Challenges with implementing the Diabetes Prevention Program for Medicare beneficiaries in an integrated health system.

Publisher: Clinical Care Targeted Communications Group, LLC Country of Publication: United States NLM ID: 9613960 Publication Model: Electronic Cited Medium: Internet ISSN: 1936-2692 (Electronic) Linking ISSN: 10880224 NLM ISO Abbreviation: Am J Manag Care

Publication: Cranbury, NJ : Clinical Care Targeted Communications Group, LLC
Original Publication: Old Bridge, NJ : American Medical Pub., c1995-

Delivery of Health Care, Integrated* ; Diabetes Mellitus, Type 2*; Aged ; Humans ; Medicare ; United States

Objectives: In April 2018, CMS began reimbursing both clinical and community settings for providing the CDC-recognized Diabetes Prevention Program (DPP) to eligible Medicare beneficiaries. To better understand the process of offering the program to Medicare beneficiaries, we interviewed relevant stakeholders in a large, integrated health care delivery system.
Study Design: Qualitative interview study.
Methods: We conducted semistructured interviews with 12 delivery system stakeholders. Data were analyzed following a thematic analysis approach.
Results: Stakeholders described systemic challenges to the implementation of Medicare DPP (MDPP), including inadequate reimbursement for the health care system, low awareness of MDPP among patients and providers, and challenges with utilizing third-party vendors to connect patients to CDC-recognized MDPPs.
Conclusions: Although the reimbursement of DPP for Medicare beneficiaries was a landmark decision, the current structure and requirements make it difficult for health systems and community-based providers to implement and promote this benefit. This study highlights the challenges that even integrated health systems are facing to implement MDPP, as well as potential strategies to overcome these barriers and expand the reach of the program. Medicare should seek ways to increase the financial incentives and decrease the barriers associated with implementing MDPP.

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R01 DK115237 United States DK NIDDK NIH HHS

Date Created: 20211116 Date Completed: 20211124 Latest Revision: 20221019

20240628

PMC9574419

10.37765/ajmc.2021.88784

34784149