Incorporating Prediabetes Screening and Referrals into Your Medical Practice


Lark Health is the largest Fully CDC Recognized Digital Diabetes Prevention Program Provider

Lark is a covered benefit for more than 43 million Americans at risk of developing Type 2 Diabetes based on the Prediabetes Risk Assessment.

As a clinician, you cannot help but see the consequences of diabetes in our society. If they themselves do not have diabetes or prediabetes, your patients are sure to have family members with or risk factors for type 2 diabetes

Your inclination is to help however you can, but how can you reduce the burden of diabetes in a feasible manner? How can you do your best for your patients and your practice at the same time? With some recent changes to Medicare Quality Payment Program’s Merit-based Incentive Payment System (MIPS), along with innovative programs such as Lark Diabetes Prevention Program, your patients and your practice can thrive. 


Stunning Health and Financial Costs of Diabetes

How much does diabetes matter to your patients and your practice? Nearly 1 in 8 American adults has diabetes, and another 1 in 3 has prediabetes

Do you serve many older adults? If so, diabetes and prediabetes are even more overwhelming when you realize that 1 in 4 adults over 65 years have diabetes, and half have prediabetes. [1]

Diabetes may be common, but it is no joke. You probably have some idea of its consequences from your education and experience treating patients, and here are some cold, hard facts.

  • It is the seventh-leading cause of death and a risk factor for other leading causes of death, such as heart disease (first), stroke (fifth), Alzheimer’s disease (sixth), and kidney disease (ninth). [2]

  • The risk for diabetes patients is 50 to over 100% higher for coronary heart disease and ischaemic stroke. [3]

  • Complications from poorly controlled diabetes include kidney, [4] cataracts and other vision problems, amputations, and nerve damage. [5]

Diabetes is not only unhealthy, but also financially costly.

  • The cost of diagnosed diabetes was an estimated $327 billion in 2017, including 1 in 4 healthcare dollars spent.[6]

  • A diabetes patient has an estimated medical cost 2.3 times higher than a patient without diabetes.

  • The average estimated excess lifetime cost for a diabetes patient is $35,900 or $124,000, if the patient is diagnosed at age 65 years or 40 years, respectively. [7]


Preventability of Diabetes 

Diabetes is rampant, but highly preventable in most cases. One study looked at the link between a healthy lifestyle and diabetes development. Researchers concluded that 72% of diabetes cases could be prevented with healthy lifestyle factors. [8] In a different study, Harvard researchers attributed as many as 91% of diabetes cases to an unhealthy lifestyle. [9]

The healthy lifestyle factors are nothing extraordinary. They are the same ones that are known to prevent heart disease, many types of cancers, and stroke. They include maintaining a healthy weight, engaging in regular or recommended amounts of physical activity, refraining from smoking or tobacco use, and keeping alcohol use to moderate amounts. They also had healthy dietary patterns, such as limiting red meat or having high vegetable consumption.


Potential Benefits of Diabetes Prevention

Preventing diabetes can clearly have far-reaching consequences for patient quality of life, for population health, for healthcare costs, and for your practice. 

  • Quality of life: preventing diabetes can save patients from burdensome self-care such as injecting insulin and measuring blood glucose multiple times a day.

  • Population health: with 1.5 million new cases of diabetes per year, [10] prevention of 90% through lifestyle changes would save 1.35 million people from getting diabetes.

  • Healthcare costs: an annual per-patient cost savings of $2,671 annually when prediabetes does not progress to diabetes. [11]

What about your practice? You can build your reputation with healthier patients, but there is more. Now, you can get reimbursement by promoting diabetes prevention care in your practice. If you participate in Medicare’s Merit-based Incentive Payment System (MIPS), you should be aware of two new Improvement Activities (IA) for 2018. 


Get the Details on How to Refer Patients to Lark's Digital Diabetes Prevention Program

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Improvement Activities in Medicare Merit-Based Incentive Payment System

Your practice’s IAs count towards 15% of your final MIPS score in 2018. [12] The two new activities that are targeted towards helping high-risk patients prevent diabetes are: 

  1. Glycemic Screening Services: the idea is that if you detect prediabetes as soon as possible, you have a higher chance of helping patients prevent diabetes.

  2. Glycemic Referring Services: the idea is that if you can connect prediabetic patients with proven effective programs, they can lower their risk of developing type 2 diabetes.


Glycemic Screening Services

Glycemic screening services can allow for early detection. Such services are currently underutilized, as is evident with the fact that 9 out of 10 people with prediabetes are unaware that they have it. Being aware of prediabetes is more than just pedantic; with healthy lifestyle changes, people with prediabetes can lower their diabetes risk by 58% or more. [13]

Screening is not difficult for your practice. You can follow US Preventive Task Force Services (USPTF) [14] or American Diabetes Association (ADA) [15] guidelines for screening high-risk patients, such as overweight or obese patients or patients with a family history of diabetes. 

You can use a simple blood test that is undoubtably offered in your in-house lab or the one your patients typically use.

  • Fasting blood glucose (FBG)

  • Oral glucose tolerance test (OGTT)

  • Glycated hemoglobin (A1C)

To qualify, you must implement your screening program in at least 60% of your practice in the 2018 performance period, and 75% after that.

Also know that the glycemic screening serving AI is:

  • Weighted “Medium”

  • ACI CEHRT Bonus Eligible

  • In the “Population Management” subcategory


Glycemic Referring Services

So your patient has prediabetes. Now what? Of course you want to help them, but how? That is where the glycemic referring services IA comes in. It directs you to connect your patients with a CDC-recognized Diabetes Prevention Program (DPP).

The DPP is a year-long program with the goal of preventing or delaying type 2 diabetes through healthy behaviors such as weight loss, increased physical activity, and nutritious food choices. A 3-year study found that the program lowered risk for diabetes by 58%, with higher risk reduction among certain subgroups, such as older adults. [16] In addition, participation in a DPP for 3 years is linked to a 42% ROI. [17]

To qualify, you must refer at least 60% of eligible patients in the 2018 performance period, and 75% after that.

Also know that the glycemic referring service AI is:

  • Weighted “Medium”

  • ACI CEHRT Bonus Eligible

  • In the “Population Management” subcategory

Each CDC-recognized DPP has a standardized curriculum with 16 lessons to be covered in the first 6 months, and 6 lessons to be covered in the last 6 months. To remain CDC-recognized, each DPP must meet certain standards. [18] They include:

  • Ability to offer the program within 6 months of gaining CDC approval.

  • Commitment to deliver the entire program.

  • Ability to provide data in an ongoing fashion regarding patients’ weight loss, food logging, and physical activity.

  • Personnel such as a trained lifestyle coach and a DPP coordinator.

You do not need to start your own DPP just to comply with this MIPS IA. You can refer your patients to an extant DPP in your area. The CDC website lists several.


Streamlining Your Glycemic Referring Services: Lark DPP

Regardless of how effective a program is, it is not going to become a regular part of your practice or your patients’ lives if it is not realistic. You do not want to spend value time and labor on administrative tasks, and your patients will not be highly compliant with a program that is burdensome.

Lark DPP simplifies the process for you, and it makes participation easier for your patients. Lark Health: 

  • Helps you identify eligible participants.

  • Enables real-time verification for eligibility.

  • Avoids billing and claims headaches.

  • Uses performance-based billing.

For patients, the digital DPP allows for 24/7 access to their personal health coach via their smartphone. There is no need to attend DPP classes at possibly inconvenient times or in faraway locations. Plus, patients can chat with their Lark coach whenever they want.

The patient experience begins when they receive their health tools: a wireless scale, a Fitbit, and the Lark DPP app. The user’s account is already set up so coaching can begin immediately, with no start-up hassle. Patients can log in and go through conversations to learn how the program works and to set their goals. 

Lark is easy to use and has proven results. It is built to provide a tailored program with healthy eating, physical activity, stress management, and lasting behavior change strategies. 


Ready to Redouble Your Efforts to Fight Diabetes?

Over 1.5 million Americans will develop diabetes this year, but you can do your part to make sure that they are not your patients. Now, MIPS provides you with the financial incentive to screen and refer your high-risk patients, and Lark offers you a seamless partnership for an effective DPP. What are you waiting for?


Find out how to Refer Patients to Lark's Digital Diabetes Prevention Program

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