As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on topics that might affect employers or employees. This is a reprint of a blog post from KBGH:
Our work at the Kansas Business Group on Health straddles our employer-oriented pursuits and efforts to advance the goals of two grants from the Centers for Disease Control (CDC). One of the goals of our work with the CDC is to increase the number of people being screened for diabetes. For people who are “pre-diabetic,” meaning their blood sugars are higher than normal but not high enough to qualify for a diagnosis of “full-blown diabetes,” our goal is to get them into the Diabetes Prevention Program (DPP), a one-year behavior change program that, through dietary changes and increased physical activity, reduces the risk of progressing to diabetes by 58%.
This is a challenge. Though the DPP is a covered benefit through Medicare, it is not consistently covered by private insurers. And even with coverage, people’s enthusiasm for paying for and completing a program to treat a disease state that is asymptomatic is generally low. So we work with employers to make the DPP a covered benefit. You may have heard from us about this. If not, please contact us. But we also work with clinics on strategies to increase screening for diabetes and to increase patient use of the DPP.
So we were encouraged to see a paper in the Journal of General Internal Medicine this week (paywall) demonstrating a quick way to substantially increase the likelihood of patients agreeing to enter “intensive lifestyle interventions” like the DPP.
The investigators surveyed patients who qualified for the DPP to measure their intention to participate. 70% of patients at baseline said they would be willing to participate. Then the staff members of the health center presented this decision aid to the subjects by reviewing the icons, reading the written information out loud, and briefly discussing the participants’ needs and next steps:
Northwestern University
The backside of the decision aid, which I’m not showing here, contained open-ended questions assessing needs related to the prevention of type 2 diabetes and defining next steps for management. After seeing the decision aid, the participants in the study willing to participate in the DPP rose to 88%, a statistically significant increase.
This is encouraging for a couple of reasons. First, it didn’t matter who presented the decision aid to the participants. Staff members and medical assistants had similar results.
Second, this is the rare tool that has shown such a positive effect. Simply handing out pamphlets to patients repeatedly fails to change behaviors. When we try to induce behavior change through interaction with patients we have a bad habit of falling back on fear: “Quit smoking or you’ll die young.” “Don’t drink pop or you’ll get diabetes.” The trouble with this strategy is that it has almost no effect on complex, long-term behaviors like diet, physical activity, and smoking. Fear might work to convince someone to take an antibiotic for two weeks to keep from dying from pneumonia, for example. But for longer term decisions, we have to exploit people’s senses of autonomy, mastery, and purpose instead, just like we use in designing meaningful work for employees. (If you’re interested in this topic I recommend Drive by Dan Pink.) But those three components don’t lend themselves easily to a quick intervention. Doctors and nurses are trained in motivational interviewing to accomplish complex behavior change, but it requires a trusting relationship and time to work. This study showed that even a brief intervention, delivered both in writing and in person in a few minutes, can have a powerful effect. What if we could harness this strategy for other behaviors, like encouraging mask-wearing for COVID-19 protection?
The DPP, which is available both as an in-person class and via virtual platforms, has been shown to drastically reduce health care costs for employers of people at high risk of diabetes. If you want to know your own company’s potential savings, go to the American Medical Association’s Cost Saving Calculator. Let us know if we can help make this calculation. And if you’re interested in covering the DPP as a benefit to your employees, contact us!