Clinical and Economic Impact of a Digital, Remotely-Delivered Intensive Behavioral Counseling Program on Medicare Beneficiaries at Risk for Diabetes and Cardiovascular Disease

Abstract

BackgroundType 2 diabetes and cardiovascular disease impose substantial clinical and economic burdens for seniors (age 65 and above) and the Medicare program. Intensive Behavioral Counseling (IBC) interventions like the National Diabetes Prevention Program (NDPP), have demonstrated effectiveness in reducing excess body weight and lowering or delaying morbidity onset. This paper estimated the potential health implications and medical savings of a digital version of IBC modeled after the NDPP.Methods and FindingsParticipants in this digital IBC intervention, the Omada program, include 1,121 overweight or obese seniors with additional risk factors for diabetes or heart disease. Weight changes were objectively measured via participant use of a networked weight scale. Participants averaged 6.8% reduction in body weight within 26 weeks, and 89% of participants completed 9 or more of the 16 core phase lessons. We used a Markov-based microsimulation model to simulate the impact of weight loss on future health states and medical expenditures over 10 years. Cumulative per capita medical expenditure savings over 3, 5 and 10 years ranged from $1,720 to 1,770 (3 years), $3,840 to $4,240 (5 years) and $11,550 to $14,200 (10 years). The range reflects assumptions of weight re-gain similar to that seen in the DPP clinical trial (lower bound) or minimal weight re-gain aligned with age-adjusted national averages (upper bound). The estimated net economic benefit after IBC costs is $10,250 to $12,840 cumulative over 10 years. Simulation outcomes suggest reduced incidence of diabetes by 27–41% for participants with prediabetes, and stroke by approximately 15% over 5 years.ConclusionsA digital, remotely-delivered IBC program can help seniors at risk for diabetes and cardiovascular disease achieve significant weight loss, reduces risk for diabetes and cardiovascular disease, and achieve meaningful medical cost savings. These findings affirm recommendations for IBC coverage by the U.S. Preventive Services Task Force.

5. Prevention or Delay of Type 2 Diabetes: Standards of Medical Care in Diabetes—2018

“…Information technology platforms may effectively deliver the core components of the DPP (24-26), lowering weight, reducing risk for diabetes and cardiovascular disease, and achieving cost savings (27,28). Recent studies support content delivery through virtual small groups (29), Internet-driven social networks (30,31), cell phones, and other mobile devices.…”

Impact on dietary intake of a self-directed, gender-tailored diabetes prevention program in men

“…However, modifications to the traditional diabetes prevention programs are considered necessary for translation to non-research or “real-world” settings[ 42 ] and to promote sustainability of effective programs through delivery of these programs at scale. Delivery of programs using various media and technologies, such as DVD or web- or mobile-based platforms, have demonstrated effectiveness in terms of weight loss[ 6 , 11 , 43 ], while other diabetes prevention programs have begun to provide higher intensity interventions through the supplementation of mobile applications with remote support from a trained health coach[ 44 , 45 ].…”

PA job availability in primary care during 2014 and 2016

“…The additional growth reflects updates to the Disease Prevention Microsimulation Model (DPMM) used to model changes in disease states and mortality caused by achieving the model population health goals. [61][62][63] Updates to the DPMM include using newer data from the National Health and Nutrition Examination Survey, using updated health-transition equations derived from published clinical trials and observational studies, and adding new components to the DPMM around behavioral health and modeling additional disease states. Updated modeling with the DPMM suggests the modeled population health goals would lead to a larger reduction in mortality than previously modeled, so more people would still be living in future years in this scenario.…”