Effect on health care expenditures during nationwide implementation of the diabetes prevention program as a health insurance benefit

Ronald T. Ackermann, Raymond Kang, Andrew J. Cooper, David T. Liss, Ann Holmes, Margaret Moran, Chandan Saha

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE Lifestyle interventions slow development of type 2 diabetes by half, but the impact of health payer reimbursement for delivery of intervention programs is not well known. We evaluated net commercial health payer expenditures when offering reimbursement for access to YMCA's Diabetes Prevention Program (YDPP) in 42 states. RESEARCH DESIGN AND METHODS We used a nonequivalent comparison group design to evaluate net health care expenditures for adults with prediabetes who attended one or more YDPP visit between 1 July 2009 and 31 May 2013 ("YDPP users"). Rolling, 1:1 nearest neighbor propensity score (PS) matching was used to identify a comparison group of nonusers. Administrative data provided measures of YDPP attendance, body weight at YDPP visits, and health care expenditures. Random effects, difference- in-difference regression was used to estimate quarterly health care expenditures before and after participants' first visit to YDPP. RESULTS Worksite screening identified 9.7% of the target population; 39.1% of those identified (19,933 participants through June 2015) became YDPP users. Mean weight loss for YDPP users enrolled before June 2013 (n = 1,725) was 7.5 lb (3.4%); 29%achieved≥5%weight loss. Inclusive of added costs to offer YDPP, there were no statistically significant differences in mean per-person net health care expenditures between YDPP users and PS-matched nonusers over 2 years ($0.2 lower [95% CI $56 lower to $56 higher]). Mean reimbursement to the YMCA was $212 per YDPP user, with 92.8% of all expenditures made for those who attended at a high rate (≥9 completed YDPP visits). CONCLUSIONS Worksite screening was inefficient for identifying the population with prediabetes, but those identified achieved modest YDPP attendance and clinically meaningful weight loss. Over 2 years, added costs to offer the intervention were modest, with neutral effects on net health care costs.

Original languageEnglish (US)
Pages (from-to)1776-1783
Number of pages8
JournalDiabetes care
Volume42
Issue number9
DOIs
StatePublished - Sep 1 2019

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Insurance Benefits
Health Insurance
Health Expenditures
Delivery of Health Care
Prediabetic State
Weight Loss
Propensity Score
Workplace
Costs and Cost Analysis
Health Services Needs and Demand
Health Care Costs
Type 2 Diabetes Mellitus
Life Style
Body Weight
Health
Population

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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Effect on health care expenditures during nationwide implementation of the diabetes prevention program as a health insurance benefit. / Ackermann, Ronald T.; Kang, Raymond; Cooper, Andrew J.; Liss, David T.; Holmes, Ann; Moran, Margaret; Saha, Chandan.

In: Diabetes care, Vol. 42, No. 9, 01.09.2019, p. 1776-1783.

Research output: Contribution to journalArticle

Ackermann, Ronald T. ; Kang, Raymond ; Cooper, Andrew J. ; Liss, David T. ; Holmes, Ann ; Moran, Margaret ; Saha, Chandan. / Effect on health care expenditures during nationwide implementation of the diabetes prevention program as a health insurance benefit. In: Diabetes care. 2019 ; Vol. 42, No. 9. pp. 1776-1783.
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AB - OBJECTIVE Lifestyle interventions slow development of type 2 diabetes by half, but the impact of health payer reimbursement for delivery of intervention programs is not well known. We evaluated net commercial health payer expenditures when offering reimbursement for access to YMCA's Diabetes Prevention Program (YDPP) in 42 states. RESEARCH DESIGN AND METHODS We used a nonequivalent comparison group design to evaluate net health care expenditures for adults with prediabetes who attended one or more YDPP visit between 1 July 2009 and 31 May 2013 ("YDPP users"). Rolling, 1:1 nearest neighbor propensity score (PS) matching was used to identify a comparison group of nonusers. Administrative data provided measures of YDPP attendance, body weight at YDPP visits, and health care expenditures. Random effects, difference- in-difference regression was used to estimate quarterly health care expenditures before and after participants' first visit to YDPP. RESULTS Worksite screening identified 9.7% of the target population; 39.1% of those identified (19,933 participants through June 2015) became YDPP users. Mean weight loss for YDPP users enrolled before June 2013 (n = 1,725) was 7.5 lb (3.4%); 29%achieved≥5%weight loss. Inclusive of added costs to offer YDPP, there were no statistically significant differences in mean per-person net health care expenditures between YDPP users and PS-matched nonusers over 2 years ($0.2 lower [95% CI $56 lower to $56 higher]). Mean reimbursement to the YMCA was $212 per YDPP user, with 92.8% of all expenditures made for those who attended at a high rate (≥9 completed YDPP visits). CONCLUSIONS Worksite screening was inefficient for identifying the population with prediabetes, but those identified achieved modest YDPP attendance and clinically meaningful weight loss. Over 2 years, added costs to offer the intervention were modest, with neutral effects on net health care costs.

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