A physician in suburban Detroit recently created his own diabetes prevention program (DPP), and it's already proving effective. Here's how he launched a DPP that has produced positive results among patients in less than two months.

Charting new solutions: one physician's plan for diabetes prevention

Robert Jackson, MD, a family physician with Western Wayne Physicians, decided to develop his own DPP after struggling to find viable care options that fit value-based payments for many of his working class patients with prediabetes.

"We've been heavily invested in fee-for-value, but I got really frustrated with care as it had to be for my practice to be profitable," Dr. Jackson told AMA Wire. "I wanted to deliver better care, and I wanted to deliver the right care at the right time. That's why I became a doctor. So I immersed myself in finding new ways to help patients and the community."

He contemplated starting a diabetes prevention program but didn't have enough resources to properly train his staff, so for months, his DPP ideas languished. Thankfully, this didn't last very long: fellow members at the Michigan Academy of Family Physicians and Michigan State Medical Society introduced Dr. Jackson to staff on the AMA's Improving Health Outcomes team -- and that's when his program planning took off.

"I really feel nurtured by the AMA," Dr. Jackson said. "They kept meeting with my staff, giving direction, holding our hands along the way."

With the help of the AMA, Dr. Jackson received enough guidance and resources to successfully launch a DPP for Western Wayne. AMA staff advised Dr. Jackson and his care team on CDC requirements for DPPs, employee training and establishing a strong program infrastructure.

Patients in Western Wayne's program now meet for an hour and a half, once a week, on Tuesday evenings, for the first 16 weeks. After they complete this first phase of the program, their meetings shift to once every three weeks through the 26th lesson.

Since starting their diabetes prevention sessions nine weeks ago, many of Jackson's patients have witnessed positive results, including improved activity levels and temperament. Of the 14 patients who agreed to participate, 13 are still enrolled and many have lost weight -- some up to as much as seven pounds.

"People are losing weight. They're engaged in the meetings. They're exercising. It's doing the right things," said Kayla Jones, the office's receptionist and lifestyle coach for the group. "Some have lost about seven pounds, but most have lost three or four pounds, which isn't huge, but it's definitely significant considering they're only looking to lose 5 to 7 percent in the first six months. Two months in, having any weight loss is a good thing."

Six steps to start your own DPP

So what's the secret to their success? If you wish to launch your own effective DPP, Western Wayne suggests:

1. Find room in your budget. While Medicare coverage of CDC-recognized DPPs will begin January 1, many of the nation's 86 million people with prediabetes are under 65, and coverage of the benefit outside of Medicare is spotty. "You have to be able to pay your staff -- Kayla isn't doing this for free, and we had to backfill her position," Dr. Jackson said. "You'll need to make a commitment to doing something that may not make you money for a while."
     
2. Identify key staff members. "Pick people who like people. They have to be able to stand in front of a group and talk," Dr. Jackson said. "You'll also need people who are studious enough to review the curriculum and understand it."
     
3. Get trained. Sign up with a CDC-approved training program. "It's definitely something that's doable, regardless of what kind of staff you have. They give you the resources you need," Jones said. "Once we went through the training, it didn't take us very long to get it started. Within a matter of weeks, we were able to contact patients and get the first class going."
      
4. Download and organize the literature. This will be available from the CDC-approved program after you have done the training. "We put it all in three-ring binders with tabs," Jones said. "You're giving patients 26 weeks' worth of information, and you want them to stay organized so it's easier for them to remain interested in what's going on."
5. Locate a meeting space. Western Wayne uses one of its conference rooms. "Theoretically, somebody could do this in their waiting room after patient hours," Dr. Jackson said.
      
6. Recruit patients. Dr. Jackson's staff pulled a list of patients with prediabetes from the practice's EHR. "Then I looked for patients who I thought would work well in groups and seemed motivated," Dr. Jackson said. "Going forward, we're going to have to pick some people who might fail, but I wanted my staff to have more motivated people at first so they could gain experience. And as they gain that experience, they'll be able to deal with more difficult patients."

Preventing Diabetes Michigan

The AMA and Michigan State Medical Society have partnered to continue advancing patient participation in similar DPPs throughout Michigan. This partnership is part of Prevent Diabetes STAT, a strategic effort launched by the AMA in collaboration with the CDC in 2015 to engage more Americans with prediabetes and slow the progression of type 2 diabetes.

"In Michigan, the prevalence of diabetes over the past three decades has exceeded U.S. national statistics," said David Krhovsky, MD, MSMS President. "In partnership with the AMA we are working hands-on with Michigan physicians and health systems to take action in implementing meaningful diabetes prevention efforts to improve the health of our residents in Michigan and ultimately improve the health of people across the country."

Ready to prevent diabetes among your patients?

• Use this online tool from the AMA to calculate net savings and ROI for starting a DPP among a patient population in your area. In a few clicks, this calculator can help you determine how enrolling more patients in a DPP can impact the number of patients who develop diabetes in a particular population sample and how much money can be saved through prevention.
     
• Download this comprehensive toolkit from Prevent Diabetes STAT , which features key resources -- including handouts, questionnaires, sample referral forms, and step-by-step guidelines -- on diabetes screening and prevention.
     
• Review the MSMS Prevent Diabetes STAT website for up-to-date information on Prevent Diabetes STAT program and the work we are doing with the AMA