Referring patients to diabetes prevention program: One practice's story

Troy Parks , News Writer

Nine out of 10 people who have prediabetes, the precursor to type 2 diabetes, don’t know they have it. Fortunately, evidence-based diabetes prevention programs are available to support physicians who treat these patients—and recently, groundbreaking steps were taken to soon cover these costs under Medicare. Find out how a practice in Minnesota used a local diabetes prevention program to help their patients stop the onset of type 2 diabetes.

A three-year demonstration project funded by the Center for Medicare and Medicaid Innovation allowed the YMCA of the USA (Y-USA) to deliver its Diabetes Prevention Program, modeled after the Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program, through local YMCAs at no cost to nearly 8,000 Medicare beneficiaries at a high risk of developing type 2 diabetes.

As part of its Improving Health Outcomes initiative, the AMA teamed up with the Y-USA and 26 physician practice pilot sites in eight states to develop tools and resources to increase physician screening and testing for prediabetes and to help them refer those patients to local programs

One of those sites was Park Nicollet’s clinic in Brookdale, Minn. Steven Reed, MD, a primary care physician at the Brookdale location, said that for years he’s seen patients who are overweight who have all the signs of prediabetes, but “you sort of sound like a broken record after awhile saying you need to lose weight and exercise and eat right.”

“To have a program that’s been proven in studies to be effective in the ultimate goal to reduce risk of developing diabetes is exciting,” he said. “There is data that shows that this, for most patients, marks a change in their lifestyle that is lasting … so it’s not a quick-fix diet where you lose the weight and it comes back.”

The program is 12 months long and focuses on behavior such as diet and exercise, but “they cover a lot of practical things,” Dr. Reed said. “It’s not just what to eat, but it’s how you get through the holidays, how to shop at the grocery store and what to do when you go out to eat. They cover how to deal with stress and keep your motivation up to keep doing these things.”

Park Nicollet became part of the demonstration project with only a few months left to participate in the program, so they had to work quickly. “We had a limited window of time where we could do this,” Dr. Reed said. “We wanted to get as many people into this program as we could.”

“The impressive thing to me is that we were able to use the power of the electronic health record (EHR) to find the patients who would be eligible for this,” Dr. Reed said. “It cut down on a lot of man hours that would be required to do it as patients came in.”

“I think the program was a success in that way,” he said. “We worked with the IT folks to build a work list that scoured our patient database.”

The search was for patients who met three criteria:

  • Aged 65 or older and on Medicare
  • Had a body mass index of 25 or greater
  • Had a diagnosis of prediabetes (met the hemoglobin A1c and glucose criteria)

Dr. Reed noted that EHRs can have their share of frustrations but said that “this is a case where it can be good to be able to easily identify these patients who could benefit from the program.”

Using the list produced by their EHR, Park Nicollet sent referral letters to each patient, notifying them of their prediabetes condition and eligibility for the diabetes prevention program at the YMCA.

“We went through several versions of that letter,” Dr. Reed said. “We had a couple patients who said they were surprised by it, [but] no one was really upset or didn’t like the way we communicated it.”

“The YMCA did a nice job of giving us updates when the patients were going through the program to let us know if it was working for them or whether they had completed it or not and how many sessions they went to.”

For physicians contemplating referring their patients to a diabetes prevention program, Dr. Reed suggested “be aware of the program, promote it to patients and know where it’s available in your community. For us it was the YMCA, but there are a lot of other places it’s available.”

The U.S. Department of Health and Human Services (HHS) announced it soon will begin covering diabetes prevention programs for Medicare beneficiaries as the result of the Y-USA’s demonstration project. The announcement highlights the project’s success.

It is the first time a preventive service model from the Center for Medicare and Medicaid Innovation has been expanded into the Medicare program, and the agency said the model holds promise for employers, private insurers and patients.

“That is exciting,” Dr. Reed said. “If it’s covered by Medicare, at least in the area where I work, that alleviates a huge barrier to care, which is the cost of the program—400 plus dollars—which is a lot of money for a lot of patients that I see. To have that barrier removed is a major step forward.”

“The solutions really are lifestyle changes,” he said, “and this program has been proven to work and can make it available to more people—I think it’s fantastic.”

Learn how your practice can start helping patients with prediabetes reduce their risk for developing type 2 diabetes. The AMA and the CDC offer practical resources through the joint Prevent Diabetes STAT: Screen, Test, Act–Today™ initiative. The resources center on three important steps to take with your patients:

  • Screen patients for prediabetes risk using the CDC Prediabetes Screening Test or the American Diabetes Association Diabetes Risk Test
  • Test patients to confirm prediabetes using one of three blood tests, which may already be recorded in your EHR
  • Act by referring patients with prediabetes to a nearby CDC recognized diabetes prevention program