With no DPP in reach, a family medicine practice created its own

Timothy M. Smith , Contributing News Writer

Dismayed by the scarcity of referral options and inspired to practice at the top of their abilities, the staff at an independent practice in suburban Detroit implemented their own diabetes prevention program (DPP). The lead physician on the project shares the steps he took to set it up, as well as some successes evident in patients just two months into the program.

“We’ve been heavily invested in fee-for-value, but I got really frustrated with care as it had to be for my practice to be profitable,” said Robert Jackson, MD, a family physician with Western Wayne Physicians. “I wanted to deliver better care, and I wanted to deliver the right care at the right time. That’s why I became a physician. So I immersed myself in finding new ways to help patients and the community.”

Western Wayne has a largely blue-collar patient population. The organization’s three sites in the western suburbs of the Motor City provide care largely to the region’s auto workers, many of whom have prediabetes.

“I read about DPPs a couple years ago and thought, ‘This is really important. We could do this,’” he said. “But there were no programs in my community that I could refer patients to. Plus, I started thinking, ‘I’m a family doc, why would I refer this to a hospital?’ "

As a family physician, Dr. Jackson said it is the nature of his specialty to refer many matters to other specialists. But one thing he didn’t want to send out for referral is patient education.

“That’s what I’m an expert in,” he said. “Referring that away because I don’t have enough time to do it is ridiculous. I wondered how I could train people to do it.”

The idea lay dormant for months, though, because Dr. Jackson did not know where to find appropriate training and other resources. Then, through fellow members of the Michigan Academy of Family Physicians and the Michigan State Medical Society, he was connected with staff on the AMA’s Improving Health Outcomes team.

“I really feel nurtured by the AMA,” Dr. Jackson said. “They kept meeting with my staff, giving direction, holding our hands along the way.”

Eventually, the receptionist, medical assistant and nurse case manager at one of Western Wayne’s three locations were connected with State of Wellness, one of nine organizations approved by the Centers for Disease Control and Prevention (CDC) to provide lifestyle-coach training for the National DPP. With that help, Western Wayne was able to launch its DPP nine weeks ago.

Early successes

CDC-recognized DPPs are 12-month, evidence-based lifestyle interventions that help patients achieve lasting behavior changes such as healthier eating, more physical activity and improved problem solving and coping. They have been shown to help people with prediabetes cut their risk of progressing to type 2 diabetes by 58 percent overall and by 71 percent in those 65 years and older.

Western Wayne’s group is meeting for an hour and a half once a week, on Tuesday evenings, for the first 16 weeks, at which point meetings will shift to once every three weeks through the 26th lesson. Of the 14 patients who agreed to participate, 13 are still enrolled, and they are already seeing results.

"People are losing weight. They’re engaged in the meetings. They’re exercising. It’s doing the right things,” said Kayla Jones, the office’s receptionist and the lifestyle coach for the group. “Some have lost about seven pounds, but most have lost three or four pounds, which isn’t huge, but it’s definitely significant considering they’re only looking to lose 5 to 7 percent in the first six months. Two months in, having any weight loss is a good thing.”

In addition, Jones noted, patients with prediabetes often have other underlying issues, so even that small amount of weight loss can help with other conditions, such as hypertension and knee pain.

“When we ventured into this, we didn’t see any way to make money, but we knew it was the right thing to do,” Dr. Jackson said. That has changed, he said, with the help of the impending reimbursement of DPP from Medicare.

“Now,” Dr. Jackson said, “we have the opportunity to provide this service for pay beginning Jan. 1, 2018. I’m not certain how much we’ll get for these sessions, but it will help pay for something that we know is important.

“In today’s health care system, primary care physicians have to get involved in things like this to boost the value they provide to patients. That’s the primary care of the future, and diabetes prevention will play a big part in it. I would almost say think twice before you don’t do it.”

The CDC and the AMA have been working together since 2014 to address diabetes prevention on a national level. This has included a national co-branded initiative, Prevent Diabetes STAT™, which aims to increase engagement with physicians, care teams and patients to reach some of the millions of adults with prediabetes and stop their progression to type 2 diabetes.

The AMA has also partnered with San Francisco-based Omada Health and Intermountain Healthcare, a Salt Lake City-based health system, to incorporate Omada’s online DPP into the care setting at Intermountain. The goal of the partnership is to create a road map for health care organizations across the country to integrate proven online prevention programs into physician referrals and clinical workflows.

Editor’s note: This is the first of two articles exploring Western Wayne Physicians’ work to create a DPP. The second article, appearing tomorrow in AMA Wire®, will outline the practice's detailed advice on starting your own DPP.