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Pennsylvania Medicaid Managed Care Organizations Implement National DPP

State: Pennsylvania

Submitted Date: 2018

Public Health Issue
  • The National Diabetes Prevention Program (National DPP) is an evidence-based program to improve health outcomes and reduce healthcare costs by preventing or delaying type 2 diabetes.
  • Despite the proven benefits, private insurance coverage for the National DPP is limited.
  • Covering the cost of providing National DPP lifestyle change programs for employees can help employers manage healthcare costs, make the programs more accessible, and promote employee health and productivity.
Program Action
  • Beginning in 2014, the Pennsylvania Department of Health’s (PADOH) Diabetes Prevention and Control Program convened quarterly meetings with Pennsylvania Medicaid managed care organizations to educate their leadership about prediabetes and the National DPP lifestyle change program.  PADOH supplied the Pennsylvania Department of Human Services Office of Medical Assistance Programs (OMAP) staff with the research evidence on the National DPP and the potential return on investment for this program, along with sample contracting language. 
  • PADOH, in cooperation with the National Association of Chronic Disease Directors, implemented a diabetes prevention State Engagement Meeting (StEM) in August 2017 to bring together stakeholders, including managed care organization directors and the OMAP chief medical officers, to create an action plan for scaling and sustaining the National DPP.
  • At the StEM, OMAP announced pilot coverage of the National DPP from nine Pennsylvania Medicaid managed care organizations. Following the StEM, PADOH and OMAP discussed follow-up steps needed to support the Medicaid pilots.
  • With support from the National Association of Chronic Disease Directors and Leavitt Partners, PADOH held a National DPP Coverage Toolkit webinar for the managed care organizations in November 2017. PADOH staff later gave an in-depth presentation to managed care organizations on the National DPP and the PADOH work to strengthen the program in the state.
  • The Philadelphia Department of Public Health (PDPH), a grantee under Pennsylvania’s State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke 1422PPHF14 funding, established a partnership with a Medicaid managed care organization to implement coverage strategies with local, federally qualified health centers. PADOH and PDPH worked to align program delivery strategies in the Philadelphia area to prevent duplication.
  • Effective January 1, 2018, Medicaid beneficiaries at risk for type 2 diabetes or with prediabetes are eligible to participate in the National DPP lifestyle change program at no cost under a pilot program implemented by all nine Pennsylvania Medicaid managed care organizations, serving about 400,000 beneficiaries.
  • The Health Promotion Council, a nonprofit, and AmeriHealth Caritas, a Medicaid managed care organization, are implementing a pilot to increase patient access and referral to National DPP lifestyle change programs operating in AmeriHealth’s 42 county area of coverage. 
  • The Philadelphia Health Management Corporation, an affiliate of Health Promotion Council that is assisting PADOH with program evaluation at 60 PADOH-supported National DPP sites, is designing a process to collect data on National DPP participants enrolled in Pennsylvania Medicaid.
Camelia Rivera
Pennsylvania Department of Health