An Ounce of Digital Prevention Is Worth the Same Pound of Cure

In 2016, the Centers for Medicare and Medicaid Services (CMS) announced the expansion of its model test of the Diabetes Prevention Program (DPP), making the program available to all eligible Medicare beneficiaries. Public health advocates rejoiced. So did budget hawks. Projections estimated that the program would help between 50,000-110,000 people every year, and would lower Medicare health care spending by $182 million in a 10-year period. 

Unfortunately, as a recentPolitico analysis highlighted, that vision has not become reality, with only 202 claims filed for the program in 2018. It would be very easy for officials to say “this program isn’t working, we need to throw in the towel,” but that is a short-sighted view and doesn’t take into account the proven results that the DPP has delivered when patients are able to access the program. 

CMS should not use this analysis of the DPP as a reason to dial back investment in prevention programs, but rather as an opportunity to evaluate how such programs are delivered. Digital providers offering the DPP have so far been excluded from any Medicare demonstration models. Lark’s AI-augmented DPP, which is fully recognized by the Centers for Disease Control and Prevention (CDC), is among them. Opening the door to these kinds of technological innovations would help CMS increase access to the DPP and get the program back on track to reach its original savings and outcomes goals.  

Barriers to wider adoption of the Medicare DPP mostly center around access issues. Many geographic areas don’t have a certified provider, with 10 states having zero providers according to Politico. Strict CMS requirements also price out many of the nonprofits and providers who may have been interested in offering the program but can’t afford the up-front costs. This is where digital solutions could help fill gaps.  

The sheer scale of the diabetes crisis highlights the need for solutions that can scale, and scale quickly. Over 84 million Americans are now living with prediabetes and are likely to develop the disease within five years if they remain untreated. Even if we maximize the use of virtual health coaches, there would not be enough provider hours in the day to deliver the DPP to everyone who needs it. 

That’s why Lark designed its DPP to be fully digital built with expert coaching via Cognitive Behavioral Therapy and AI. Our ability to replicate human coaches for routine interventions while involving them for more significant interventions maximizes the program’s reach and delivers it more economically. Lark has proven superior outcomes at scale, and has quickly become one of the nation’s largest DPPs.

Research shows that virtual DPP solutions are demonstrating similar, if not better, outcomes to the in-person program. Some may argue that older Americans would be less likely to engage with virtual programs, but Lark has found that to be untrue. In a study of 360 adults ages 50-85 using Lark, participants had an average weight loss of 4.4kg over 12 months, and 28 percent of participants dropped an entire BMI category.  

With diabetes rates so much higher among older Americans, and 61 percent of all health care expenditures related to diabetes being borne by Medicare, CMS would be wise to consider innovations that can help prevent this disease among beneficiaries. A week after Politico released their analysis, a bipartisan group of Senators penned a letter expressing their agreement and highlighting the power of these virtual solutions. They have asked CMS to expand its DPP program and reimburse CDC-recognized virtual providers. 

When digital programs can offer the same outcomes, at scale, and for a markedly lower cost, CMS would be mistaken to continue excluding them from the Medicare DPP. The future of chronic disease care will include virtual solutions, and CMS can be at the forefront of that innovation by adopting these solutions today. 

Author: Julia Hu, Founder and CEO of Lark Health

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