Diabetes prevention benefits everyone – developing coverage policies

Diabetes is an epidemic with far-reaching health and economic consequences for patients, health care systems and payors. Currently, 29.1 million people in the US have diabetes and an estimated 86 million have prediabetes. People with prediabetes are at risk for stroke and heart disease and without an intervention, 12.9 to 25.8 million will develop type 2 diabetes within five years. A health and economic burden of this magnitude demands a change of practice from employers and insurers to offer preventive benefits to insureds to prevent or delay diabetes onset. Diabetes accounts for $245 billion annually in direct medical costs and lost productivity. Fortunately, mounting evidence shows that type 2 diabetes is largely preventable through lifestyle change interventions.

The American Medical Association partnered with the Centers for Disease Control and Prevention to develop a multi-pronged strategy to prevent type 2 diabetes by increasing awareness about prediabetes, increasing physician prediabetes screening and referral to a diabetes prevention program and by expanding insurance coverage for diabetes prevention programs.                                                                                                               

This presentation will demonstrate the challenges, opportunities and results of building a case and value proposition for employers and insurers to offer diabetes prevention programs in their suite of benefits. In addition, the presentation will conclude with lessons learned for public health practitioners and others on how to best develop a business case and strategy for engaging private payors and employers around coverage of a prevention program and implementation options.