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Expanding Diabetes Prevention Program Private Insurance Coverage

State: Wisconsin

Submitted Date: 2018

Public Health Issue
  • On average, Wisconsin employers incur $10,000 of annual diabetes-attributable costs for each adult age 64 or younger with diabetes. Yet, about $500 per year would cover the cost of a lifestyle change program that can reduce a person’s risk of developing diabetes by more than 50%.
  • Providing the National Diabetes Prevention Program (National DPP) lifestyle change program at no cost to employees can help employers manage health care costs, make the programs more accessible, and promote employee health and productivity.
Program Action
  • Four Wisconsin insurers asked the Wisconsin Department of Health Services (WI-DHS) to help them understand the evidence on the National DPP for persons with prediabetes, including how the program might benefit their insured members.
  • Discussions with insurers on this topic led WI-DHS to hold a workshop for Wisconsin insurers on the National DPP Coverage Toolkit launched by the National Association of Chronic Disease Directors and Leavitt Partners. The Coverage Toolkit supports health insurance plans, employers, and state Medicaid agencies in making the decision to cover the National DPP.
  • Representatives of two public insurers (Wisconsin Medicaid, Wisconsin Department of Employee Trust Funds); two self-insured employers (Ascension Health, QuadMed); and eight private insurers (Dean Health Plan, Group Health Cooperative of South Central Wisconsin, Group Health Cooperative of Eau Claire, Humana, Molina Healthcare of Wisconsin, Network Health, Security Health Plan, and United Healthcare) attended the workshop.
  • WI-DHS partnered with the Wisconsin Department of Corrections to train one of their Lifestyle Coaches as a Master Trainer Select. WI-DHS now contracts with that trainer to lead Lifestyle Coach Trainings across the state. WI-DHS provides ongoing technical assistance to the Lifestyle Coaches and their CDC-recognized organizations.
  • Ten private insurers or employers now provide coverage for the National DPP for insured members, as follows:
    • UnitedHealthcare provides reimbursement to eligible members.
    • Molina Healthcare Wisconsin provides a member educational benefit implemented by their community navigators.
    • Ascension-Wheaton Franciscan Healthcare, Aurora Healthcare Milwaukee South Market, Iowa County Health Department, Northwestern Mutual, Pitney Bowes-Neenah, Quad/Graphics, ThedaCare, and Thrivent Financial provide the National DPP as part of their employee wellness programs.
    • Froedtert & Medical College of Wisconsin Workforce Health, QuadMed, and ThedaCare Onsite provide the National DPP to a variety of employers as part of their worksite wellness services.
  • Participation by Wisconsin residents in the National DPP grew by more than 25% between Jan. 2015 and July 2017.
  • WI-DHS trained 209 National DPP Lifestyle Coaches by sponsoring 16 trainings beginning in May 2013.
Chronic Disease Prevention Program
Wisconsin Department of Health Services