DPCA: DIABETES PREVENTION AND CONTROL ALLIANCETM

MN HEALTH ACTION GROUP – NATIONAL DPP

Presentation to

DIABETES PREVENTION AND CONTROL ALLIANCE 3/25/2013

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Our Mission

Helping individuals with prediabetes and diabetes live healthier lives by offering structured access to evidence-based interventions that improve outcomes and reduce cost

Our Primary Goals

Reduce the conversion to diabetes among people with prediabetes Reduce heart attacks, strokes, kidney disease, amputations, and

blindness in people living with diabetes Support primary care physicians in comprehensive patient care

programs

Our Innovative Partnerships

Collaborate and contract with other trusted health and wellbeing organizations at the local level in a non-traditional manner to broaden the care delivery opportunities available to those at risk: Diabetes Prevention Program with community organizations (e.g., the Y) for

individuals with prediabetes Diabetes Control Program with local pharmacists for individuals with diabetes

Diabetes Prevention and Control Alliance Overview

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1. Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393-403, 2002 2. Ackermann and Marrero. Adapting the Diabetes Prevention Program Lifestyle Intervention for Delivery in the Community. AADE 2007.

Diabetes Prevention Program (DPP) Evidenced-based Intervention for Prediabetes

Study Diabetes Prevention Program1 Deploy22

Sponsor(s) National Institutes of Health Centers for Disease Control & National YMCA

Methodology Randomized Control Trial

(Lifestyle/drug/control) 27 sites, 3,234 prediabetics ages (>25) and various ethnicities

Pilot-cluster Randomized Trial (Lifestyle / Control)

Interaction 1:1 PhD-level Clinician (long-term maintenance, consistent training)

Group YMCA Lifestyle Coach (long-term maintenance, consistent training)

Frequency 16 Sessions (with optional year-long monthly follow-up)

Content

Welcome & Getting Started ▪ Be a Fat & Calorie Detective ▪ Ways to Eat Less Fat & Fewer Calories ▪ Healthy Eating ▪ Move Those Muscles ▪ Being Active: A Way of Life ▪ Tip the Calorie Balance ▪

Take Charge of What’s Around You ▪ Problem Solving ▪ Four Keys to Healthy Eating Out ▪ Talk Back to Negative Thoughts ▪ The Slippery Slope of Lifestyle Change ▪ Jump Start Your Activity Plan ▪

Make Social Cues Work for You ▪ You Can Manage Stress ▪ Ways to Stay Motivated

Goals 7% weight loss <25% fat calories 1200-1800 calories/day >150 minutes weekly physical activity

Results 5% weight loss 58% reduction in diabetes conversion 6% weight loss

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DIABETES PREVENTION PROGRAM (DPP) Lifestyle Management and Weight Loss

People diagnosed with prediabetes can slow and even prevent the onset of type 2 diabetes through weight loss and lifestyle management. Participants are guided in group sessions by specially-trained health coaches. DPP Overview

16 core 1-hour small group sessions, then monthly follow up for one year Recognized by Centers for Disease Control and Prevention (CDC) Sustained weight loss in 40% of participants at 10 year follow up Adult risk of developing type 2 diabetes reduced by nearly 60%; in adults

age 60+, the reduction is 70% Program lifestyle changes proven to be more effective than medication Regular communication provided to physicians Preventive benefit; no copayment for participants Claim payment is progressive and based on outcomes (not a PMPM)

Diabetes Prevention Program (DPP) Delivered via Local Lifestyle Coaches

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DPCA Operations & Technology Health Information Technology & Scalable Business Practices

Plan Sponsor Services: • Eligibility Management • Risk Scoring/Data Mining • Outreach/Engagement • On-line Enrollment • Screening/Testing • Call Center Member Support • Reporting and Measurement • Claim based reimbursement

Adjunct Provider Services: • Billing/Claims • Scheduling • Intervention Workflow/Class Tracking • PCP Provider Portal – Referrals • Reporting & Measurement • Call Center – Tech Support • Data Security

DPCA Operations & Technology Health Information Technology & Scalable Business Practices

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Advanced analytics / Large scale management work flow / Call center and participant engagement tracking / Connections among providers of care across different care settings / Outcomes tracking and administration of complex, incentive based payment structures

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DPCA Engagement Process at a Glance

Outreach by DPCA call center

Contacts eligible diabetic participants can answer questions and assist with enrollment. Participants can also enroll online.

Send welcome kits to DCP enrollees Diabetic participants receive lab kit and stored value card

Collect employer information

Capture group setup and eligibility data in MYnetico

Deploy OptumInsight Impact analytics OptumInsight HealthImpact process uses employer claim data to identify eligible participants

“Welcome aboard” calls to DPP & DCP enrollees YMCA Lifestyle Coach contacts DPP enrollees to confirm first date and time of first session at the Y

Pharmacist calls DCP enrollees to remind about lab kit and confirm first appointment;

Report program results to employer Provide employer with reports on program participation and outcomes

Enrollee participation – DPP weekly sessions & DCP quarterly consults The comprehensive 16-session program covers weight loss, healthy eating habits, risk reduction, lifestyle change & behavior modification

Pharmacist consults include: ADA exam schedule, weight, BP, labs. medication review, complication monitoring, diabetes education

1 Outreach to eligible participants begins Outreach letter, emails, testing events, etc. to engage eligible prediabetic or at-risk participants

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Screen participants for prediabetes Conduct screening events at employer sites, community locations, physician offices to identify those at risk for diabetes

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CURRENT & SCHEDULED DPCA MARKETS

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DPP Combined Active Market DPP Active Market

Market Planned for 2013

Minnesota DPP Locations

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Bold and engaging with a strong call-to-action Mindset transition from “It can’t happen to me” to “I won’t let it happen to me” Relevant across full concern / hope / pride spectrum; meets people where they are

DPCA Consumer Brand

2013 “Tell Diabetes Not Me” Tour Overview

• 2 NOT ME branded trucks, national, year-long tour stopping in most markets twice • Dedicated “Not Me” and carrier branding offering lab grade finger stick A1c testing • Goal: 50,000 tests = 50,000 teachable moments = 1 every 10 minutes! • Imagine what could be accomplished if every 10 minutes we influenced somebody

to live a healthier life! • Truck events with all-new, hands-on, multi-media experience to entertain and educate:

– Excerpts of our groundbreaking reality series “Project NOTME” on TVs in public spaces – Testimonials from past program participants – Educational materials that creatively illustrate and explain the negative impact and long term

effects on the body of high blood sugar and diabetes – Fun give-aways – Program materials for DPP and DCP with contact information for enrollment and questions – Immediate, on-site enrollment opportunities

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Key Points:

2013 MOBILE TOUR SPECIFICATIONS

13 * Actual tour graphics and artwork for illustrative purposes and subject to change

TRUCK AND TRAILER • Truck measures 21’11” long, 6’8” wide, 6’9” tall &

weighs 11,500 lbs. – Truck disconnects from trailer during event.

Separate parking space is needed. • Trailer measures 32’ long, 8’6” wide, 10’3” tall and

weighs 12,500 lbs. • Driver needed 25’ to navigate a turn into a venue • Self contained power

– 2 -10k Generators – Interior/Exterior 110 outlets available

• WIFI Hotspot equipped EVENT SITE FOOTPRINT • 60’ by 40’ space required

– Roughly 6-10 parking spaces long – Roughly 5 side street spaces – External equipment can be adapted based on

space available . • Flat, paved surface is required TIPS • Best location is nearest employee entrance • Cone/rope off event location evening before event • Setup time: 1.5 to 2 hours • Breakdown time: 1 hour

DPCA Event Contact Peter Peckskamp (952) 932-7691

Peter.peckskamp@notme.com

Event Contacts Lindsey Patterson (214) 659-5668 Office (214) 205-4803 Cell Tory Saks (214) 451-1914 Office (972) 849-4175 Cell

West Coast Tour Manager Michael Amos (323) 474-2900 East Coast Tour Manager Michael Rankin 215-789-0333

2013 NOTME Event Basics & Calendar For DPCA Eligible Customers

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Event Basics & Requirements: Calendar of Truck Visits through June: Members at

Location Recommended

Time @ Site 200-500 1 day (4 hrs.)

500-1,000 2 days (4 hrs. each)

1,000 – 2,500 3 days (4 hrs. each)

2,500 + 4 days (4 hrs. each)

Truck Event Recommendations • Minimum of 100 people • May coordinate with other nearby

employers to co-host event • Must be DPCA sponsored for testing • 1 four-hour event per worksite – can expand

based on employer size

For sales related information and questions contact: Colin McLaughlin @ 952-932-7544 Charlotte Smith @ 469-633-8844

Week of Truck 1 Truck 2 2/25 Houston Orlando/Jacksonville

3/4 Houston Orlando/Jacksonville

3/11 Dallas Tampa

3/18 Dallas Georgia

3/25 Ft Worth DC Metro

4/1 Ft Worth DC Metro

4/8 Tucson Baltimore

4/15 Tucson Philadelphia

4/22 Phoenix New York

4/29 Phoenix Long Island

5/6 Las Vegas Rochester

5/13 Denver Rochester

5/20 St Louis Rhode Island

5/27 St Louis Cleveland

6/3 Columbus Cleveland

6/10 Columbus Wisconsin 6/17 Cincinnati / Dayton Wisconsin

6/24 Cincinnati / Dayton TBD

To check availability of truck for purposes of requesting days, please visit our site: http://corp-wss.uhc.com/sites/DPCA/TestingEvents/Lists/Calendar/calendar.aspx Please contact Peter Peckskamp to request a reservation for the truck: (952)932-7691

WHERE IS THE BENEFIT OFFERED?

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Payer Participation • 262 self-funded employers –

adding 10-15/month • Five National/Regional health

plans – Medica – UnitedHealthcare (multiple

markets) – Regence BCBS – MVP Healthcare – Florida Blue (active in March)

• Additional regional plans in the process of contracting

Results of Coverage • 4.2 million covered adults with

benefit • Only 1.5 million have access

to DPP provider within 30 miles

• 1.2 million with health plans currently being contracted

• Goal for 2013 is to add coverage for >2.3 million new members

PROGRAM TO DATE PARTICIPATION?

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Payer Participation • 12,000+ participants are

either enrolled or have completed core DPP sessions

• Mean weight loss 4.8%. 5.1% for those with >9 sessions (74%)

• Only 13% drop out (attend <4 sessions)

• Mean attendance 13 our of 16 core sessions

Attendance = Weight Loss

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The Diabetes Prevention and Control Alliance is a pure performance-based payment model. This unique payment model demonstrates confidence in our expected success and in our clients’ associated

return on investment.

Results-based metrics are part of the program for service providers—YMCAs and retail pharmacies. The more favorable the

participant outcome, the greater the reimbursement.

Payments to DPCA are tied to enrollment, program completion and clinical outcomes. The performance-based program fees cover

member identification and analysis, engagement and participant outreach, call center support, consumer materials, payment to

network providers and reporting solutions.

Unique Performance-based Payment Model

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Estimated Diabetes Costs1

Category Percent PMPY

Prediabetes 26.0% $3,673

Diagnosed diabetes (Four types) 8.0% $9,202

1. No complications 1.5% $4,592

2. Complications: hypertension only

Compliant 1.4% $5,595

Non-compliant 1.7% $6,195

3. Complications: hypertension & other

Compliant 1.0% $13,093

Non-compliant 1.6% $17,762

4. Complications: other no hypertension 0.9% $8,447

Undiagnosed diabetes 2.7% $8,213

Total diabetes & prediabetes 36.7% $5,212

1. Source: UnitedHealthcare 2008 analysis for Diabetes Health Plan for several large employers Medical only no Rx; Per Member Per Year (PMPY)

These results are based on the assumptions used to generate them and may not be indicative of the actual return on investment. Actual results may vary significantly based on the facts and circumstances of a particular case including, but not limited to, demographics and utilization trends.

Return on investment Methodology

Medical Savings Overview – Diabetics tend to progress

through higher cost disease categories over time

– Mission is to slow or prevent the progression

Medical Savings Estimation: 1. Estimate cost of population with

normal progression of disease (no intervention)

2. Estimate cost of population after members participate in DPCA programs

3. Calculate the difference between normal progression (1) and DPCA intervention (2)

Return on Investment Potential Savings Illustrated

Total number of eligible prediabetic includes both those employees who are “known” and “unknown”

Model enrollment rate assumes 20.7% of those living with prediabetes are identified and join a class

Savings is a result multiple benefits including:

– Reduction in the percentage of people with prediabetes converting to diabetes

– Reduction in diabetic complications and overall improved health of members participating

– Behavior modification; better decisions, e.g., weight loss, healthy eating

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3 Year Analysis Prediabetics Program Projections

Total Number of Adults 1 51,360

Estimated Eligibles 2 10,272

Estimated Enrollment 3 2,128

Expected Savings $3,241,260

- Total Costs $1,084,216

Net Savings $2,157,044

Per Enrolled Member

Total Savings $1,523

- Total Costs $510

Net Savings $1,013

¹ Estimated number of Adults located in DPCA rollout markets through 12 / 31 / 2012

DPCA Markets through 12/31/2012 Illustrative Financial Statement

Cumulative ROI Ratio 3.0 : 1

² Estimated Eligibles for DPP (% of Adults ~ 20.0% Prediabetics) Source: Center for Disease Control and Prevention ³Estimated Enrollment for DPP (% of Eligibles ~ 20.7% Prediabetics ) Source: DPCA Consumer Research: Intent to Enroll with conservative adjustment

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