Dr Paul Chew Explains How Medicare DPP Can Benefit From Digital Providers

CMS’ decision to exclude digital health from its proposal for the Medicare Diabetes Prevention Program (DPP) has caused a controversy, explained Paul Chew, MD, chief medical officer of Omada Health.

Transcript

As you know, CMS has proposed to delay full participation of digital health providers in the Medicare DPP when it launches in April 2018. Is CMS’ call for more evidence legitimate, or this barrier emblematic of others that digital health has encountered?

One of the greatest innovations in the digital approach or the diabetes prevention approach has been the CMS program that will go into effect next April. As you may know at this stage they are approving and reimbursing DPP programs that have been approved or certified by CDC. They are still getting comments for digital diabetes prevention. We feel very strongly that the evidence base for seniors is strong for diabetes prevention already. We’ve published 2 articles on the effectiveness of the Omada program with results that are even better than the YMCA program, which is the basis for the CMS program. The second study showed that the return on investment is even sooner than the 1- to 2-year time period for seniors. So overall, we felt the evidence base is there.

Most importantly, if the CMS benefit is to its full realization for seniors, we have to access seniors who may not have the ability or the desire to go to a face-to-face program once a week. We have to be able to provide access digitally for those participants, and we also have to recognize that there’s only a very thin slice of time you spend in a face-to-face program, whereas in a digital program, it’s constantly accessible—when you need it and where you need it.

Where do you see the digital health and the DPP heading in the next 5 years?

The next 5 years is going to be very important as we go forward in digital health, because we will get a critical mass of experience. It will become even more clear that diabetes prevention is needed. The CMS program, the MACRA, and the MIPS initiatives to encourage screening—I believe—will make it easier for physicians and other healthcare providers to recognize and refer prediabetes patients.