# Health and Economic Impacts of Coverage Requirements and Health System-Community Coordination for Diabetes Prevention

> **NIH NIH R18** · NORTHWESTERN UNIVERSITY · 2020 · $505,688

## Abstract

Project Summary
Currently, 86 million Americans have prediabetes, but 9 in 10 of them remain unaware. Randomized trials have
demonstrated that more than half of all new cases of type 2 diabetes can be prevented or delayed when high
risk adults are offered resource-intensive lifestyle intervention programs, such as the Diabetes Prevention
Program (DPP). While numerous organizations have engaged in efforts to expand screening and subsequent
access to interventions for adults with prediabetes, those services are far from routine in clinical and public
health practice. However, implementation efforts in this arena are expected to accelerate rapidly during the
next 3 years as several forthcoming policies will catalyze efforts to identify and intervene upon prediabetes.
The US Preventive Services Task Force (USPSTF) recently issued a grade B recommendation that all
overweight or obese adults with cardiovascular risk conditions (including prediabetes) be offered intensive
lifestyle interventions, specifically referencing the DPP as a case example. This recommendation, together with
Affordable Care Act (ACA) legislation requiring commercial and public payers to provide coverage of USPSTF
A and B recommendations, has led payers to begin structuring coverage policies that will include a mix of
clinical and community intervention services. In parallel, key stakeholders such as YMCA of the USA and the
American Medical Association (AMA) have engineered a series of strategic regional initiatives to strengthen
healthcare-community linkages for the screening and diagnosis of prediabetes, as well as the coordination of
referrals to community-based interventions, and the billing and payment for delivery of those interventions. In
close collaboration with these stakeholders, we propose this natural experiment, employing a mix of qualitative
and quantitative research methods, and leveraging available data from the Health Care Cost Institute (HCCI),
OptumHealth Care Solutions, and other accessible sources to evaluate the reach, implementation,
effectiveness, and costs of these interrelated policies likely to impact the prevention of type 2 diabetes for
potentially several million Americans over the next 5 to 10 years. Our proposal aims to: (1) evaluate and
compare the impacts of large-scale, regional healthcare-community linkages on changing rates of prediabetes
screening, diagnosis, and National DPP intervention attendance following enactment of USPSTF
recommendations for those services; (2) describe implementation features and elicit barriers and facilitators of
implementation, replication, and future scaling of large-scale regional initiatives; and (3) compare the effects of
exposure to the YMCA’s DPP on healthcare costs and utilization for different subgroups of patients with
prediabetes. This evaluation will provide critical information about whether particular strategies should be
discontinued, refined, or replicated on a larger scale to achieve maximal impact ...

## Key facts

- **NIH application ID:** 9924263
- **Project number:** 5R18DK110741-04
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Ronald T. Ackermann
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $505,688
- **Award type:** 5
- **Project period:** 2017-04-21 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9924263

## Citation

> US National Institutes of Health, RePORTER application 9924263, Health and Economic Impacts of Coverage Requirements and Health System-Community Coordination for Diabetes Prevention (5R18DK110741-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9924263. Licensed CC0.

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