Health plan tackles pre-diabetes

Emphasis is on prevention rather than management

Instead of waiting until members develop diabetes to intervene, Molina Healthcare is offering members with pre-diabetes a chance to participate in the Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program, a prevention program that encourages moderate weight loss, exercise, and lifestyle changes.

The Long Beach, CA-based health plan is partnering with America’s Health Insurance Plans and extension services and state Diabetes Prevention and Control programs to implement the Centers for Disease Control and Prevention’s (CDC) National Diabetes Prevention Program to at-risk individuals in New Mexico and Florida.

“The program is evidence based, and results from a clinical trial were good. It’s a lifestyle intervention program, rather than a disease management or weight loss program. The goal is to make lifestyle changes that are sustainable. Results from most regular weight loss programs often are not sustainable,” says Ellen Rudy, PhD, director of strategic research and epidemiology for Molina Healthcare.

Once people develop diabetes, it can’t be cured and managing it is difficult, but people with pre-diabetes can prevent or delay developing diabetes, Rudy point out.

The program has three components: moderate weight loss of 5% to 7%, an increase in physical activity to 150 minutes a week, and learning to manage the social and environmental cues that encourage unhealthy eating.

Program participants attend one-hour sessions each week for 16 weeks and six monthly sessions for six additional months. The sessions are led by trained lifestyle coaches and attended by 10 to 15 participants.

“The group sessions make this program different from typical weight loss programs. Participants provide social support for each other and collaborate on problems with adhering to the plan,” Rudy says.

Participants learn to track their calorie and fat-gram intake using a food log and to understand what foods they should eat and what they should avoid. They learn about the psychology of eating and how to choose healthier options in a restaurant. The coaches help them choose ways to increase their physical activity and to set small goals that they can reach easily.

“The coaches encourage people to take baby steps so it’s not overwhelming. If someone has been mostly sedentary, exercising for 150 minutes a week will be overwhelming. They might start with 30 minutes and build up,” she says.

Molina Healthcare primarily serves the Medicaid population. The program is open to all Molina members who are diagnosed with pre-diabetes and is focusing on the Medicaid population because of their high risk for developing diabetes and their challenges in managing it, she says. The program is free to participants who are reimbursed for transportation. “We recognize the challenges this population faces in developing healthy behaviors. The classes are structured so the participants look forward to attending. In addition, we are trying to address the barriers, and offer small incentives for participating, such as a raffle on Week 4,” she says.

The coaches go through a CDC-approved lifestyle coach training program to become certified as a lifestyle coach. “There are no educational requirements. The program can be presented by lay people in the community, but they do need the ability to engage a group and encourage people to help each other,” she says.

Molina is working with its network of providers in New Mexico and Florida to inform them of the program and encourage them to refer patients with pre-diabetes. Criteria include a body mass index of 24 or greater — 22 or greater for Asian-Americans — and blood sugar levels that are higher than normal but not high enough for a diagnosis of diabetes.

“We’ve found that provider referral is the most powerful way to encourage patients to attend this program because of the trust patients build with healthcare providers through the years. Participants in focus groups have told us that they are more likely to participate in a program if their provider recommends it,” she says.

The program has been enthusiastically received when Molina representatives have discussed it with clinics that serve an indigent and at-risk population, she says. “One provider told me he could fill our classes in a week because there is such a need for the program,” she says.

In the first year of the program, Molina is offering classes at one location in Albuquerque and one in Los Cruces, NM, and one each in Broward County and West Palm Beach in Florida. In the second year of the program, the classes will be offered at two locations in each county.

Molina Healthcare is partnering with the New Mexico State University College of Agricultural, Consumer, and Environmental Sciences Cooperative Extension Services and the University of Florida Institute of Food and Agricultural Sciences Cooperative Extension Services as well the Diabetes Prevention and Control Program administered by Department of Public Health in each state.

“We are developing relationships with the state extension services and departments of public health to leverage our resources. We all have the same goal, which is to reduce diabetes in the underserved population. It’s a win-win situation for everyone,” she says.