The Jefferson College of Population Heath is coordinating the Philadelphia Diabetes Prevention Collaborative, a group of local stakeholders working to design multi-pronged public health efforts to prevent Type 2 diabetes and enroll 2,000 area participants in the National Diabetes Prevention Program (DPP) in 2020.
According to the Centers for Disease Control and Prevention’s latest fact sheet, 34.2 million Americans have diabetes and 88 million have pre-diabetes.
The National DPP focuses on behavior changes related to healthy eating and physical activity. Research has shown that its participants can reduce their risk of developing Type 2 diabetes by 58 percent (71 percent for people over 60 years of age).
With the support of the American Medical Association and CDC, Jefferson helped convene the collaborative, made up of organizations including the Health Promotion Council, HealthShare Exchange, the Philadelphia County Medical Society, the American Diabetes Association and others.
During a Sept. 2 webinar about the Philadelphia Diabetes Prevention Collaborative launch, Felicia Hill-Briggs, Ph.D., senior director of population health research and development and a professor of medicine at Johns Hopkins University, described the experience Baltimore has had rolling out DPP the last few years.
First, she noted that because of the demonstrated success of DPP programs, CMS has made it a reimbursable service under Medicare and Medicaid, and the program can be delivered in community settings using trained laypeople as coaches.
The Johns Hopkins effort, launched in 2016, is centered at the Brancati Center for the Advancement of Community Care, which serves as a DPP umbrella organization and brings capacity building to community organizations that want to deliver DPP at their sites, she said. It handles things like community partner recruitment, training certification oversight, data collection and management, and billing and compliance.
The community partner sites include faith-based organizations, schools, federally qualified health centers, and employer groups. In Baltimore, 85 percent of participants are African-American; the mean age is 52, and 51 percent of participants are on Medicaid. “Our DPPs have exceeded CDC metrics in terms of outcomes,” said Hill-Briggs, who is a clinical psychologist and behavioral scientist. “Moving forward we are expanding to work on diabetes prevention across the greater Baltimore metropolitan area.” Among the keys to success, she said, are to make sure participants understand it requires a 12-month commitment, and developing rapport between coaches and participants. The umbrella organization can provide valuable technical and data/analytics support.
Hill-Briggs noted that CMS reimbursement does not cover infrastructure costs for setting up the program, “but this is the most representative program under IRS requirements for community benefit there is.” She added that the State of Maryland has made diabetes prevention a top population health goal in its all-payer model, and has provided grant funding for the program.
Alexis Skoufalos, Ed.D., associate dean for strategic development and an associate professor at Jefferson, said that about a year ago the College of Population Health convened meetings to assess the local landscape to support a regional approach. Now, with support from the American Diabetes Association and American Heart Association, Jefferson is the backbone of a five-county effort that includes a network of community-based organizations, strong health systems and the HealthShare HIE to help share data. “Our goal is to raise awareness, and increase access and build capacity in organizations that want to offer the program,” she said. “COVID has had a big impact, and some organizations have had to pause or cancel their work for most of the year, but many have switched to virtual offerings and those have been popular with participants. “We also are working with payers to expand coverage.”
Mitchell Kaminski, M.D., program director for population health at Jefferson and a family physician, said that his initial reaction to hearing about the program was to be a little bit skeptical that behavior change would work. Plus, he was already incredibly busy dealing with adjusting medications for patients who are already diabetic.
“As I learned more about the DPP program, I realized it makes a lot of sense from a population health point of view,” he said. After attending a meeting with DPP participants, Kaminski said he was “blown away from what I learned from participants who were successfully losing weight and reducing their hemoglobin A1c out of diabetes range. I was humbled by that.” Many of these people are overcoming barriers such as not having good places to walk or good grocery stores in their neighborhoods. “Since then, I pay attention to those patients with prediabetes, and the DPP program is as easy as one phone call. I can help motivate the patient and plant the seed. I truly feel as a primary care physician that I am having more impact in DPP than I am in treating the diabetes in my practice.”
