St. Louis County Diabetes prevention Programming Jim Gottschald, HR Director MN Health Action Group – Member Meeting September 24, 2015

St. Louis County Self-Insured health plan 4,352 covered lives Actives Retirees Dependents $29.5 million in annual claims expenditures Comprehensive Major Medical Plan Design $250 Deductible 0% - 10% coinsurance $750 OPM Previous four year premium increases: 0%, 0%, 1.75%, 0% Located in the Northeast Minnesota DPP focus area – Healthy Northland project

Prevalence of Chronic Diseases

Diabetes – Rankings & Trends 2014 Insulin #1 therapeutic class for non-specialty Rx PMPM cost increase - $1.92; #1 increase in trend Ingredient/Rx cost increase - 26.8%; #2 increase in trend #2 in total plan paid; #12 by utilization January-June 2015 PMPM cost increase - $3.19; #1 increase in trend Ingredient/Rx cost increase - 21.5%; #4 increase in trend #2 in total plan paid; #14 by utilization

How Did We Learn About NDPP? Minnesota Health Action Group Diabetes Summit in November 2014 Omada Novo Nordisk YMCA’s Employer testimonial – The Schwan Food Company Panel discussion – BCBSM, Schwan’s & RedBrick Health Centers for Disease Control and Prevention Essentia Health Care System Public Employer Action Collaborative for Health (PEACH) State of Minnesota MN Department of Health & Human Services

The Minnesota Diabetes Collective Impact Initiative To become the State with the lowest incidence and healthiest outcomes for diabetes in the country. Prevention: Significantly reduce new cases of diabetes among those at high risk of developing the disease. Care Delivery: Reduce the human burden and rising cost of care for people with diabetes and its complications. More than three dozen organizations including private plans, industry, community groups, the Centers for Disease Control, Minnesota Department of Health, and the American Diabetes Association Source: MN Health Action Group – Diabetes Summit 11/19/14

Prevention Strategy Our efforts will significantly reduce new cases of diabetes among those at high risk of developing the disease. Strategy: Identify, prioritize and scale evidence-based interventions with the highest benefit for participants and public and private payers. Objective: Ensure the National Diabetes Prevention Program is offered and available to all Minnesotans for whom it is indicated. Source: MN Health Action Group – Diabetes Summit 11/19/14

Strategic Imperatives Ensure all Minnesota payers and employers reimburse for the NDPP Ensure all providers are aware of pre-diabetes, test for it and refer to the NDPP Ensure the NDPP is available to those without health insurance Develop infrastructure to coordinate efforts and monitor progress until scale achieved Generate awareness about pre-diabetes and drive those at risk to test and enroll Scale a diverse workforce to deliver the NDPP Source: MN Health Action Group – Diabetes Summit 11/19/14

SLC – Developing a Diabetes Prevention Program St. Louis County Health Promotion Coordinator received certification to teach the curriculum in early 2015 Essentia Health presented their capacity to deliver NDPP in a clinical setting to SLC’s labor/management health insurance committee in February and May 2015 Pre-diabetes defined as A1c level of 5.7% to 6.4% and fasting glucose level ranging from 100 to 124; Essentia would identify and reach out to their covered patient population Face to face clinic or worksite meetings MN Dept of Health presented info on the “I CAN prevent diabetes program” to the PEACH group in March 2015 Meeting with DHS policy analysts to discuss potential for Medicaid DPP benefit April 2015

SLC – Developing a Diabetes Prevention Program PEACH adopted promoting NDPP as a strategic action item in June 2015 BCBSM reported their capacity to adjudicate claims in July 2015 Omada presented their Prevent online diabetes prevention program to the SLC’s labor/management health insurance committee in July 2015 Medica was invited to the August 2015 PEACH meeting to discuss NDPP SLC labor/management health insurance committee agreed by consensus in September 2015 to recommend, on a pilot basis, adjudication of NDPP claims via the self insured health plan

SLC’s Pilot Diabetes Prevention Program Commences January 1, 2016 Payment for services adjudicated through the carrier BCBSM Results based payments: 1) enrollment; 2) completion of 9 of 16 group sessions; 3) 5% weight loss; 4) 10% weight loss Maximum payment: $700

Effective January 1, 2016 Mobile Clinical On Site Omada Prevent – similar to State of Minnesota program Essentia Health – 6 credentialed NDPP coaches St. Luke’s – in the process of getting NDPP coaches credentialed Clinical St. Louis County Health Promotion Coordinator – NDPP credentialed Essentia Health – if we can coordinate groups of at least 10 to 12 On Site

Strategic Imperatives Our target contribution Ensure all Minnesota payers and employers reimburse for the NDPP Ensure all providers are aware of pre-diabetes, test for it and refer to the NDPP Ensure the NDPP is available to those without health insurance Develop infrastructure to coordinate efforts and monitor progress until scale achieved Generate awareness about pre-diabetes and drive those at risk to test and enroll Scale a diverse workforce to deliver the NDPP Source: MN Health Action Group – Diabetes Summit 11/19/14

What could your contribution be?

Questions and discussion Jim Gottschald, HR Director (218) 725-5066 gottschaldj@stlouiscountymn.gov