Employers: Thank you for considering the National Diabetes Prevention Program.   We understand there may be several people involved in your wellness program decision-making. So, we’ve created this presentation template to help facilitate your communication process. Use this slide deck template to customize a presentation for your senior leaders. On the following slides, you’ll find several opportunities to tailor the business case based on your organization’s profile. Be sure to populate the highlighted areas of the presentation with your own data. We wish you great success in your efforts to prevent type 2 diabetes!

Tools to make your business case It is important to develop the business case. AMA and CDC have developed cost calculator tools to help employers, insurers, and other stakeholders estimate potential return on investment (ROI) and other cost and health outcome measures associated with offering the National DPP lifestyle change program to employees, beneficiaries, or members. Cost effectiveness—and potential cost savings—are factors to think about when considering the impact of offering the National DPP lifestyle change program. Different cost calculator tools can yield different conclusions because of the data and assumptions underlying their calculations. Two of the primary factors leading to differences in conclusions generated by these two tools are the estimates of 1. Progression from prediabetes to type 2 diabetes; and 2. The reduction in risk provided by lifestyle intervention. The CDC’s assumptions for these estimates are towards the lower ranges modeled after a more nationally representative sample, and the AMA’s assumptions are towards the higher ranges modeled after a more targeted employer representative sample. While the datasets and assumptions supporting the AMA and CDC cost calculators are different, both tools can help organizations forecast the benefits of offering the National DPP lifestyle change program. *Default values programmed in the AMA diabetes prevention cost savings calculator are based on studies referenced in the Assumptions and Methodology provided with the tool. Cost estimates in the AMA diabetes prevention cost savings calculator are derived from the Khan et al 2017 study using claims data from the Truven Health MarketScan® Lab Database (commercially insured population). Default values programmed in the CDC Diabetes Prevention Impact Toolkit are based on numerous studies referenced in the Technical Report that accompanies the Toolkit as well as early data from the CDC Diabetes Prevention Recognition Program. Both tools allow for some customization.

Targeted wellness for diabetes prevention ADD YOUR LOGO HERE What we can do to help our team and our bottom line

Prediabetes facts 1 out of every 3 adults has prediabetes, and 90% do not even know it.1 Prediabetes occurs when blood glucose levels are higher than normal, but have not reached the levels needed for a diagnosis of diabetes. If prediabetes is not addressed, it may develop into type 2 diabetes.

<Organization Name> Concern #1: Inflated medical costs People with diabetes have medical expenses that are approximately 2.3 times higher than the medical expenses of people without diabetes.2 In the general population, the average total medical expense incurred by people with diabetes is $13,700 per year.2 Employees with diabetes have a much higher likelihood of developing serious conditions such as heart disease, stroke and hypertension.3 EMPLOYER IMPACT: Health insurance loss ratios Health insurance premiums Workers’ compensation medical costs Workers compensation insurance premiums Takeaway: We can help control health insurance and workers’ compensation insurance costs by preventing type 2 diabetes.

<Organization Name> Concern #2: Lost productivity Diabetes-related lost productivity costs the United States roughly $69 billion per year.2 Employers experience lost productivity in many forms including: Time off. Employees with diabetes may need to take time off work to deal with health issues. Higher turnover rates. Employees with diabetes may need to stop working due to serious health complications and disability. Reduced morale. A sick workforce is not as energized and productive as a healthy workforce. Takeaway: We have a vested interest in our team’s health and welfare. Employees are with us for an average of <XX years>, making type 2 diabetes prevention a worthwhile investment.

Potential prediabetes at <Organization’s Name> Prediabetes is a problem in the workforce. Employees are at risk for prediabetes if they: Are 45 years or older Are overweight Do not get enough physical activity Have high blood pressure Have a family history of type 2 diabetes Have had gestational diabetes To estimate the number of employees with prediabetes: Take # of employees in our company: ___________ Divide by 3 = # of employees who could have prediabetes: _____ Insert the result from #2 into the slide Prediabetes could progress to type 2 diabetes within 5 years We could have XXX employees with prediabetes. Fortunately, we can help!

How <Organization Name> can make a difference We can make a big difference by offering the National Diabetes Prevention Program (National DPP) as a covered benefit. Why? Aligns with our corporate wellness goals Supports the health and longevity of our team CDC-recognized, evidence-based program that could generate positive ROI by controlling medical costs and lost productivity (details on next slide) While focus is type 2 diabetes prevention, results support many broader wellness initiatives How? Employees are invited to participate in program screening Those who qualify receive plan components as a covered health benefit We can also offer this plan to spouses and children over 18 if we choose Program is 1-year long with focus on healthy eating, physical fitness, 5-7% weight loss and stress management Program delivery can be customized with onsite, off-site or online course options, in a variety of formats We can name and promote the program in the way that fits best with our corporate culture We can also incentivize participation, if we wish

What is the National DPP? The National Diabetes Prevention Program is an intensive lifestyle change program that reduces the incidence of diabetes by 58 percent.4 The CDC-recognized program is delivered by a trained lifestyle coach and includes 16 weekly sessions followed by 6 monthly sessions over 12 months. The goal is a 5 percent weight loss and 150 minutes of weekly physical activity.

Insert screenshot/pic of CDC tool The business case- Sample 1 CDC Insert screenshot/pic of CDC tool Participants in the original DPP research trial reduced the risk of developing type 2 diabetes by 58% through moderate weight loss and increased physical activity.4 Over 3 years, we could expect to see: A 1 to 2% decrease in absenteeism and lost productivity5 The average cost per participant is only $450.7 This small investment is all that’s needed to reduce the occurrence of type 2 diabetes. It is particularly affordable when you consider that those with diabetes incur $13,700 in total medical costs each year, of which $7,900 is attributed to diabetes.2

The business case- Sample 2 AMA Participants in the original DPP research trial reduced the risk of developing type 2 diabetes by 58% through moderate weight loss and increased physical activity.4 Over 3 years, we could expect to see: A 1 to 2% decrease in absenteeism and lost productivity5 A possible savings of $8,000 per participant that does not progress to type 2 diabetes6 The average cost per participant is only $450.7 This small investment is all that’s needed to reduce the occurrence of type 2 diabetes. It is particularly affordable when you consider that those with diabetes incur $13,700 in total medical costs each year, of which $7,900 is attributed to diabetes.2 PROJECTED ROI: ORGANIZATION NAME Using the calculator at ama-roi- calculator.appspot.com/, we have projected a potential savings of: $XXXX over 3 years Projections based on XX employees. Individual results vary depending on the cost of program participation, the prevalence of prediabetes, the enrollment rate and the completion rate. The above results were calculated based on common ranges.

Here’s how the program could work Health Plan: Add information about your plan – will they add the National DPP as a covered benefit?   Local Providers: Add information - Which providers in your area are potential partners? Plan Delivery Ideas: Add information - How could the program be delivered in your organization – onsite classes, offsite through community partners or online (or a combo approach)? Program Promotion: Add information - How will you name and market the program to encourage participation? Timing: When will you roll out the program? How much time is needed to set it up?

Questions / Discussion

Sources Diabetes Latest. Centers for Disease Control and Prevention. https://www.cdc.gov/features/diabetesfactsheet/. Published June 17, 2014. Accessed November 12, 2016. American Diabetes Association. Economic costs of diabetes in the US in 2012. Diabetes Care. 2013;36(4):1033-1046. Gillespie CD, Hurvitz KA. Centers for Disease Control and Prevention (CDC). Prevalence of hypertension and controlled hypertension- United States, 2007-2010. MMWR Suppl. 2013;62(3):144-8. Knowler WC, Barrett-Connor E, Fowler SE, et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. Ratner et al.  American Diabetes Association. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the Diabetes Prevention Program. Diabetes Care. 2005;28(4):888-894. doi:10.2337/diacare.28.4.888. Khan T, Tsipas S, Wozniak GD. Medical care expenditures for individuals with prediabetes: The potential cost savings in reducing the risk of developing diabetes. Popul Health Manag. 2017. doi:10.1089/pop.2016.0134 Li R, Qu S, Zhang P, et al. Economic evaluation of combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the Community Preventive Services Task Force. Ann Intern Med. 2015;163:452–460. American Medical Association. Diabetes Prevention Cost-savings Calculator. 2015. https://ama-roi-calculator.appspot.com. Accessed June 1, 2017. Centers for Disease Control and Prevention. Diabetes Prevention Impact Toolkit. 2017. https://nccd.cdc.gov/Toolkit/DiabetesImpact/Employer. Accessed July 1, 2017.