Online Program

Diabetes prevention benefits everyone – developing coverage policies

Tuesday, November 3, 2015

Christopher S. Holliday, PhD, MPH, Improving Health Outcomes, American Medical Association, Chicago, IL
Vanessa Salcedo, MPH, Improving Health Outcomes, AMA, Chicago, IL
Shannon Haffey, MHSA, Value Based Benefit & Reimbursement, AMA, Chicago, IL
Kathleen A Heneghan, MPH, Improving Health Outcomes, American Medical Association, Chicago, IL
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.

Learning Areas:

Administration, management, leadership
Advocacy for health and health education
Chronic disease management and prevention
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Describe the business case for private payor coverage of a diabetes prevention program Identify how to engage private payors and employers

Keyword(s): Chronic Disease Prevention, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Katy is the Project Manager for Improving Health Outcomes Collaborations at the American Medical Association. She is responsible for identifying strategic partnerships with public and private organizations. Previously, she was the Program Manager for Cancer Control at the Rhode Island Department of Health. Ms. Heneghan holds a Bachelor of Arts degree from Fordham University, a MPH from the University of Kentucky, and is pursuing her DrPH in Leadership at the University of Illinois Chicago.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.