CMS Expands Medicare Diabetes Program

CMS Expands Medicare Diabetes Program



The Centers for Medicare and Medicaid (CMS) has expanded its Medicare Diabetes Prevention Program (MDPP) to now enroll traditional healthcare providers and community-based organizations as Medicare suppliers of health behavior change services.
 
The (MDPP) seeks to prevent or delay type 2 diabetes through health behavior changes. MDPP is a structured intervention geared to prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. 
 
Key to prevention or delay of any chronic disease is to identify at-risk members earlier and close gaps in care faster. 
 
In working with Medicare plans, we have experienced that the key driving force is to get Medicare Advantage plan members to take clinical actions. We have found that the right incentives can drive these clinical actions to interpret more data to find risks earlier.
 
Some clinical action improvements/success we have encountered in working with Medicare Advantage plans include the following:
 
+40% increase – adult BMI assessment (E/M visit)
+31% increase - in-home assessment
+17% increase - retinal eye exam
+31% increase - kidney disease monitoring
+10% increase - A1c tests 
As the MDPP model expands, the devil is in the details, and getting the right detailed data starts with a member who takes clinical action.
 
In the end, every action can add up to data that can be interpreted to improve the overall plan performance including increased risk adjustment revenue, consistently high Star Ratings and lower cost of care.