PREVENTING COSTS & CHANGING LIVES
National Diabetes Prevention Program
(NDPP)
Maine Diabetes Prevention and Control
Program (DPCP)
Division of Population Health
October 2014
Panelist
Nathan Morse, CHES, TTS-C, Maine CDC, Diabetes and
Control Program Coordinator - Moderator
Health System: MaineGeneral
Barbara A. Crowley, MD, VP, MaineGeneral Health
Laura Holweger, CHES, Program Mgr., Prevention Center
Michelle 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
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.
29 million
with Diabetes
86 million
with Prediabetes
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
WHAT WERE THE DPP STUDY FINDINGS?
New England Journal of Medicine, 2002
100
90
71%
80
Reduced chance
of developing
diabetes
70
58%
60
50
31%
40
30
20
10
0
Lifestyle - total Lifestyle - 60+
Metformin
• 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%)
Source: CDC DPRP Program Data as of 3/19/2013
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.
National Diabetes Prevention Program in
Clinical and Community settings
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
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
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
All Over The Map
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
Clinical Support
•
•
•
•
Improved patient outcomes
Patient engagement
Extension of the practice
EEHR reports
Provider Success Story
Catherine Nielsen, MD
Oakland Family Medicine
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.
Peer Coaches and Success
Stories
Dorothy Turner, volunteer Lifestyle Coach
demonstrating her groups weekly weight
loss goal
“ 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!”
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.”
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.”
Social Determinants of Health
Implementing the Framework
Fully Insured
Commercial
Self-Insured
Commercial
Medicare
Medicaid
Self-Pay
Reimbursement Methodology:
Incentivize Efficiency and Reward Quality
Specialty Care
- Outpatient
Outpatient
Diagnostics &
Surgery
Acute Care ED &
Inpatient
Home Health
& Hospice
Anchored on Primary Care
Healthy
Chronic
Acute
PostAcute &
LTC
End of
Life
KENNEBEC REGION HEALTH ALLIANCE
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
Incorporating Diabetes Prevention into
L.L.Bean’s Wellness Efforts
Maine Health Management Coalition
Fall Symposium
October 15, 2014
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
Employee Wellness at L.L.Bean
A business is in a unique and responsible position
to effectively enhance the well-being
of its employees”
- Leon Gorman, 1982
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.
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
L.L.Bean
– Area
Risks
Healthy
Lifestyles
- 2013Health
Corporate
Results
LLBean
2013
LLBean
2010
Benchmark
Average
C.S. N'port
C.S. Peck
OFC
Returns
Mfg.
Facilities
Finance /
Security
HR/HSW
IS
Office Areas
Stores
3,756
3,530
1.2 / 1.7 M
302
214
84
182
536
192
262
141
119
115
341
559
648
Average Age
51
49
47 / 43
55
54
54
54
51
53
50
52
50
52
50
47
49
Smoking
5.9
7.3
7.7
5.3
7
2.4
8.1
9.5
8.9
12.4
6.5
8.3
2.5
2.9
3.1
2.8
Tobacco Use
7.1
8.5
9.5
Hypertension
6
8
2.4
9.1
11.2
10.5
13.9
9.4
9.1
2.5
4.3
4
3.4
6.6
21.8
13.2
9.9
9.8
7.1
11.5
7.8
8.3
3.8
8.5
5
8.7
6.8
2.5
4.8
52.7
51.6
47.1
51.7
51.9
71.4
58.8
56.3
52.1
61.5
56
51.3
47.8
47.8
47.1
51.7
13.1
11.3
8.7
12.3
16
12.2
13.2
13.8
12.1
13.1
13.5
17.8
13.9
10.3
11.9
12.8
34.1
30.9
27
34.8
35.2
25.6
33.5
32.1
36.3
35.5
34
28.8
34.8
35.1
35.2
32.7
8.7
7.1
6.7
8
11.3
11
6.6
10
6.9
10.8
10.6
8.5
9.6
7.1
6.6
9.3
Obese
BMI > 30
34.9
34.5
33.5
42.3
48.1
66.6
47.3
36.9
42.2
45.4
37.6
26.9
31.3
28.4
19.7
30.5
Overweight
BMI 25 - 30
34.7
35.7
34.9
30.4
29.9
17.9
31.3
37.1
32.3
31.7
39.7
34.5
37.4
40.2
36.7
36.6
Ideal Weight
BMI < 25
30.3
29.8
31.4
27.4
22
15.5
21.4
26
25.5
22.9
22.7
38.7
31.3
31.4
43.7
32.9
Exercise
21.9
22.1
31.7
23.3
28.4
36.5
24.7
23.8
28.4
27.8
21.7
24
18.5
16.2
13.8
20.3
5.8
4.6
5.2
8.9
4.7
11
10.4
6.8
7.4
6.6
8.5
5.9
3.5
5
2.7
3.3
Glucose
100 - 125 (Impaired)
19.2
15.7
19
19.9
19.7
22
16.5
23.6
27.9
22.8
16.3
23.7
18.3
15.9
13.5
18.4
A1C > or = 6.5
5.8
na
5.6
8.9
7.5
7.3
9.3
7.9
7.9
7
8.5
5.1
2.6
5.6
2.7
3.3
Emotional Health
12.1
12.2
17.6
11.6
10.9
21.2
16.1
12.8
12.6
20.1
4.3
8.3
12.6
9
8.1
11.8
Stress
37.4
43.8
48.9
37.5
40.8
58.8
42.5
37.5
35.3
47.1
31.2
35.5
34.5
33.8
29.5
38.1
Alcohol
4.6
4.9
3.6
3.7
7
1.2
3.2
5.7
4.7
7.7
5.8
0
4.2
4.9
2.9
4.9
Health Risk
Total Participants
(> or = 140/90)
Pre-Hypertension
(120/80-139/89)
Cholesterol
(> or = 240)
Cholesterol
(200 - 239)
LDL
(> or = 160)
(< 90 min./wk)
Glucose > 125
(Diabetic)
2013 Company Average
C.S. Bangor C.S. Home
2010 Company Average
Above company average
Highest risk in the company
Diabetes Prevention Program
• CDC-DPP
• BIW
• Training
• BIW-L.L.Bean class
• Bangor class
Class Structure
• Instructors
• Number of Participants
• Class process
• Lessons
• Learnings
Results BIW/L.L.Bean
Pounds Lost/Participant
% Weight Loss
35
16%
30
14%
12%
25
10%
20
8%
15
6%
10
4%
5
2%
0%
0
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
•
11 participants completed program
•
Average pounds lost – 13
•
Average % weight lost – 7%
6
7
8
9
10
11
12
Results - Bangor
35
Pounds Lost/Participant
30
12.0%
% Weight Lost
10.0%
25
8.0%
20
6.0%
15
4.0%
10
2.0%
5
0.0%
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16
1
2
3
4
5
6
7
-2.0%
•
15 participants completed program
•
Average pounds lost – 12.4
•
Average % weight lost – 3.6%
8
9 10 11 12 13 14 15 16
Key Learnings
• Program pace
• Participant involvement
• Maintaining the integrity of the program
• Making it your own
• Realistic Results
Next Steps
• Continue pilot effort
• Continue data assessment
• Integrate with Healthy Lifestyles HRA program,
Actions/Outcomes
• Clinic referrals
• Explore opportunities to
reach home agents
Questions?
Susan Tufts
Employee Health & Wellness Manager
L.L.Bean, Inc.
207-552-4538
stufts@llbean.com
Bath Iron Works
National Diabetes Prevention Program
Anthony Anderson, Fit for Life
Program Manager
Version 9/19/2014
55% of BIW employees screened are at risk
for developing diabetes within four years.
39
Diabetic patients account for almost 3x the
cost and 2x the absences of non-diabetics
2013
Average Cost
Days Absent (for
employees)
Diabetic Patient
$14,222
15 days/ year
All BIW employees
$4,761
8.7 days/ year

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
40
Building Community Partnerships
Fall 2013
Winter
2013
Spring
2014
Fall 2014
• BIW and L.L.Bean met to discuss a potential
partnership.
• BIW and L.L.Bean offered a NDPP coach training
hosted by L.L.Bean.
• Joint BIW and L.L.Bean NDPP program began for
employees and spouses.
• Completed 16 core classes
• Participants averaged 7% weight loss
41
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
42
43
Bath Iron Works and L.L.Bean NDPP Class
44
Discussion
Thank you
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