-based lifestyle changes for adults at risk for developing type 2 diabetes. The National Diabetes Prevention Program (National DPP) lifestyle change program, a year-long program, helps people who are disproportionally affected by type 2 diabetes build healthy habits and reduces their risk for type 2 diabetes, with an emphasis on priority populations. Despite evidence that the National DPP is a cost-effective and proven method to prevent or delay type 2 diabetes, there is a low participation rate among Delawareans who are at high risk. The DHDPCP seeks to increase referrals to and enrollment in the National DPP using both widespread approaches to reach all Delawareans and approaches intended to reach those at high risk.

Program Action:

In March 2021, during the COVID-19 public health emergency, the DHDPCP convened a virtual State Engagement Meeting (vStEM) Series for key stakeholders to collaborate and advance efforts to prevent type 2 diabetes. Delaware’s vStEM Series, supported by the National Association of Chronic Disease Directors (NACDD), used collective action to grow sustainable partnerships, improve provider referrals, expand program availability, strengthen program support, increase enrollment, and secure coverage for the National DPP lifestyle change program.

The DHDPCP established an Umbrella Hub Arrangement (UHA) with the Health Promotion Council of Pennsylvania, increasing the availability of the National DPP lifestyle change program in Delaware. A UHA is convened by an Umbrella Hub Organization (UHO) which has full CDC recognition to offer the National DPP lifestyle change program. UHOs can provide administrative support, such as billing services, claims submissions, data management and reporting, to subsidiary organizations. Subsidiary organizations, often community-based organizations, may lack the infrastructure needed to support billing for services. However, many of these organizations can access and engage priority populations. When participating in a UHA, these organizations can focus on engaging priority populations and delivering the National DPP lifestyle change program.

Contracts were created with Medicare and Medicare Advantage plans in Delaware to cover the National DPP lifestyle change program for eligible beneficiaries. The UHA is working with all three managed care organizations in Delaware to also offer Medicaid coverage of the National DPP lifestyle change program.

Three organizations, each representing one of the three Delaware counties, were recruited to deliver the National DPP lifestyle change program. Of those, Focus Pharmacy and Beebe Healthcare are offering the National DPP lifestyle change program to cohorts and Willey Pharmacy is preparing to launch the program. Beebe Healthcare began by offering the program as benefit for their patients with Medicare coverage. They are planning to offer the program as a covered benefit for employees and plan to expand to the broader community as Medicaid coverage becomes available.

Impact/Accomplishments:

The development of the UHA creates connections with trusted community-based and health care organizations that serve populations disproportionally affected by type 2 diabetes, ensuring that the program reach is expanded to those who will benefit the most.

The current cohorts administered through the UHA are being offered in a low-rent, subsidized housing facility for older adults and adults with disabilities, and in a library in a rural area with limited health care services available. Focus Pharmacy’s first cohort of four participants is being offered in a Wilmington Housing Authority apartment complex. The group has a 97% attendance rate, with eight total pounds lost and an 84% increase in activity minutes. Similarly, in the first five weeks of the start of the first cohort offered by Beebe Healthcare at a public library, the 15 participants have achieved an 87% participation rate, an average weight loss of 1.5% of their starting weight, and a weekly average of 139 activity minutes.

The UHA creates a centralized and efficient administrative structure that promotes sustainability of the National DPP lifestyle change program by developing long-term, reliable reimbursement from public and private payers including Medicare and Medicare Advantage plans. The model is also expanding the reach of the National DPP to priority populations by working closely with community-based organizations.

Next Steps:

The UHA established by DHDPCP and the Health Promotion Council of Pennsylvania lays the foundation for reaching populations disproportionately affected by type 2 diabetes. Wendy Bailey, trainer and educator for the DHDPCP, noted, “People don’t engage in these kinds of programs unless someone they know told them it was good. So, you must start small and build.” Recruitment and retention of participants and subsidiaries is bolstered by the establishment of a UHA. The UHA removes several administrative challenges that prevent many community-based organizations from participating in and offering the National DPP lifestyle change program.

As coverage expands to include new payers, particularly Medicaid managed care organizations, the UHA will coordinate with Quality Insights who engage with health systems and electronic health records to increase provider referrals to the National DPP lifestyle change program. Quality Insights will be able to provide lists of eligible participants and recruit potential participants through letters and phone calls. The existing work with Quality Insights provides a pathway for participant recruitment to further strengthen the work of the UHA.

State Contact Information:

Delaware
Kelli Janowski
Delaware Department of Health and Social Services, Division of Public Health, Diabetes and Heart Disease Prevention and Control Program
302-744-1079
Kelli.Janowski@delaware.gov

Board President's Challenge:

No

Program Activities Date Range:

March 2021

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