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Case for Coverage for Commercial Plans and Employers

 

This page explains how to make the case for commercial health plans (commercial plans) and employers (including state and local public employers) to cover the National Diabetes Prevention Program (National DPP) lifestyle change program. It contains the following sections:

  1. Why Making the Case for Coverage is Important
  2. Engaging Employers
  3. Preparing and Presenting the Case for Coverage
  4. Key Decision Points
  5. Assessing Success Through Evaluation
  6. Supporting Program Sustainability
  7. Resources

 

Why Making the Case for Coverage is Important

The National DPP lifestyle change program’s ability to improve health in participants and reduce health costs for payers is supported by a significant amount of evidence. Unfortunately, this evidence is not widely known. For employers and commercial plans to secure leadership support and funding for the National DPP lifestyle change program, they need to understand this evidence, as well as key decision points needed to plan a successful delivery. Many individuals could compile this information for an employer or a commercial plan, including an individual within the organization, a broker, a benefit consultant, or another interested party, such as a public health department, a business group on health, or a CDC-recognized organization.

The case for coverage can be shared with employers and commercial plans one-on-one, or to multiple organizations at once such as through business groups on health, other collaboratives on health, industry-specific trade groups, HR associations, and health care publications targeted to the desired audience.

Did You Know?
  • The number of US adults with diagnosed diabetes quadrupled from 5.5 million in 1980 to 21.9 million in 2014; it is estimated that 2 in 5 adults in the US could have diabetes by 2060.1
  • Diabetes is the costliest of the 155 most common diseases in the country, at $306.6 billion in direct medical costs and $106.3 billion in indirect costs (e.g., reduced productivity and absenteeism) in 2022.2, 3
  • Annual medical expenditures for people diagnosed with diabetes is $19,736 per year – 2.6 times as much as those without diabetes.3
  • Diabetes increases the risk of physical disability: People with diabetes have a 1.8 percentage point higher rate of being out of the workforce and receiving disability payments in comparison to their peers without diabetes.3

Templates for Sharing

Sharing about the National DPP lifestyle change program with an employer or a commercial plan does not have to be time consuming or intimidating. The premade documents below can be used for these conversations.

  1. CDC has created an editable Presentation Template for Employers and a Presentation Template for Commercial Plans, which can be used as a starting place when building a presentation.
    • To supplement the CDC Presentation Templates, NACDD and Leavitt Partners created the Case for Coverage: Commercial Presentation Outline, which contains tips for presenting, and additional information, statistics, and graphics that can be added to the CDC Presentation Templates.
    Presentation-Template-for-Employers
    Presentation-Template-for-Commercial-Plans
    Case-for-Coverage---Commercial-Presentation-Outline
  2. The Elevator Pitch for Commercial Coverage of the National DPP Lifestyle Change Program document contains a quick summary of talking points that can be used when approaching leadership and/or partners.
    Elevator-Pitch-for-Commercial-Coverage
  3. Finally, many health care organizations are a large employer themselves. The American Medical Association (AMA) created an editable case for coverage presentation template for health care organizations offering the National DPP lifestyle change program to their employees, which can be found here.

Additional studies supporting the efficacy of the National DPP lifestyle change program in preventing type 2 diabetes are compiled on the Evidence page of the Coverage Toolkit, and a downloadable comparison of these studies can be found in the National DPP Lifestyle Change Program Literature Review.

National-DPP-Literature-Reviews

Engaging Employers

Employers across the nation are making the decision to cover the National DPP lifestyle change program for various reasons, including the fact that it can:

  • Decrease the cost of providing health care to employees over time;
  • Improve the health of at-risk employees by preventing or delaying the onset of type 2 diabetes;
  • Engage employees in preventive care practices, resulting in higher productivity; and
  • Provide a wellness benefit for employee retention.
Healm

Partners interested in supporting employers in covering the National DPP lifestyle change program can consider using Healm. Healm is a free-to-use online platform that walks employers through the process of covering the National DPP lifestyle change program for their workforce. Healm includes proprietary decision-making software, a personalized progress tracking and metrics dashboard, and assistance from trained Guides. These tools can help employers gain support from leadership and implement the program successfully. More information on how Healm can be used by employers is available on the Healm Employer Platform page of the Coverage Toolkit.

Healm Banner

Additionally, the National Association of Chronic Disease Directors (NACDD) and the Centers for Disease Control and Prevention (CDC) have created a network of employer champions called the Employer Network. Healm gives access to this network, which allows employers to participate in webcasts and discussions with these champions and meet with subject matter experts from NACDD and CDC.

Additional Benefits for Employers

Employers have also cited additional benefits from offering the National DPP lifestyle change program, including positive behavioral health modifications, a focus on population health improvement, increasing employee engagement, and increasing employee satisfaction. Employee health can improve through reducing blood pressure, cholesterol levels, and weight, and increasing sleep quality by decreasing sleep apnea (see the Evidence page of the Coverage Toolkit). For more information, see the Cost and Value page of the Coverage Toolkit.

An employer’s interest in the National DPP lifestyle change program will vary based on the organization’s size, demographics, disease burden, stability, and dispersion of the workforce, as well as whether the company continues to have financial obligations to employees after retirement.

About Employer Health Insurance

Employers can provide health insurance coverage for their employees through a variety of methods, including through a fully-insured health plan or self-funded health plan.

  • Employers with a fully-insured health plan pay an insurance company to assume financial risk for their employees; i.e., the employees’ health care claims are paid by the insurance company.
  • Employers with a self-funded health plan accept financial risk and administer their own health insurance plan; i.e., the employees’ health care claims are paid by the employer.

According to an analysis in 2018, 49% of individuals in the United States had health insurance through their employer, and a 2018 Employer Health Benefits Survey found that 61% of covered employees were in a health plan that was completely or partially self-funded.

Employers with a Fully-Insured Health Plan

Employers with a fully-insured health plan work with a fully-insured health plan vendor (often with assistance from a broker or benefit consultant) to decide whether to cover the program for their employees or a subset of their employees. Employers with a fully-insured health plan do not have the same financial motivations as employers with a self-funded plan, since those in a fully-insured plan have shifted the financial risk associated with the management of the plan, including care management and wellness programs, to the fully-insured health plan vendor.

Employers with a Self-Funded Health Plan

Employers with a self-funded health plan decide themselves (often with assistance from a broker or benefit consultant) whether to cover the National DPP lifestyle change program for their employees or a subset of their employees. When employers use a self-funded health plan, the employer is responsible for managing the financial risk of providing benefits to its employees and their eligible family members and is on the front line for managing health plan expenses and containing cost increases. Therefore, these employers are highly motivated to implement changes that will contain health care costs and are likely to be more receptive to offering the National DPP lifestyle change program. Typically, the program is most appealing to employers with a self-funded health plan who have at least 750 employees.

Self-Funded Health Plan Administrators

In addition to sharing the case for coverage of the National DPP lifestyle change program with employers directly, it can also be shared with self-funded health plan administrators. These entities provide administrative support for multiple employers with self-funded health plans, yet do not assume the risk for the cost of health care. While a self-funded health plan administrator does not have the same financial incentives or program flexibility as an employer, they do have access to large numbers of employers in different industries, geographies, and demographics.

The role of the administrator can also extend beyond establishing coverage. Once the program is implemented, the self-funded health plan administrator may be able to pull together detailed claims data and outcomes reporting for the enrolled participants, providing deeper insight into the impact of the National DPP lifestyle change program on the members’ health and the total cost of care. The self-funded health plan administrator may also be able to reward participating and engaged members with incentives through their own wellness platform.

Wellness Programs Vs. Covered Benefits

Employers can organize and administer the National DPP lifestyle change program in multiple ways. It can be provided as a health benefit under the insurance plan; or many employers provide a wellness program for their employees that is designed to help employees eat better, improve fitness, lose weight, or simply improve overall health. The National DPP lifestyle change program shares these common goals and is an evidence-based program that has proven effective for employees at risk for type 2 diabetes. It would be an effective addition to an employer’s wellness program.

Wellness Programs vs. Covered Benefits

Wellness Programs:

  • Used to promote health and fitness
  • Often offered through a workplace, not the participant’s health insurance, at low or no cost to the participant
  • Often tied to a reward for the employee, such as health insurance premium discounts, cash rewards, or other incentives
  • Programs or options may be added or removed at any time
  • Examples of wellness programs include:
    • Smoking cessation
    • Weight loss
    • Preventative health screenings

Covered Health Insurance Benefits:

  • Health care items or services covered under a health insurance plan
  • Costs to the participant are associated with the health insurance (e.g., premiums, deductibles, co-payments, etc.)
  • Used to treat sickness or injury generally, but may also have programs to improve health in the absence of acute sickness or injury
  • E.g., can have benefits for preventive care and/or population health
  • Benefit options are generally stable (won’t change more frequently than yearly)
  • Using HSA Dollars to Pay for the Program

    Guidance provided by the Internal Revenue Service (IRS) in Publication 502 suggests that under certain circumstances individuals may be able to use funds in their Health Savings Accounts (HSA) to cover the costs of participating in the National DPP lifestyle change program. According to the IRS’ guidance, individuals would need to be diagnosed by a physician with a disease such as obesity, hypertension, or heart disease to use funds in their HSA account.

    The IRS stipulates the following:

    You can include in medical expenses amounts you pay to lose weight if it is a treatment for a specific disease diagnosed by a physician (such as obesity, hypertension, or heart disease). This includes fees you pay for membership in a weight reduction group as well as fees for attendance at periodic meetings. You can’t include membership dues in a gym, health club, or spa as medical expenses, but you can include separate fees charged there for weight loss activities.

    Note: Individuals should consult with an HSA or tax expert to ensure any expenditure of HSA funds complies with IRS guidance.

    Brokers and Benefits Consultants

    Health insurance brokers and benefit consultants are uniquely positioned to promote the National DPP lifestyle change program among their employer client base and can be an effective way to reach multiple employers at once. The Diabetes Prevention: A Practical Guide for Brokers and Benefits Consultants document explains why a broker or benefit consultant would want to promote the National DPP lifestyle change program and how to promote the program. For further information on how brokers and benefits consultants can talk to clients about the National DPP lifestyle change program, visit the CDC’s page for Insurance Brokers and Consultants. There you can find resources such as introductory email and script language, informational flyers for employers, and a customizable savings infographic.

    Brokers-and-Benefits-Consultant-Guide

    Consultant Perspective: Aon

    A consultant from Aon, a leading global professional services firm, shared the following perspective about the role of a consultant in supporting employers’ coverage of the National DPP lifestyle change program.

    • Consulting firms, like Aon, have teams that lead health and benefit consulting relationships with employers.
    • The National DPP lifestyle change program was a “hot topic” for employers when it first became available, but interest has waned in recent years as treatment vendors are typically advertised more. As such, employers generally gravitate towards treating the problem. Part of the consultant’s role is to try to expand their focus to address the root of the issues by focusing on prevention and risk reduction as well.
    • There is no one-size-fits-all approach and consultants tailor their feedback to each employer’s needs and budget constraints.
    • When bringing a program like the National DPP lifestyle change program to the table for employers, they look at data, culture, needs, and cost-drivers to help the employers make the best decisions that integrate within their overall wellbeing strategy.
    • A major barrier to employers implementing the National DPP lifestyle change program is that it must integrate with the organization’s overall wellbeing strategy and needs to differentiate itself from other weight-loss programs and solutions the organization may already be providing or considering. Employers manage a number of solutions and programs/vendors so each must have a clear purpose and integration strategy.
    • “It’s imperative for employers to see an additional added value when considering adding a new vendor. Vendors that have multiple offerings may appeal more to employers.”
    • When discussing programs like the National DPP lifestyle change program with employers, Aon does not talk about costs alone because, when investing in prevention, it could take time to see downstream improvements. They focus on the “value on investment (VOI)” as opposed to the “return on investment (ROI)”. Aon works with employers to develop a robust measurement framework to be able to measure the value and impact.
    • The process used to decide to implement the program depends on each employer. Some employers have built the business case and are ready and willing to implement programs and tactics. In that case, the decision-making process could take around six months. For others who are still looking at the data and available solutions, it could take up to 18 months.
    • Employers that are ready to act typically have data supporting the need for prevention, leadership that understands the data, a strong wellbeing strategy, and the budget to implement a new vendor.
    • Employers may hesitate to add a new vendor that only offers one modality or program to address a small portion of their population. If an employer is looking for a smaller number of vendors, they may want a new vendor to impact multiple population health factors or a broader population. At a minimum, the integration with other programs, offerings, and comorbidities should be clear.
    • Aon looks to impact health across prevention, risk reduction, and treatment. To increase employer awareness of the National DPP lifestyle change program, success stories from all different types and sizes of employers are important. Employers often want to see case studies from other employers to see their successes and learn from others.

    Preparing and Presenting the Case for Coverage

    Identify the Decision Makers and Potential Advocates

    A key step to preparing the case for coverage is identifying the decision makers or potential advocates within an organization who may have interest in pursuing coverage of the National DPP lifestyle change program. For employers, the individual responsible for benefits and/or wellness typically plays a critical role in making or evaluating the case for coverage. This individual’s title may be the Director of Benefits, Director of Wellness, Wellness Program Manager, Chief Medical Officer, Corporate Director of Human Resources, or an equivalent title.

    Public-Private Partnerships

    State health departments can be strong advocates for the National DPP lifestyle change program. Each state is funded by the CDC’s Division of Diabetes Translation to scale the National DPP lifestyle change program by increasing awareness of prediabetes and increasing referrals to, availability of, and coverage for the program. Most states have dedicated staff who focus on these efforts. The State Health Department should be considered a resource for payers regarding the National DPP lifestyle change program, and other evidence-based interventions, as they are highly informed in health policy, able to navigate rules and regulations, and bring far-reaching experience and relationships among various government and private sector services, programs, and people.

    More information about how businesses and public health agencies can partner together can be found in the CDC webinar entitled Developing Public-Private Partnerships to Improve Employee and Population Health. Additionally, a description of the value proposition of partnerships between businesses and public health agencies to improve community health can be found here.

    Consider the Timing

    Employers and other commercial payers may be more receptive to considering coverage of the National DPP lifestyle change program at certain times of the year. For example, the graphic below shows the typical benefit decision-making timeline for private employers that operate on a calendar year. While private employers may make decisions outside of this timeline, they are more likely to be amenable to learning about the National DPP lifestyle change program during the 1st quarter (January-March) or the 2nd quarter (April-June) of the year. Employers that operate on a fiscal year rather than a calendar year, such as many public sector employers, typically have open enrollment during the 2nd quarter (April-June), and therefore may be more receptive to new benefit information during the 3rd quarter (July-September) and the 4th quarter (October-December) of the year.

    Employer-Decision-Making-Timeline

    Address Questions About the Program

    When discussing the National DPP lifestyle change program with decision-makers and potential advocates, it may be necessary to address questions about the program. The Barriers to Coverage FAQ document addresses frequently asked questions about coverage of the National DPP lifestyle change program. Employers can also access personalized answers to all their questions through Healm.

    Barriers-to-Coverage-Frequently-Asked-Questions

    Employers considering offering the National DPP lifestyle change program as a covered benefit should also connect with their current health plan or self-funded health plan administrator. The Key Questions for Employers to Ask their Health Plan document can help employers start that conversation.

    Key-Questions-for-Employers-to-Ask-Their-Health-Plans

    Gather Data and Create a Budget Projection

    Most decision makers are interested in seeing data on how the National DPP lifestyle change program can improve employee or member health and reduce health care costs. Commercial plans and employers are likely to be most responsive to data that is reflective of their member or employee population. For example, data that matches the demographics (age, gender, socioeconomic status, etc.), industry, or geographic location of the member or employee population is more persuasive. Where such data is unavailable, national statistics can be used.

    The following resources contain data in support of covering the National DPP lifestyle change program:

    • The Cost and Value page of this toolkit compiles several resources describing the effectiveness and cost implications of the National DPP lifestyle change program. The Evidence page of the toolkit also contains additional resources.
    • Case studies can also communicate the impact the National DPP lifestyle change program. A compilation of case studies of employers and commercial plans offering the National DPP lifestyle change program can be found on the Commercial Coverage Landscape and Employer Coverage Landscape pages of the Coverage Toolkit.

    The following tools can help assess potential costs and savings related to the National DPP lifestyle change program:

    • The Budget Projection Template can be used to estimate the total cost of providing the National DPP lifestyle change program to eligible members or employees, as well as the average cost per participant. The Commercial Budget Projection Template Instructions is meant to be used alongside the Budget Projection Template to help the user identify the decisions and data needed. It also explains how to interpret the results of the Budget Projection Template.
      Commercial-Budget-ProjectionTemplate-Instructions
      Commercial Budget Projection Template Instructions
    • The CDC Diabetes Prevention Impact Toolkit is a user-friendly, interactive website that allows commercial plans and employers to assess the likely cost-effectiveness or cost-savings of covering the National DPP lifestyle change program. The default values in the Impact Toolkit are based on the best available data from relevant research, program implementations, state and industry averages, and expert judgment.

    Key Decision Points

    State health departments or other partners supporting commercial health plans and employers in covering the National DPP lifestyle change program should be aware of a few of the major decisions these payers would need to make when implementing the program.

    Program Elements and Options for Employers
    Delivery Method*
    Onsite – at the worksite
    Online or distance learning
    Community partners – in the community
    Coverage Method
    Employer-offered benefit
    Insurance-covered benefit
    Contracting Party
    Contract directly with CDC-recognized organizations that provide the National DPP lifestyle change program
    Contract directly with a third-party administrator (TPA) that handles billing processes and/or network management. The TPA establishes contracts with CDC-recognized organizations for the employer.
    Contract Type
    Invoice method
    Claims processing method
    (if coverage method is Insurance-covered benefit)

    *Regardless of the delivery method—onsite, online, or in the community—the organization should be recognized by the CDC’s Diabetes Prevention Recognition Program (DPRP).

    Who Will Deliver the Program?

    The National DPP lifestyle change program must be delivered through a CDC-recognized organization. CDC-recognized organizations are those that have demonstrated the ability to effectively deliver the evidence-based lifestyle change program with quality and fidelity as described in CDC’s Diabetes Prevention Recognition Program (DPRP) Standards.

    Contracting with CDC-Recognized Organizations

    Commercial plans and employers have the option to contract with existing CDC-recognized organizations to deliver the National DPP lifestyle change program. If this option is chosen, contracts between commercial plans and CDC-recognized organizations should outline expectations between the parties and include the National DPP lifestyle change program requirements. For more information on common elements included in a contract with a CDC-recognized organization, see the Contracting with CDC-Recognized Organizations page. Commercial plans and employers can see CDC-recognized organizations listed by state here.

    Alternatives to Contracting with CDC-Recognized Organizations

    Instead of contracting with a CDC-recognized organization, commercial plans and employers can choose to seek CDC recognition and provide the program themselves. There are specific requirements that need to be met if an organization elects to take this approach, and resources about this process can be found on the CDC website and in the DPRP standards, as well as through the National Diabetes Prevention Program Customer Service Center.

    Alternatively, they can also contract with a third-party organization to create a network of CDC-recognized organizations that provide the National DPP lifestyle change program. Umbrella hub arrangements (UHAs) connect community-based organizations with health care payment systems to pursue sustainable reimbursement for the National DPP lifestyle change program.

    How Will the Program Be Delivered?

    There are many considerations for how to deliver the National DPP lifestyle change program, which can be found on the National DPP Lifestyle Change Program Delivery Options page of the Coverage Toolkit.

    Employer preference for the delivery method of the National DPP lifestyle change program (in-person, distance learning, or online) often depends on their culture and workforce demographics and whether the organization is global, national, or local in reach.

    • If the organization is local, employers may be more interested in in-person programming. Local, smaller employers may be less likely to have a larger budget for online delivery of the program.
    • If the organization is national, it’s a challenge to coordinate in-person programs. Many employers are looking for the same benefit to be rolled out to all employees, regardless of location, which is why online or virtual delivery is preferred.

    Which Billing Model Will Be Used?

    There are two billing models that payers can use when covering the National DPP lifestyle change program:

    • Invoicing: Commercial plans and employers can contract with CDC-recognized organizations and establish an invoicing method for billing. In this scenario, the CDC-recognized organizations invoice the payer based on the terms defined in the contract.
    • Medical Claims: CDC-recognized organizations can submit claims either directly to the payer or to the applicable UHA or third-party organization that handles billing and/or network management. To cover the National DPP lifestyle change program in a claims-based system, commercial plans will need to update their systems to accept claims with a specified combination of CPT codes with modifiers and ICD-10 diagnosis codes.

    Whether a claims process is used, or an invoice is sent, CDC-recognized organizations would be required to comply with all HIPAA regulations to ensure participant privacy. For more information on selecting a billing model, see the Coding and Billing page.

    How Will Employees or Members Learn About the Program?

    Employers or commercial health plans that begin offering the program will need to make an engagement and outreach plan for employees or members. A full description of this process can be found on the Screening and Identification, Recruitment and Referral, and Retention pages of the Coverage Toolkit. Employers and commercial health plans must comply with all health information privacy laws when implementing the National DPP lifestyle change program and outreaching to employees or members.

    CDC has created the following customizable templates for employers or commercial plans to outreach to employees or members about the National DPP lifestyle change program.

    • Email Template – This email template is for employers or insurers to email employees or members to encourage them to get tested for prediabetes and enroll in a program if eligible. It could be used for initial outreach or tailored for use during National Diabetes Month and Diabetes Alert Day.
    • Promotional Images – These images can be added to emails, slide presentations, intranet or social media posts, or other communications about the National DPP lifestyle change program. They also can be printed as postcards and mailed to employees or members.
    • Fact Sheet Template – This fact sheet is a one-page document for employees or members on prediabetes, the National DPP lifestyle change program, and enrollment.
    • Workplace Poster Template (24” x 36”) – This poster encourages employees to seek more information on available lifestyle change programs and to find out if they are eligible. It is meant to be posted in a common area.
    Healm

    Healm offers a full Program Pathway that guides employers through the decision-making and implementation process for the National DPP lifestyle change program, as well as access to experts and other employers along the way.


    Assessing Success Through Evaluation

    Why Evaluate?

    Planning to evaluate the impact of the National DPP lifestyle change program is an important part of the coverage discussion. There are several reasons why an employer or commercial payer would benefit from evaluating the program:

    • Obtaining feedback to improve the delivery of the National DPP lifestyle change program
    • Gathering data that demonstrates the value and effectiveness of the program
    • Measuring changes over time against a baseline
    • Securing continued funding for the program
    • Establishing accountability for the use of resources
    • Comparing the efficacy of the National DPP lifestyle change program to different interventions

    Developing a comprehensive evaluation plan will support efforts to improve the National DPP lifestyle change program and can be done in any context, such as during a pilot, when the program is a fully covered Medicaid benefit, or within a commercial context. The data collected during an evaluation can be used for many purposes, including to guide benefit design, measure changes over time against a baseline, and establish accountability for the use of resources.

    To learn about potential evaluation questions and measures, data sources, collection methods, and to find examples of states that have evaluated the National DPP lifestyle change program, please see the evaluation section of the Data, Reporting, and Evaluation page of the Coverage Toolkit. The Midwest Business Group on Health has a Diabetes Management in the Workplace Toolkit that includes additional suggestions for evaluation and measurement of the National DPP lifestyle change program.

    Scaling or Expanding the Program

    Collecting and evaluating information about the National DPP lifestyle change program puts commercial plans and employers in the position to expand the program in an effective and data-driven manner. Scaling up the program may have benefits such as efficiency gains when programs are scaled to larger groups, allowing the expanded group to be covered by the program with little to no additional overhead or administrative costs. However, scaling up may have hidden costs as well, which is why the decision should be data-driven.

    Data collection needs for scaling the program will likely revolve around the business decisions that need to be made. Business-related data elements may include:

    • Cost per program participant
    • Program enrollment and retention rates
    • Benefits directly resulting from the program, such as:
      • Reduced health care costs
      • Reduced employee absenteeism
      • Improved productivity
      • Improved member/employee satisfaction
      • Improved customer satisfaction
    • Future costs, based on expansion
    • Return on investment models, based on expansion
    • New logistical needs, based on expansion, such as:
      • Larger meeting places or more frequent use of meeting places to allow for multiple classes
      • Potential need for additional staff
      • Expanded delivery options, such as including an online option if not previously offered

    These data aren’t all inclusive but may help drive thinking around what should be considered when scaling the program.


    Supporting Program Sustainability

    After implementation of the National DPP lifestyle change program has begun, there are several ways a commercial plan or employer can ensure the program has enough traction to support ongoing coverage of the program. Employers who are already covering the program can also receive individualized assistance through Healm to support sustainability of the program.

    Continue to Engage the Referral Network

    Potential National DPP lifestyle change program participants may come from a variety of referral sources. While the initial launch may be limited to select members or employees, many payers have found that without continually working to engage the referral network, the success of the program can be limited. Healm can be used to help employers access state and local resources to identify employees who are at high risk for developing type 2 diabetes.

    Referring Health Care Providers and Clinical Care Teams

    Commercial plans and employers may consider outreaching to local health care providers’ offices to encourage referrals of eligible members to the National DPP lifestyle change program. Many entities have found that individuals are more likely to enroll in the program when referred by their health care provider. The CDC-recognized organization can also take the lead on outreaching to health care providers. Additional information about provider referrals can be found on the Recruitment and Referrals page of the Coverage Toolkit.

    Using Health Care or Claims Data for Referrals

    Commercial plans and employers can bolster referrals by working with the health plan administrator and/or network providers to generate eligibility reports either manually or from electronic medical records (in a HIPAA compliant manner). The contact information of individuals who are potentially eligible for the program can be transmitted to the CDC-recognized organization or the health care provider for outreach. Also, as more health care providers are engaged for referrals, the query fields could be shared with them to expedite the initial screening for eligible participants among their patient population.

    Continue to Engage Eligible Individuals and Participants

    Making individuals aware of their eligibility for the National DPP lifestyle change program is a helpful step toward enrollment, but simple awareness is often not enough to translate into referrals into program participants. Supplementary engagement and encouragement provided at key times may help motivate individuals start and continue the program.

    As an employer, wellness or screening events can be organized, internal emails can be sent, or announcements made at company-wide meetings. Incentives may also be offered for participating in a screening for the National DPP lifestyle change program, enrolling in the program, reaching program milestones, or completing the program. Commercial plans can send mailers to members or make phone calls to individuals who have not yet accepted the offer to participate.

    Additional information on how commercial plans and employers can increase the retention of program participants can be found on the Retention page of the Coverage Toolkit. These efforts to continue to engage and expand the referral network, as well as engaging the participants themselves, can be refined through analyzing the data that is generated by program participation.

    Consider a Pilot

    In some cases, commercial health plans or employers may be able to increase the sustainability of the program by piloting new approaches, such innovative payment models, using a UHA to help simplify administrative components of the program, or participating in a community care hub or partner network.

    Share Coverage Successes

    State and local public health agencies may consider partnering with commercial health plans or employers to create new and compelling case studies about successful implementation of the National DPP lifestyle program. This can support increased enrollment, increased program recognition, and/or an enhanced image for the participating organization.

    Commercial health plans and employers covering the program can participate in state-level panels, webinars, and conferences to share their stories and connect with other organizations. For example, by joining the Employer Network, employers can connect with other employers covering the program and participate in peer-to-peer sharing activities hosted by NACDD and CDC. Commercial health plans and employers can also have their National DPP work highlighted on this Coverage Toolkit by contacting us for more information.


    Resources to Help Make the Case for Coverage

    References:

    • 1. Lin J, Thompson TJ, Cheng YJ, Zhuo X, Zhang P, Gregg E, Rolka DB. Projection of the future diabetes burden in the United States through 2060. Popul Health Metr. 2018 Jun 15;16(1):9
    • 2. Dieleman JL, Baral R, Birger MI, et al. U.S. spending on personal health care and public health, 1996-2013. JAMA. 2016;316:2627-2646.
    • 3. American Diabetes Association. Economic costs of diabetes in the U.S. in 2022. Diabetes Care. Diabetes Care 2 January 2024; 47 (1): 26–43
    Content Updated: May 20, 2024