Diabetes PreventionPast, Present and Future

Understanding the Minnesota Landscape:

Diabetes Unit

Outline

Why does Minnesota need to prevent type 2 diabetes?

What have we accomplished so far?

What opportunities lie ahead?

Why does Minnesota need to prevent type 2 diabetes?

Diabetes prevalence has risen and is at an all-time high

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0Pe

rcen

tage

of M

inne

sota

Ad

ults

Year*,**

The current diabetes prevalence among adults (2014) is 8.1%.

*Note: Percentages are age-adjusted to account for any changes in age distribution in the MN population over time.**Percentages reflect an average of 2-3 years of data.

Sources: Centers for Disease Control & Prevention, National Diabetes Surveillance System located at: http://apps.nccd.cdc.gov/DDTSTRS/default.aspxMDH analyses of Behavioral Risk Factor Surveillance System Data.

CDC estimates 37% of adults have prediabetes and yet... In 2012, only 5.2%* of Minnesota

adults said they knew that they had prediabetes.

This compares to: A median of 5.9% for the US Range across states: 4.7% - 10.6%

We have a lot of room for improving awareness of prediabetes.

* Age-Adjusted Rates. Source: 2014 National Diabetes Report Card, CDC, located at:http://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2014.pdf

Some communities feel the sting of diabetes more strongly...

The report Income, Employment and Diabetes in Minnesota can be found at:http://www.health.state.mn.us/divs/healthimprovement/data/reports/diabetesincome.html

Diabetes is costly to MinnesotansType of Expense Total Cost in 2012

Extra medical costs & lost productivity1

$3.14 billion

Total medical spending for insured Minnesotans with diabetes2

$5.2 billion

Average medical spending for insured Minnesotans with diabetes2

$16,300 per person

1ADA. Diabetes Care 36(4):1033-46.2MDH Analyses of the Minnesota All-Payer Claims Database located at:http://www.health.state.mn.us/divs/hpsc/hep/publications/costs/20160127_chronicconditions.pdf

If preventing type 2 diabetes is our goal…

What have we accomplished so far?

Minnesota Diabetes Collective Impact Initiative

Started in 2012 Vision: To become the State with the

lowest incidence and the healthiest outcomes for diabetes in the country

Goals: Prevention and Care Delivery

Five Conditions of Collective Impact

.

Condition Definition

Common AgendaAll participants have a shared vision for change including a common understanding of the problem and a joint approach to solving it through agreed upon actions.

Shared MeasurementCollecting data and measuring results consistently across all participants ensures efforts remain aligned and participants hold each other accountable.

Mutually Reinforcing Activities

Participant activities must be differentiated while still being coordinated through a mutually reinforcing plan of action.

Continuous Communication Consistent and open communication is needed across the many players to build trust, ensure mutual objectives, and create common motivation.

Backbone Support

Creating and managing collective impact requires a separate organization(s) with staff and a specific set of skills to serve as the backbone for the entire initiative and coordinate participating organizations and agencies.

American Diabetes Association Blue Cross Blue Shield of Minnesota CDC Courage Center Decade of Discovery Essentia Health Haberman Halleland Habicht, llC HealthEast HealthPartners Himle Rapp ICSI International Diabetes Center The Insuroon Project LifeScience Alley Mayo Health System

Medica Minnesota Community Measurement Minnesota Department of Health Minneapolis Urban League Novo Nordisk Sanford Health System SEIU Healthcare Minnesota Stairstep Foundation Stratis Health Southside Community Clinic UCare United Health Group United Way University of Minnesota West Side Community Health Services YMCA of the Greater Twin Cities 3E Consulting

Collective Impact Members

Collective Impact LeadershipAcknowledging Executive Team Members Since 2012

David Etzweiler, U of MN and Mayo Decade of Discovery

Sheila Kiscaden, Decade of Discovery Andrew Nelson, HealthPartners Institute Carolyn Pare, Minnesota Health Action Group Jim Eppel, Blue Cross Blue Shield of Minnesota Alfred Babington-Johnson, Stairstep Foundation Gretchen Taylor, Minnesota Department of Health

Collective Impact Strategies and Leadership

Workgroup Chairpersons

Prevention – David Etzwiler and Gretchen TaylorDiabetes Care Delivery – Sheila Kiscaden and Gary OftedahlData and Knowledge – Steve Smith and Jay DesaiPolicy and Advocacy – Jim McGowan and Mike Connelly

Our Prevention StrategySignificantly reduce new cases of diabetes among those at high risk of developing the disease.

Strategy: Identify and scale evidence-based interventions with the highest benefit for participants and public and private payers.

Objective: Ensure that the Diabetes Prevention Program is available and accessible to all in Minnesota for whom it is indicated.

Our Prevention Vision All payers and employers support the adoption of the NDPP

through reimbursement and plan design All providers are aware of prediabetes and are supported to

test those at risk and refer to the NDPP A diverse, trained workforce with organizational and

community capacity is in place to deliver the NDPP A comprehensive and culturally appropriate marketing plan

encourages those at risk to be tested and seek referral to the NDPP

Budget, infrastructure and human resources are in place to coordinate the plan for statewide implementation and to monitor progress

Our Work Plan Goals

All payers and employers support adoption of the DPP through plan design and reimbursement Engage state payers (Medicaid and SEGIP) Outreach to employers and self-insured businesses

Coverage of the DPP was and continues to be a foundational goal

Monitor progress Develop a shared measurement system

Implement a communications plan about the effort Raise awareness among providers and the general public

Minnesota Accomplishments: DPP Coverage

For state employees – April 2015 Minnesota Health Action Group, MN Management and

Budget, MDH

For private and public employees MHAG, YMCA, St Louis County, other Minnesota employers

For Medicaid beneficiaries – Jan 2016 DHS, MDH

Medicaid beneficiaries study – 2011-2016 DHS, MDH, HPI, YMCA, DPCA, 23 metro-area clinics

Medicare Progress: DPP Coverage

For Medicare beneficiaries pilot –AMA, YMCA, Park Nicollet

Medicare coverage in 2018 – CMS, CDC!

Progress: Shared Measurement New Diabetes Dashboard

The Diabetes Dashboard is located at: http://www.health.state.mn.us/diabetes-dashboard

Progress: DPP Communications to Engage Physicians and Public

Marketing materials for populations at risk Ad Council media campaign CDC/AMA toolkit for patient testing and

referral to DPP Toolkit for clinic system change

2008 CDC Grant 2006-08 Developer of the

group DPP model trained coaches

4 sites in 4 communities

2016

Progress: A System Built from Humble Beginnings…

The map includes sites listed on the CDC Diabetes Prevention Recognition Program page, and additional information that we could obtain from other webpages. Some sites may not be listed and on-line programs have not been included.

Let’s Build a DPP System for the Future!

Infrastructure to support a DPP delivery system: Statewide repository of current DPP

classes that allows enrollment Call center to help people find classes Accessible, affordable data collection

system Ongoing training and technical support

system for Minnesota coaches

What opportunities lie ahead?

What Opportunities Lie Ahead?

We can make a difference together as a statewide group of partners: Address diabetes prevention head-on Change the picture for diabetes

Who: You and your organization

When: Start today, 9/13/2016

Why Now? We have made substantial progress on our

foundational goal of insurance coverage for the DPP

The time is right: there is national and state momentum and opportunities are advancing

We MUST take action! Diabetes continues to increase, and it’s imperative that we act.

What Opportunities Lie Ahead?

How would this work moving forward? MDH will re-convene and structure work

teams We will develop an action plan together Starting on 9/14/2016 Get broader input from the group

We will meet together regularly – plan, learn and expand the National DPP in Minnesota

How Do We Engage Today?

Up next: Learn what has happened nationally and in Minnesota to expand the NDPP

Learn about resources that can support our work

Meet new diabetes prevention colleagues

Sign-up to be a part of the team!

Let’s Make a Difference!I used to eat four or five pieces of chicken, eat four pieces of bread, and then go lay down and go to sleep… What I do is I don’t eat to get full anymore… If I bloat my stomach, I'm going to sleep, so I learned not to do that. I'll eat just enough that I feel all right, then I'm up and I'm more energetic. I'm 20 pounds lighter than I was. But the biggest thing of it is, I'm a hundred times more energetic than I was.

- Man from African American focus group, We Can Prevent Diabetes study, 2016