Tuesday, November 19, 2019

Adapting the Diabetes Prevention Program Protocol to Intensive Behavioral Treatment

In 2011, Medicare started covering intensive behavioral therapy for the treatment of obesity. The treatment was part of Medicare’s preventive services. Therefore, an obese Medicare beneficiary would not have to pay for the treatment – no copay, no coinsurance and no deductible. As part of Medicare’s guidelines for delivering the Intensive Behavioral Treatment (IBT) services, it was recommended that providers use the 5 As counseling framework. However, Medicare recommended no specific protocol for the framework. So, the CDC’s Diabetes Prevention Program (DPP) protocol has been recommended for the IBT framework.

Medicare based its IBT coverage on the United States Preventive Services Task Force (USPSTF) evaluation. The USPSTF is an independent organization that evaluates preventive services, and rates the services with a letter grade of A, B, C, D of I. And the USPSTF gave IBT treatment service a grade of B. Specifically, “The USPSTF… found fair to good evidence that high intensity counseling combined with behavioral interventions in obese adults (as defined by a BMI ≥30 kg/m2) “produces modest, sustained weight loss.”

And the IBT should be consistent with the 5 As counseling framework. While there are variations of the 5 As framework, the framework shown on Medicare’s website may be summarized as follows: Acting within the framework, the provider should: Ask about and Assess a patient’s health risks; 2. Advise the patient; 3. Agree or collaborate with the patient; 4. Assist the patient in making healthy changes; and 5. Arrange to work with the patient in the future in support of the patient healthy activities.

The Diabetes Prevention Program, or DPP, is a patient-centered, value-based, evidence-based protocol. The DPP protocol consists of a one-year set of group sessions where a lifestyle coach delivers the sessions. The coach acts as a facilitator. The participants learn to follow a healthy eating pattern, increase physical activity, and modify behavior. The most important outcome is weight loss, since weight loss can lead to preventing or delaying type 2 diabetes in individuals with prediabetes.

Because weight loss is the most important outcome for both the DPP, and the IBT, using the DPP protocol within the IBT framework is a good approach. 


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