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Michigan’s State Story of Medicaid Coverage

 

Overview

Since 2020, the Michigan Department of Health and Human Services (MDHHS) has used CDC 1815 funds to partner with two CDC-recognized organizations, Beaumont Health and National Kidney Foundation of Michigan (NKFM), to engage Medicaid MCOs in a state-supported pilot of the National DPP lifestyle change program. Michigan is using this pilot to understand what is needed to sustainably offer the National DPP lifestyle change program to Medicaid beneficiaries throughout the state.

The following MCOs are working collaboratively with NKFM and Beaumont Health to provide the National DPP lifestyle change program for their members as part of a pilot: United Healthcare Community Plan MCO (UHCCP) (working with both Beaumont and NKFM), McLaren, Blue Care Complete, and Priority Health Choice (working with NKFM). This pilot currently represents 44% (4 out of 9) of MCOs in Michigan (previously 5 out of 10, and then Total Health merged with Priority Health).

Although the COVID-19 public health emergency has impacted the implementation of the pilot, efforts are ongoing to identify and recruit participants, deliver the National DPP lifestyle change program while addressing social determinants of health, and collect and analyze data. Unique to Michigan, MDHHS is offering technical assistance to organizations participating in the pilot to carry momentum and further efforts towards supporting the National DPP lifestyle change program as a statewide Medicaid benefit.
 


Establishing Coverage

Initial Steps Towards Medicaid Coverage

In 2015, the Diabetes and Other Chronic Diseases Section staff within the Michigan Department of Health and Human Services (MDHHS) began considering policy options to establish Medicaid coverage of the National DPP lifestyle change program in Michigan. However, due to the parallel timing of CMS authorizing the Medicare Diabetes Prevention Program (MDPP), Michigan Medicaid opted to wait to pursue state Medicaid coverage to determine if and how the Medicare benefit might impact the design of a Michigan Medicaid benefit.

State-Supported MCO Pilot of the National DPP Lifestyle Change Program

In the meantime, MDHHS decided to pursue an MCO pilot of the National DPP lifestyle change program in Medicaid, using CDC’s 1815 funds. A state-supported MCO pilot would give MDHHS an opportunity to collect effectiveness data for the state Medicaid agency, and to test out administrative processes and delivery of the National DPP lifestyle change program to Medicaid beneficiaries in Michigan. For general information on state-supported MCO pilots and examples in other states, see the Engaging MCOs to Attain Coverage page.

Recruiting MCOs to Participate in the Pilot

As a first step in MCO recruitment, the MDHHS staff attended a “Pay for Success” convening and a meeting with the Michigan Association of Health Plans (MAHP), where MDHHS, in collaboration with NKFM, pitched the idea of a National DPP lifestyle change program pilot to Medicaid MCOs. Prior to the MAHP meeting, MAHP assisted MDHHS in sending out a survey to the attending MCOs to assess the MCOs’ current efforts around diabetes prevention. The Michigan team considered the survey to be an important step for partner engagement as it allowed them to structure their pilot proposal to complement the work of the MCOs.

The MCO pilot was framed as “free to the MCO” and as an opportunity for MCOs to work with experienced CDC-recognized organizations and receive technical assistance from the state. It was also presented as an opportunity to set up the necessary processes that may be required of MCOs if the program becomes a statewide Medicaid benefit.

Selecting MCOs

United Healthcare Community Plan MCO (UHCCP) was one of the first MCOs to show interest in piloting the National DPP lifestyle change program to beneficiaries. UHCCP took steps to pull prediabetes data to determine the current need and potential geographic areas of focus. MDHHS began having conversations with UHCCP to identify a potential CDC-recognized organization to work with.

In addition to UHCCP and the above MAHP meeting, NKFM and MDHHS conducted a readiness assessment with the additional interested MCOs to determine capacity and needs to build a successful pilot. The readiness assessment questions included:

  • Have you pulled prediabetes incidence data?
  • Do you have staff available?
  • Do you have capacity to do outreach?
  • Can you offer a data sharing agreement?

MDHHS was encouraged to find that quite a few plans were interested in the pilot. Several factors made these plans a good fit for Michigan’s pilot, including:

  • These plans were already pulling data on prediabetes rates for their members or had the ability to easily begin.
  • The plans were able to propose a focus on a higher-risk geographic area using this data.
  • The plans had staff capacity to assist in identifying and engaging members in the National DPP lifestyle change program.

Launching the State-Supported MCO Pilot

MDHHS launched the state-supported MCO pilot of the National DPP lifestyle change program with UHCCP and Beaumont Health in January 2020.

Since then, MDHHS has also partnered with the National Kidney Foundation of Michigan (NKFM) as an additional CDC-recognized organization to deliver the National DPP lifestyle change program to UHCCP members and to engage additional Medicaid MCOs to provide the National DPP lifestyle change program for their members as part of the pilot.

MCOs identify eligible participants, using indicators such as prediabetes diagnosis code, age, and history of gestational diabetes, and then send initial outreach to members using letters and/or emails. Business associate agreements (BAAs) are formed between the CDC-recognized organization and the MCO to allow sharing of information on eligible members (see the Contracting with CDC-Recognized Organizations page to learn more about contracting between MCOs and CDC-recognized organizations). In some cases, the CDC-recognized organization follows up directly with eligible members after initial contact by the MCO.

The COVID-19 public health emergency impacted the implementation of the state-suppored MCO pilot, especially since one of the participating CDC-recognized organizations is a large health system. However, as of late 2021, over 60 participants had enrolled in National DPP lifestyle change program. The pilot and recruitment and retention efforts are ongoing.
 


Implementing Coverage

Pilot Breakdown

Delivery Methods In-person and distance learning (distance learning only permitted during the COVID-19 public health emergency)
Participant referral requirements Same as the Diabetes Prevention Recognition Program (DPRP) requirements
Lifestyle coaches Same as the DPRP requirements
Medicaid enrolled provider eligibility N/A
Accepted CDC recognition levels Preliminary and full recognition
Provider enrollment N/A
Program duration Same as the DPRP requirements
Program repeatability Same as the DPRP requirements
Medicaid data submission requirements None
Reimbursement, coding, and billing MDHHS is using 1815 funds for the pilot, which are not sent directly to the MCO. Instead, Michigan contracts with the CDC-recognized organization, which receives reimbursement for the service. The 1815 funds are able to reimburse up to $1,000 per participant, in alignment with CDC 1815 guidelines. At least one MCO is providing in-kind support in the form of staffing and outreach, as well as program resources for members.


Program Features Unique to Michigan

Technical Assistance for Pilot Participants

The structure of Michigan’s state-supported MCO pilot is unique because it focuses on providing technical assistance to CDC-recognized organizations while also collecting data to support development of a statewide Medicaid benefit. The realities of the COVID-19 public health emergency complicated the pilot implementation and its timelines; however, the structure of the pilot has provided for quality improvement and continued momentum despite ongoing challenges.

As part of the 1815 requirement, each CDC-recognized organization funded through the pilot has been required to submit data on per-participant costs to provide the program. MDHHS also collects evaluation data to assess whether participating organizations are meeting their standards, which include targets for enrollment, attendance, and weight loss. MDHHS modeled these requirements after the current CDC recognition standards.

MDHHS set up a timeline for evaluation that prompts them to give technical assistance to CDC-recognized organizations that are not meeting standards. If CDC-recognized organizations are not reaching standards halfway through the contract year, MDHHS works with them over the course of the year to create a performance improvement plan. If at the end of the year the CDC-recognized organization has still not achieved the standards, pilot reimbursement will be decreased incrementally until funding ends. From the health department perspective, this process creates a realistic model for pay-for-performance that builds capacity for CDC-recognized organizations.


Lessons Learned

Best Practices for Engaging MCOs

MDHHS notes several best practices for MCO engagement that contributed to their success, including:

  • Leverage existing relationships between MCOs and CDC-recognized organizations.
    • Consider CDC-recognized organizations that are in-network with MCOs and if any MCOs have existing data sharing agreements with CDC-recognized organizations.
  • Before approaching MCOs about a pilot, consider surveying potential partners about current efforts around prediabetes to understand what each MCO is already doing.
  • Consider the audience to approach first within the MCO. Michigan decided to contact the Chief Medical Officers at the MCOs to get leadership buy-in.
  • Engage influential community-based partners in the process when approaching MCOs.
  • Present to MCOs the national perspective of diabetes and the National DPP alongside the pitch for a pilot. This helps MCOs see where the program can fit within a national perspective and can inspire some competition between states and other health plans.
  • MCOs participating in a pilot can provide key insights into how the National DPP lifestyle change program can be operationalized in Medicaid, including input on participant identification, enrollment, and retention; promotion of the benefit; and billing and reimbursement processes.

Additional Resources

Content Last Updated: April 6, 2022