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

2. 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

3. Prevalence of Chronic Diseases

4. 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 %; #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 %; #4 increase in trend
#2 in total plan paid; #14 by utilization

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. What could your contribution be?

15. Questions and discussion
Jim Gottschald, HR Director
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