PREVENTING COSTS & CHANGING LIVES National Diabetes Prevention Program (NDPP)

1. PREVENTING COSTS & CHANGING LIVESNational Diabetes Prevention Program (NDPP) Maine Diabetes Prevention and Control Program (DPCP) Division of Population Health October 2014

2. Panelist Nathan Morse, CHES, TTS-C, Maine CDC, Diabetes and Control Program Coordinator - Moderator Health System: MaineGeneral Barbara A. Crowley, MD, VP, MaineGeneral HealthLaura Holweger, CHES, Program Mgr., Prevention CenterMichelle Aldrich, RN, MaineGeneral Health Employers: Susan Tufts, Manager of Occupational Health & Wellness, L.L. Bean, Inc. Anthony Anderson, Fit for Life Program Manager, General Dynamics – Bath Iron Works

3. Learning Objectives • Learners will understand the principals/fidelity standards of the NDPP and how to scale and apply it in Health Systems, Employer settings, and Health Plan design such as ACO/VBID. • Learners will at the conclusion of the session understand how to apply NDPP in care settings as a population health management strategy. • Learners can demonstrate knowledge base of NDPP and take next steps within their respective Healthy System/Community/Employer/Payer settings to apply this evidence based lifestyle intervention program to their scope of practice and health plan coverage.

4. 29 millionwith Diabetes 86 millionwith Prediabetes

5. NDPP Overview • If you do have prediabetes, research shows that doing just two things can help you prevent or delay type 2 diabetes: Lose 5% to 7% of your body weight, which would be 10 to 14 pounds for a 200-pound person; and get at least 150 minutes each week of physical activity. • 16 Core; 6 Post-Core; high touch, group support, facilitated by Certified NDPP Lifestyle Coach

6. What Were the DPP Study Findings? New England Journal of Medicine, 2002 • Lifestyle intervention sharply reduced the chances of developing type 2 diabetes (58%) • 71% for aged 60+ • Metformin group reduced their risk but not as much as the lifestyle intervention group (31%) Reduced chance of developing diabetes

7. Source: CDC DPRP Program Data as of 3/19/2013

8. Our Maine Goal for NDPP • Sustainability: Multi Payer approach to coverage of NDPP. • Innovative payment models: VBID, ACO, Population Health approach… • Community, Provider, Worksites communications that inform and support this evidence based approach to prevent/delay Type 2 diabetes. • Continue to provide high quality TA for NDPP deployment/sustainability.

9. National Diabetes Prevention Program in Clinical and Community settings

10. Why? • 90,000 patients in the greater Kennebec and Somerset county are at risk >60% of the population • Prevent disease burden and prevalence • Reduce overall cost of care associated with Diabetes

11. Project Set Up • Single leader of project funded through grant • Centralized HUB • Report creation to identify in EMR who is at risk or diagnosed with pre-diabetes • Meetings with leadership at the practice • Key stakeholders - community and clinical • One key contact

14. Statistics From the CTG 2 Year Project 88.6% completion rate for 16 week core class • 67 trained Lifestyle Coaches • 60 programs provided to date • 9 programs associated with practices NDPP class at Hathaway Bonnie Tracy, volunteer Lifestyle Coach

15. All Over The Map

16. Assessment of Population • Readiness for change assessment by Psychologist • Contact from the practice to initiate conversation • Algorithm • Referral coming from practice • Team based approach • Education from all team members • Huddles • Second approach – MA calls

17. Clinical Support • Improved patient outcomes • Patient engagement • Extension of the practice • EEHR reports

18. Provider Success Story I have a stack of risk assessment screening cards in every exam room and read through the risk assessment with all of my patients. I tell them about success from my other patients who have completed the program, it seems to motivate them to take action and register.I love when patients come to their appointment with improved numbers, they typically comment: “I can’t believe this works, I have tried everything in the book, I’m impressed with the program results!” I am thankful we have this valuable program to refer patients free of charge, also, there are so many programs starting each month in various communities. Both help diffuse barriers for our patients to take advantage of this wonderful program. Catherine Nielsen, MD Oakland Family Medicine

19. Peer Coaches and Success Stories “ My PCP referred me to NDPP because I was pre diabetic, I completed the program with great success and LOVED IT! I wanted to give back to my community, help others and keep myself accountable. NDPP Master Trainer, Laura trained me to deliver the program, I am working on delivering my second program as a volunteer & love every minute of it!” Dorothy Turner, volunteer Lifestyle Coach demonstrating her groups weekly weight loss goal

20. Success Stories “ I have found the program to be life changing and helpful. It has greatly helped me to change my lifestyle an adapt to new ways of improving my health and fitness. In making these changes I now have an understanding of how to make wiser decisions and how to control my portions. I plan to continue with the new lifestyle changes I have made to continue being successful.”

21. Success Stories “I lost 18 lbs. and my blood sugars are down below 100. Now I eat properly and feel great!” “I am very pleased with my 42lb weight loss.”

22. Social Determinants of Health

23. Reimbursement Methodology: Incentivize Efficiency and Reward Quality Implementing the Framework Fully Insured Commercial Medicare Medicaid Self-Insured Commercial Self-Pay Home Health & Hospice Specialty Care - Outpatient Outpatient Diagnostics & Surgery Acute Care - ED & Inpatient Anchored on Primary Care Post-Acute & LTC End of Life Chronic Healthy Acute KENNEBEC REGION HEALTH ALLIANCE

24. Principles • PCMH 2.0 • System approach • Long term investment • MUST have a program leader to work with practices and community • Train the trainer • Project time > 2 years to see full potential

25. Incorporating Diabetes Prevention into L.L.Bean’s Wellness Efforts Maine Health Management Coalition Fall Symposium October 15, 2014

26. L.L.Bean - Corporate Information • 5,000 year round employees (10,000 employees during peak) • Self-insured • 30,000,000 annual health costs • 2,000,000 workers compensation costs • Average Age 50 • 66% Female

27. Employee Wellness at L.L.Bean

28. Safe & Healthy Living Core Value We believe healthy people lead fuller, more productive lives. Our employees and other stakeholders should feel their association with L.L.Bean contributes to their health and well-being.

29. Wellness Program Offerings • Onsite Fitness Centers • Health Education Classes • Activity Classes • Comprehensive HRA Program • Tobacco Free Campuses • Healthy Foods in • Cafeteria and Vending • Employee Outdoor Club • Employee Assistance Program

30. L.L.Bean – Area Health Risks Healthy Lifestyles - 2013 Corporate Results 2010 Company Average Above company average 2013 Company Average Highest risk in the company

31. Diabetes Prevention Program • CDC-DPP • BIW • Training • BIW-L.L.Bean class • Bangor class

32. Class Structure • Instructors • Number of Participants • Class process • Lessons • Learnings

33. Results BIW/L.L.Bean • 11 participants completed program • Average pounds lost – 13 • Average % weight lost – 7%

34. Results - Bangor • 15 participants completed program • Average pounds lost – 12.4 • Average % weight lost – 3.6%

35. Program pace Participant involvement Maintaining the integrity of the program Making it your own Realistic Results Key Learnings

36. Next Steps • Continue pilot effort • Continue data assessment • Integrate with Healthy Lifestyles HRA program, Actions/Outcomes • Clinic referrals • Explore opportunities to • reach home agents

37. Questions?Susan TuftsEmployee Health & Wellness ManagerL.L.Bean, Inc.207-552-4538stufts@llbean.com

38. Bath Iron Works National Diabetes Prevention Program Anthony Anderson, Fit for Life Program Manager Version 9/19/2014

39. 55% of BIW employees screened are at risk for developing diabetes within four years.

40. Diabetic patients account for almost 3x the cost and 2x the absences of non-diabetics • Diabetes had the highest total direct costs (medical, pharmacy and short term disability) of any other condition in 2013 • In 2013, diabetes was the #1 driver of Pharmacy costs, at over twice the costs of the #2 condition

41. Building Community Partnerships

42. NDPP Goals for BIW • 2014 Goal to begin 4 classes by end of year • Shared Vision with community partners • Mid Coast Medical Group • Martin’s Point • Bath Area YMCA • L.L.Bean • MaineGeneral Medical Center

44. Bath Iron Works and L.L.Bean NDPP Class

45. Discussion

46. The Department of Health and Human Services (DHHS) does not discriminate on the basis of disability, race, color, creed, gender, sexual orientation, age, or national origin, in admission to, access to, or operations of its programs, services, or activities, or its hiring or employment practices. This notice is provided as required by Title II of the Americans with Disabilities Act of 1990 and in accordance with the Civil Rights Act of 1964 as amended, Section 504 of the Rehabilitation Act of 1973, as amended, the Age Discrimination Act of 1975, Title IX of the Education Amendments of 1972 and the Maine Human Rights Act and Executive Order Regarding State of Maine Contracts for Services. Questions, concerns, complaints or requests for additional information regarding the ADA may be forwarded to DHHS’ ADA Compliance/EEO Coordinators, 11 State House Station – 221 State Street, Augusta, Maine 04333, 207-287-4289 (V), 207-287-3488 (V), TTY users call Maine relay 711. Individuals who need auxiliary aids for effective communication in program and services of DHHS are invited to make their needs and preferences known to the ADA Compliance/EEO Coordinators. This notice is available in alternate formats, upon request. Thank you