Kentucky Diabetes Network Kentucky Employees’ Health Plan Diabetes Prevention Program
KEHP’s Diabetes Prevention Path Milestones Overview Results Future
Kentucky Employees’ Health Plan KEHP Self-Insured since 2006 School Boards (53%) $1.6 Billion total plan annual spend Early Retirees (21%) 171,000 Planholders (265,000 State Agencies (20%) covered lives), made up of active Quasi (6%) employees and pre-65 retirees 6% Mostly Kentucky residents – some retired members living outside of 20% Kentucky 53% 21% 3
Background – KEHP 3-Year Strategy Introduce wellness as a plan component – Offer a voluntary wellness plan – HumanaVitality – Develop “LivingWell” brand (LivingWell Promise ) – Increase general personal health awareness Create plan designs that further introduce Consumer Driven Health Care – Increase health insurance literacy 4
National Diabetes Prevention Program Based on a 2002 study led Evidenced-based lifestyle by the National Institute of change program to prevent Health with CDC support type 2 diabetes National Diabetes Prevention Program Research showed modest Designed for people with behavior changes – BMI >24; are pre-diabetic increase in physical activity or at high risk of helped with weight loss developing diabetes 5
National Diabetes Prevention Program Sessions: – Participants meet in person as a group with a lifestyle coach, once a week for 16 weeks, then once a month for 6‐8 months Goals: – Losing weight, getting more physically active and managing stress CDC estimate: 1 in 3 adult Americans have pre-diabetes 1 in 2 adults aged 65 and older Without intervention 15-30% of people with pre-diabetes will develop type 2 diabetes within 5 years 6
National Diabetes Prevention Program Kentucky ranks 4 th in the nation in the number of DPP recognized organizations and 11 th in the nation in number of eligible DPP participants Kentucky’s percent average weight loss over 12 months is 4.3% which is lower than the national goal of 5% From CDC National Diabetes Prevention Program (NDPP) report ( DEC 2015 data ) 7
Prevalence and Cost of Diabetes to KEHP Cost Data: Medical expenditures for diabetics are 151% more expensive than the average member 2014 Chronic Condition Prevalence per 1000 Members 8
DPP for KEHP Members KEHP covers the cost for at-risk members Members meet for 16 weekly sessions followed by 6 monthly sessions Classes are led by CDC-certified DPP Lifestyle coaches Upon completion, members are awarded 350 HumanaVitality points 9
DPP for KEHP Members Partner with Anthem to administer The foundation of Anthem’s administration of this program is to maximize member awareness Anthem’s process - the 4 “ Rs ”: Recruitment, Referrals, Reporting, Reimbursement 10
KEHP’s Diabetes Prevention Path Milestones
KEHP DPP Pilot - 2013 Partnered with King’s Daughters Medical Center in Ashland Began November 2013, provided free of charge through a CDC grant Local YMCA offered free membership for participants Participants who completed program met and maintained program goals Lost 5-7% of body weight and increased physical activity to 150 minutes per week: Average attendance: 94% Average weight loss: 23 lbs. Average physical activity: 168.5 minutes per week Based on these results, KEHP made DPP a paid member benefit in 2014. 12
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KEHP DPP Benefit - 2014 31 individual DPP classes 201 KEHP members referred 113 KEHP members participated 80 56% active 70 engagement of those 67 60 who verbally agreed to 50 participate 48 46 40 30 29 25 20 15 10 11 11 10 10 10 9 6 3 3 6 0 5 0 Louisville Lexington Northern Ashland Mt. Sterling Berea Bowling Bardstown Columbia KY/Cincy Green Referred Confirmed 14
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KEHP DPP Participation - 2015 2015 DPP Participation 511 KEHP members referred as of December 31, 2015 375 KEHP members reported actively participating in a class Number of Referrals Actively Participating 132 118 111 84 56 51 44 43 29 25 22 22 21 15 14 14 13 11 9 8 7 7 6 6 5 4 4 3 2 0 0 0 0 0 statistics updated 1.25.16 16
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KEHP’s Diabetes Prevention Path Results
KEHP DPP - Success 375 KEHP Participants** 3,339 lbs. 46,877 minutes Total Weight Loss Total Physical Activity 8.91 lbs. 125.01 minutes Cumulative Average Cumulative Average Weight Loss*** Physical Activity 6.15 A1C Beginning Average 5.69 A1C Ending Average *based on DPP provider completed data reports through Dec 2015 **calculation based on 62 DPP classes *** average weight per 62 DPP classes = 4% 19
KEHP DPP – Success Data through October 2015 With DPP Without 17,629 Members with 307 At-Risk Members Type 2 Diabetes $125,000 $6,280,917 $34 per $356 paid amount per participant/per month claimant 20
KEHP Member Testimonial “Connie” participated in a DPP class in 2015 and had this to say: “This program has been a life saver for me. My uncle had both legs removed due to diabetes. I saw that my bad lifestyle choices were leading me down the wrong path.” “I was tired of being tired.” “During this class I have lost 40 lbs but best of all my blood sugar has dropped significantly and is now in the normal range.” “This program gave me the tools to track my food choices and increase my activity.”
KEHP Member Testimonial “Regina” shared this about her DPP experience in 2015: “I am so excited the class was completely paid for by KEHP.” “ The information and encouragement provided by the program and coach is priceless, and it costs you nothing but your time.” “You learn things and strategies that truly change your life and your perspective of how you live and how you eat.” 22
KEHP’s Diabetes Prevention Path Future
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KEHP Ongoing Focus: January – February 2016 159 • Members agreed to talk to nurse • Members referred and given 38 specific class information • Members reported as actively 67 participating 25
KEHP Ongoing Focus Confirmed KEHP DPP Enrollment – January & February Start Dates 30 Upcoming classes 25 23 for March 24 5 for April 20 15 16 15 10 5 5 4 3 0 Frankfort Lexington Somerset Elizabethtown Bowling Green Bardstown Enrolled 26
KEHP Ongoing Focus 26 DPP classes starting in March Continued partnership with Cabinet for Health and Family Services to publish the Kentucky Diabetes Report Published reports in 2013 and 2015 Working together on the next report to be published in 2017 27
Diabetes Value Benefit - New for 2016 Members pay $0 for diabetic supplies and reduced costs for diabetic medications Diabetes LivingWell LivingWell Standard Standard Value Benefit* CDHP PPO PPO CDHP 30% 30-Day Supply 0% $0 $0 0% Tier 1 - Generic 10% $25 Min $10-Max $40 25% Tier 2 – Preferred Tier 3 – Non-Preferred 10% $40 Min $45-Max $85 25% 90-Day Supply 30% (Retail or Mail Order) 0% $0 $0 0% Tier 1 - Generic Tier 2 – Preferred 10% $50 Min $20-Max $80 25% Tier 3 - Non Preferred 10% $80 Min $90-Max $170 25% 28
KEHP’s Diabetes Prevention Path Milestones Overview Results Future
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