Tier 3: Offer the National DPP Lifestyle Change Program

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Many pharmacies already offer preventive care services like immunizations and smoking cessation clinics. The National DPP provides an opportunity to expand pharmacy-based preventive care services to improve health outcomes for patients. Joining this program will also allow pharmacies to build referral networks with primary care providers and health care organizations in their communities.

How Can Delivering the National DPP Lifestyle Change Program Benefit Pharmacies?

  • Applying for CDC recognition is free. Once a pharmacy’s application is accepted, it will receive pending recognition and be listed on the CDC website as part of a nationwide community of organizations working to prevent type 2 diabetes among people at risk.
  • A growing number of employers and insurers, both public and private, are reimbursing for the National DPP LCP. Most insurers require CDC recognition and reimburse using a pay-for-performance model. In 2018, the program became available to eligible Medicare beneficiaries as a covered service.
  • The National DPP can provide learning and professional growth opportunities for the pharmacy workforce. For example, pharmacy staff members are well positioned to serve as Lifestyle Coaches because they are familiar with patient care and motivational interviewing techniques.
  • NCPA can provide information and resources to help organizations deliver the National DPP LCP.

How Can Pharmacies Become CDC-Recognized Delivery Organizations?

If a pharmacy decides to deliver the National DPP LCP, it will need to submit an application to become a CDC-recognized delivery organization. See Table 3 for an outline of this process. For more detailed information, see the DPRP Standards. To learn more about delivering the National DPP LCP, go to the National DPP CSC website.

Pharmacist having a conversation with an elderly man

Examples of how schools of pharmacy are currently working to expand access to and delivery of the National DPP LCP include the following:

  • The University of North Carolina’s Eshelman School of Pharmacy embedded the National DPP into its curriculum to prepare students for when they are placed in pharmacies during their clinical rotations. This training helps increase prediabetes screening, testing, and referrals to local National DPP LCP classes.
  • The Southwestern Oklahoma State University College of Pharmacy developed a course based on the National DPP LCP to train students as Lifestyle Coaches. The course also pairs fourth-year pharmacy students with CDC-recognized organizations to support program participants in communities with limited resources in Oklahoma.
  • The Wilkes University Nesbitt School of Pharmacy created an elective course for students to train as National DPP Lifestyle Coaches. The school then matched students with local, independent pharmacies through an elective experiential rotation to support and lead implementation of the LCP. Other students partnered with pharmacies across the state to support National DPP LCP classes.
Table 3. Diabetes Prevention Recognition Program (DPRP) Process
Recognition Status Required Tasks for Recognition
Application Submitted for Recognition
Pending Recognition Meet the following requirements for pending recognition:
  • Submit a completed application.
  • Use a CDC-approved curriculum.
  • Offer a 12-month LCP that includes a minimum of 16 weekly sessions in months 1 to 6 followed by a minimum of 6 monthly sessions in months 7 to 12.
  • Agree to start the first session within 6 months of the effective date.
  • Agree to submit required participant data to the DPRP every 6 months.

Organizations can stay at this level indefinitely if they submit the required data every 6 months. At any evaluation period after the first 12 months, they can move to preliminary recognition if they meet DPRP Standards requirement 5 or to full recognition if they meet requirements 5 through 7.

Preliminary Recognition Meet the following requirements for preliminary recognition:
  • Submit required data every 6 months.
  • Meet requirements for pending recognition.
  • Meet requirement 5: Organizations must retain at least 5 completers in the evaluation cohort (eligible participants who attended at least 8 sessions in months 1 to 6 and whose time from the first session held by the cohort to the last session attended by the participant is at least 9 months).

Organizations can stay at this level indefinitely if they submit data every 6 months and meet the requirements for preliminary recognition within 3 years of first achieving it and at least every 3 years thereafter. At any evaluation period, they can move to full recognition if they meet DPRP Standards requirements 5 through 7.

Temporary Preliminary Recognition Meet the following requirements for temporary preliminary recognition:
  • Achieve preliminary or full recognition for at least one delivery mode.
  • Submit a completed application for an additional delivery mode.

Existing organizations with preliminary or full recognition can obtain a new org code (for a new delivery mode) at the temporary preliminary level rather than starting over at pending recognition. However, the organization is responsible for meeting the requirements for preliminary recognition for the new delivery mode from that point forward.

Full Recognition Meet the following requirements for full recognition:
  • Submit required data every 6 months.
  • Meet the requirements for pending recognition.
  • Meet the requirements for preliminary recognition.

Meet requirement 6: Organizations must demonstrate a reduction in risk of developing type 2 diabetes among completers in the evaluation cohort by showing that at least 60% of all completers achieved at least one of the following outcomes:

  • At least 5% weight loss by 12 months after the cohort began or
  • At least 4% weight loss and at least 150 minutes a week (on average) of physical activity 12 months after the cohort began or
  • At least a 0.2% reduction in HbA1C.

Meet requirement 7: Organizations must show that at least 35% of completers in the evaluation cohort are eligible for the yearlong National DPP LCP based on either a blood test indicating prediabetes or a history of gestational diabetes. The rest must be eligible on the basis of a high score on the ADA/CDC Prediabetes Risk Test,a,b available at  www.cdc.gov/prediabetes/risktest/index.html. For an additional 2 years of full recognition (for 5 years total), meet the following requirements:

  • Eligible participants in the evaluation cohort must have been retained at the following percentages:
    • A minimum of 50% at the beginning of the fourth month since the cohort’s first session.
    • A minimum of 40% at the beginning of the seventh month since the cohort’s first session.
  • A minimum of 30% at the beginning of the 10th month since the cohort’s first session.

Organizations can receive full recognition for a period of 3 or 5 years. They can stay at this level for 3 years if they continue to submit data every 6 months.

a Evaluation for these requirements based on all participants attending at least 3 sessions during months 1 to 6 and whose time from first session to last session is at least 9 months. At least 5 participants per submission who meet this criterion are required for evaluation.

b All Medicare Diabetes Prevention Program beneficiaries must have a blood glucose test for eligibility.

What Is an Umbrella Hub Arrangement?

To help expand the reach of the National DPP, CDC supports umbrella hub arrangements (UHAs) to connect community organizations with health care payment systems. This connection allows organizations to seek timely, sustainable reimbursement for the National DPP LCP. Each UHA is created by an umbrella hub organization and includes subsidiaries and a billing platform for submitting claims.

UHAs can reduce the administrative burden for CDC-recognized organizations by:

  • Aggregating DPRP data.
  • Sharing CDC recognition status.
  • Operating as an MDPP supplier.
  • Helping community organizations (such as pharmacies) receive reimbursement more quickly than organizations that submit claims outside of a UHA.
  • Helping expand the reach and sustainability of National DPP LCPs.

For more information about UHAs, see the National DPP Coverage Toolkit. See a Tier 3 case study below.

Case Study

School of Pharmacy Modifies Curriculum to Improve Access to the National DPP Lifestyle Change Program

In 2019, a community-minded developer built a grocery store in a low-income food desert in Richmond, Virginia. The developer recognized that the neighborhood would also benefit from a community education center that focused on healthy lifestyles. The Virginia Commonwealth University (VCU) Health Hub was created to meet this need and included service offerings from multiple university departments.

To support these efforts, the VCU School of Pharmacy drew on its past experience providing diabetes education and type 2 diabetes prevention classes to people with limited access to clinical or community resources. The school partnered with the VCU Health Dietetic Internship Program to offer the National DPP LCP. Teams of dietetic interns and pharmacy residents lead weekly classes, as well as grocery store tours, cooking classes, and physical education programs.

Tier 3 in Action: Offer the National DPP LCP

Smiling nurse holding file

VCU also adapted its Health Promotion and Communication in Pharmacy Practice course to include elements of the National DPP Lifestyle Coach training. This mandatory first-year course in VCU’s PharmD program already contained much of the required content, such as motivational interviewing, social determinants of health, health literacy, communication with older adults, and smoking cessation.

Merging the two curricula helped students understand how the healthy lifestyle content applies in the real world. Students also received their National DPP Lifestyle Coach designation at the end of the semester.

Feedback from the first class of 102 students indicated that the program had met its goals. More Lifestyle Coaches were trained, which helped expand access to the National DPP LCP. Students were paired with individual participants to provide experiential learning for the students and improve program retention.

Keys to Success

Results at a Glance

From 2019 to 2022, the program reported that:

  • 356 Lifestyle Coaches were trained.
  • 90 community members
  • 298 pounds were lost.
  • After pairing students with participants, retention doubled from the first cohort to the fourth cohort.

To ensure the success and sustainability of its efforts, the VCU School of Pharmacy:

  • Integrated Lifestyle Coach training into its PharmD core curriculum.
  • Created an interprofessional partnership with VCU’s dietetic internship program to lead the National DPP LCP.
  • Paired pharmacy students with participants to serve as individual Lifestyle Coaches between sessions, to increase retention.
  • Expanded National DPP LCP capacity by training pharmacy students to serve as Lifestyle Coaches.