Make Diabetes Prevention Programs the Next Step in Medicare Advantage’s Rapid Digital Health Adoption
By Julia Hu
CEO and Co-Founder, Lark Health
When reflecting on the last year, it’s easy to get wrapped up with what went wrong as health care was turned upside down by the COVID-19 pandemic – but we should not forget what went right. To respond to this emergency, the health care industry adopted innovative solutions that will pave the way for better care delivery long after the pandemic subsides.
Vulnerable patients at-risk of contracting serious COVID-19-related illness – many of whom are older adults – were asked to stay home, which could have meant forgoing necessary medical care, particularly preventive care. Fortunately, providers and health plans accelerated the adoption of virtual health care solutions so that these patients could continue to receive their care at home.
Research has shown how Medicare Advantage led this paradigm shift. A study from the Center for Innovation in Medicare Advantage conducted by ATI Advisory found that “Medicare Advantage plans and risk-bearing providers were strongly positioned to deploy solutions that connect Medicare beneficiaries with essential [telehealth] services.” As a result, surveys show that roughly three-fourths of Medicare Advantage beneficiaries were able to continue to receive care for their health needs during the pandemic without interruptions.
The senior population responded to the uptake of virtual care amid COVID-19 by shifting their utilization of tools that helped them manage their health from home and coordinating with their primary care providers and other specialists virtually.
We are one year into navigating COVID-19, and we must continue to accelerate the digital innovation that has taken hold in Medicare Advantage, far outpacing Traditional Fee-for-Service (FFS) Medicare. As of this month, there are over 26 million Medicare Advantage beneficiaries. Not only is this population more likely to develop a serious case of COVID-19 if they contract the virus, but they also require frequent, high-touch health care to maintain their conditions on a regular basis.
Prior to the pandemic, there was a longstanding notion that seniors are not tech-savvy and would not adopt digital health tools; however, that notion has changed drastically. December 2020 Morning Consult poll commissioned by Better Medicare Alliance found that 40 percent of Medicare Advantage beneficiaries have used virtual care to complete appointments during the COVID-19 pandemic, giving the experience a 91% favorability rating.
In 2021, with so many different virtual health care tools and solutions, telehealth apps, and other digital offerings, it’s difficult to determine what resonates with each unique patient population. For Medicare Advantage beneficiaries – many of whom have complex chronic conditions and are proportionally lower-income, more diverse, and possess higher rates of social risk factors than Traditional FFS Medicare beneficiaries – it’s clear that virtual care needs to encompass whole-person care: check-ins between primary care or specialist visits to make sure they are staying healthy; chronic condition management tools; nutrition assistance; behavioral health coaching; medication adherence help; and more.
Modern approaches to care management must combine digital and traditional high-touch capabilities to help members better understand their chronic conditions and drive self-management behavior. For Medicare Advantage beneficiaries in particular, this kind of approach will not only keep them healthy and at home but can be the foundation of value-based payment models prevalent in Medicare Advantage.
A good next step is a digital program that has both prevention and management capabilities that allow seniors to manage their chronic condition in a cost-effective way. In 2017, CMS announced its Diabetes Prevention Program was available to all eligible Medicare beneficiaries. The program was originally designed to help up to 110,000 individuals a year prevent type 2 diabetes — Politico reported in late 2019 that the program enrolled only 200 beneficiaries, or 0.18 percent of their target goal, on account of a lack of providers. While Medicare Advantage plans were eager to use DPP for their enrollees, one barrier raised by policymakers and digital health care companies was that virtual health providers were excluded from participating in the program. This caused a gap in care for many beneficiaries who could benefit from a virtual DPP option but did not have access to in-person care
This is where Medicare Advantage can take another leap forward in innovation. Scalable and digital DPPs can be an incredible line of support for beneficiaries, especially as we continue to manage our new normal and how virtual care can be delivered today. A study of older adults using a digital DPP powered by conversational artificial intelligence experienced an average weight loss of 4.4kg over 12 months, which is on par with the Centers for Disease Control and Prevention’s National DPP results, in which participants achieved a weight loss of 10 to 14 pounds for an individual weighing 200 pounds.
COVID-19 and the new rules issued by CMS in response to expanding virtual care options are promising, but only a start. As we look to build a post-pandemic health care system, Medicare Advantage can maintain its leading role by continuing to foster the adoption of digital DPPs so that beneficiaries can access preventive care wherever and whenever they need it, and in a way that is effective and user-friendly.
We need the entire system to come together, from our leaders in Washington to health plans, providers, and virtual care companies so that we can provide this patient population with the tools they need.
Julia Hu is the CEO and Co-Founder of Lark Health, a BMA Ally organization. Learn more at www.lark.com.