RESUMEN
This study examined the effects of a digital diabetes prevention program (DPP) on health care costs and utilization among Medicare Advantage participants. Patients (n = 501) received access to a plan-sponsored, digitally-delivered DPP accessible through computer, tablet, or smartphone. Prior research demonstrated a 7.5% reduction in body weight at 12 months. A comparison group who did not participate in the DPP was constructed by matching on demographic, health plan, health status, and health care costs and utilization. The authors assessed effects on cost and utilization outcomes using difference-in-differences regressions, controlling for propensities to participate and engage in the DPP, in the 12 months prior to DPP enrollment and 24 months after. Though post-enrollment data showed trends in decreased drug spending and emergency department use, increased inpatient utilization, and no change in total nondrug costs or outpatient utilization, the findings did not reach statistical significance, potentially because of sample size. The population had low costs and utilization at baseline, which may be responsible for the lack of observed effects in the short time frame. This study demonstrates the challenges of studying the effectiveness of preventive programs in a population with low baseline costs and the importance of using a large enough sample and follow-up period, but remains an important contribution to exploring the effects of digital DPPs in a real-world sample of individuals who were eligible and willing to participate.
Asunto(s)
Diabetes Mellitus Tipo 2 , Medicare Part C , Anciano , Costos de la Atención en Salud , Humanos , Aceptación de la Atención de Salud , Estados UnidosRESUMEN
OBJECTIVE: To examine the outcomes of a Medicare population who participated in a program combining digital health with human coaching for diabetes risk reduction. METHOD: People at risk for diabetes enrolled in a program combining digital health with human coaching. Participation and health outcomes were examined at 16 weeks and 6 and 12 months. RESULTS: A total of 501 participants enrolled; 92% completed at least nine of 16 core lessons. Participants averaged 19 of 31 possible opportunities for weekly program engagement. At 12 months, participants lost 7.5% ( SD = 7.8%) of initial body weight; among participants with clinical data, glucose control improved (glycosylated hemoglobin [HbA1c] change = -0.14%, p = .001) and total cholesterol decreased (-7.08 mg/dL, p = .008). Self-reported well-being, depression, and self-care improved ( p < .0001). DISCUSSION: This Medicare population demonstrated sustained program engagement and improved weight, health, and well-being. The findings support digital programs with human coaching for reducing chronic disease risk among older adults.