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According to the Centers for Medicare & Medicaid Services (CMS), more than 25 percent of Americans 65 or older have diabetes, and the number of adults with diabetes is expected to double by 2050. In addition, one in three American adults have prediabetes, yet nine out of 10 have no idea they have it. As expected, these growing numbers don’t come without significant cost to the American healthcare system. In 2016 alone, Medicare spent $42 billion more on beneficiaries with diabetes than they would have spent if the beneficiaries did not have diabetes. To top it off, Medicare spent a total of $7,300 more per beneficiary on those with diabetes, compared to those without diabetes.

While these numbers are alarming, the good news is that type 2 diabetes can usually be prevented or delayed with significant lifestyle and behavior changes. The question now is, once adequate screening identifies those with prediabetes, how can you influence a group of people to make the necessary changes?

Medicare Diabetes Prevention Program
Through its Health Care Innovation Awards, CMS has started to tackle this issue via the Diabetes Prevention Program (DPP) model test. The Medicare Diabetes Prevention Program (MDPP) is an expansion of the DPP and provides “structured behavior change intervention that aims to prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes.”

What does this mean for those Medicare beneficiaries with prediabetes? Beginning January 1, 2018, Medicare and Medicare Advantage plans will provide reimbursement to healthcare providers who deliver curriculum-based prevention training to Medicare beneficiaries with prediabetes.

About the program:

  • Includes 16 sessions of Centers for Disease Control and Prevention (CDC) approved curriculum.
  • Community healthcare workers and health professionals lead each session in a group-based, classroom setting.
  • Lessons include practical education on prevention practices such as increased physical activity, lifelong diet changes and behavior change strategies for weight control.

To aid in accountability, once beneficiaries complete the 16 sessions, they must attend monthly follow-up meetings to help maintain the learned behavior changes.

What’s Next?
While CMS does not provide reimbursement for professionals who would like to provide these services via telemedicine, CMS has noted that a telehealth-based version of the MDPP may become a CMS Innovation demonstration project in the future. This would be the critical next step to ensure access for all beneficiaries.

How BioIQ’s Comprehensive Diabetes Solution Helps Health Plans
BioIQ makes it easy to orchestrate large-scale member outreach and health testing programs to help health plans close care gaps for comprehensive diabetes care and other measures.

BioIQ has collaborated with HealPros, which provides mobile diabetic retinopathy examinations, to offer health plans a scalable, effective, solution that helps them meet requirements for all three CDC measures – retinopathy screening, HbA1c testing and HbA1c glucose control, and kidney disease screening – all from the comfort of their members’ own home in a single encounter.

BioIQ is committed to making high- value preventive health services more accessible and easier for people to use. This solution enables health plans to address not only the DRE care measure, but additional measures using at-home test kits, including colorectal cancer screening. This allows health plans to meet HEDIS requirements while maximizing the effectiveness of at-home screening initiatives and providing a seamless member experience.

To learn more, contact BioIQ at (888) 818-1594 or

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