Medicare to reimburse for Diabetes Prevention Program, including Omada's digital version

By Jonah Comstock
02:50 pm

HHS Secretary Sylvia Burwell announced today that Medicare will cover the Diabetes Prevention Program, including digital versions like Omada Health’s. This marks the first time a preventative model from a CMS Innovation Center has been expanded into the Medicare program.

“This program has been shown to reduce health care costs and help prevent diabetes, and is one that Medicare, employers and private insurers can use to help 86 million Americans live healthier,” Burwell said in a statement. “The Affordable Care Act gave Medicare the tools to support this groundbreaking effort and to expand this program more broadly. Today’s announcement is a milestone for prevention and America’s health.”

HHS reported that, based on pilot studies, participants in the program lost an average of 5 percent of their body weight, 80 percent attended at least four weekly sessions, and, compared to Medicare beneficiaries outside the program, the DPP would save about $2,650 per enrollee.

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Omada, which administers an online version of the DPP called Prevent, is the largest CDC-recognized DPP provider: it works with 45,000 individuals via employers, health plans, and health systems. Their stats are even higher than the in-person DPP stats, despite being a digital intervention offered to seniors. In a recent study, six months after starting the program, 84 percent of participants, with an average age of 69, remained engaged and lost an average of 7.8 percent of their body weight. 

“Today marks a day when a whole lot of stars aligned... in a positive way for the health of the country,” Omada Health CEO Sean Duffy told MobiHealthNews. “What typically happens on the other side of a financial coverage decision is the broader community at large takes even more notice of these important programs and issues. I think five or ten years from now, collectively, the country will look back on today as a really important moment.”

Duffy said that Omada has worked with Medicare and Medicaid populations already but on a smaller scale: with Medicare they’ve only worked in Medicare Advantage populations, and with Medicaid they’ve done some small trials. Duffy hopeful Medicaid payers will follow HHS' lead too.

“I think what we’ve felt from HHS is a really strong level of support for technology across the board, which I think is a beautiful thing,” Duffy said. “I hope this sets the stage for ‘Are their other programs with clinical proof and published evidence that show they can impact that population positively?’”


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