The digital health movement scored a big win recently, as Medicare announced it will begin reimbursing certain providers for administering digital versions of the Diabetes Prevention Program (DPP), an evidence-based program that helps individuals with prediabetes make lifestyle changes. Last year, the CDC officially recognized three digital versions of the DPP as an effective, evidence-based intervention. Previously, the agency had only recognized in-person versions of the program. Clearly, this is a sign that digital health interventions are moving into the mainstream and gaining acceptance as a reimbursable standard of care.
Some background information
The Diabetes Prevention Program started out as a clinical trial. The goal was to gather evidence that lifestyle changes like diet and exercise could indeed prevent or delay type 2 diabetes in adults at high risk of developing the disease. Those targeted for participation had impaired glucose tolerance, often referred to as prediabetes because it is likely to become diabetes in ten years or less. The results were striking. According to a press statement issued by the American Diabetes Association, “the DPP announced that the study’s two interventions, a lifestyle program designed to reduce weight and increase activity levels, and the diabetes medicine metformin, decreased the development of type 2 diabetes in a diverse group of people, all of whom were at high risk for the disease, by 58 and 31 percent, respectively, compared with a group taking placebo.”
In 2012, the CDC launched its original Diabetes Prevention Program as an evidence-based initiative that provided one-on-one support from trained lifestyle coaches—which required significant resources to carry out. This was quickly translated into group-based delivery, as a way to lower costs and broaden outreach. The program was offered by healthcare providers, clinics, community groups, churches, and corporate employees. Soon, the YMCA emerged as the single largest organization involved with enrolling participants for a modest fee.
Entering the digital age
Currently, three providers have implemented the DPP in online, digital formats that are recognized by the CDC as meeting certain performance criteria—and are eligible for Medicare reimbursement. The hope is that digital program versions will eliminate time and distance hassles, much as online education does for nursing students. Many people with jobs and family obligations find it hard to commit to the DPP’s series of 16 weekly meetings, followed by a year of monthly maintenance meetings.
Studies are beginning to show that online behavioral interventions are just as effective as in-person coaching. The DPP uses interactive lessons to help participants build the skills necessary to improve eating habits and increase activity in order to reach a healthy weight. Participants keep an online log of their daily diet and activity, which is reviewed by a coach who can provide feedback and suggestions, often in the form of real-time chats. Online support groups can allow participants to learn from one another. One provider, Omada Health, is equipping each participant with digital equipment like pedometers and wireless scales that arrive already synced to the participant’s online account.
Online programs like this can eliminate some of the challenges in broadening the reach of the DPP to those who need it. The American Diabetes Association estimates there are 87 million people in the U.S. with prediabetes, and up to 90 percent of them do not know they are at risk of developing diabetes and its complications. Digital health initiatives also have the potential to bring together payers, providers, and patients—stakeholders that have sometimes been at odds with each other over how to tackle the challenging goal of prevention.
What does this mean for nurses?
As always, the evolution of healthcare delivery systems affects nursing practice. As frontline caregivers, nurses should have the ability to respond appropriately to new technologies. As patient advocates, they should be watchful that technology does not devalue the human element in healthcare. Digital health initiatives like the DPP may also provide new career opportunities for nurses, as the informaticist that helps to design patient-centric platforms or as the nurse navigator or case manager who reviews patient progress and makes recommendations.
And of course, nurse leaders and educators will have to prepare for all of the challenges associated with a new area of medicine, in order to assure that nurses have the digital health competencies they need. The profession as a whole should be proactive, rather than reactive, when it comes to addressing the future of healthcare.
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