Challenges with implementing the Diabetes Prevention Program for Medicare beneficiaries in an integrated health system.

OBJECTIVES

In April 2018, CMS began reimbursing both clinical and community settings for providing the CDC-recognized Diabetes Prevention Program (DPP) to eligible Medicare beneficiaries. To better understand the process of offering the program to Medicare beneficiaries, we interviewed relevant stakeholders in a large, integrated health care delivery system.

STUDY DESIGN

Qualitative interview study.

METHODS

We conducted semistructured interviews with 12 delivery system stakeholders. Data were analyzed following a thematic analysis approach.

RESULTS

Stakeholders described systemic challenges to the implementation of Medicare DPP (MDPP), including inadequate reimbursement for the health care system, low awareness of MDPP among patients and providers, and challenges with utilizing third-party vendors to connect patients to CDC-recognized MDPPs.

CONCLUSIONS

Although the reimbursement of DPP for Medicare beneficiaries was a landmark decision, the current structure and requirements make it difficult for health systems and community-based providers to implement and promote this benefit. This study highlights the challenges that even integrated health systems are facing to implement MDPP, as well as potential strategies to overcome these barriers and expand the reach of the program. Medicare should seek ways to increase the financial incentives and decrease the barriers associated with implementing MDPP.