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.

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This study evaluated the impact of a virtual version of the Diabetes Prevention Program (DPP) on healthcare utilization and costs in a Medicare Advantage population. The program was offered during 2015 to a random sample of 9,497 individuals who had metabolic syndrome or prediabetes. Program enrollees (n=501) received a 12-month virtual DPP including a wireless scale, pedometer, nutrition tracker, educational lessons, health coaching, and peer group support through an online platform. Participants with available administrative claims data during the 12 months before and 24 months following program start (n=495, mean age=69 years; 64% female; 85% white) were propensity-score matched on demographic, behavioral, and clinical factors in a ratio of 1:1 to a comparison group (n=495, selected from 6,490; mean age=69 years; 58% female; 87% white) who did not receive the DPP. In the 24 months following DPP enrollment, participants averaged 0.2 inpatient admissions, 0.3 emergency department visits, and 12.2 physician visits, compared to 0.2, 0.4, and 12.0 for controls. While the utilization values do not show a large change, a difference-in-differences regression analysis of total medical and pharmacy cost for 24 months following program start showed cost savings. The adjusted difference-in-differences effect on average cumulative cost difference was $1,110 per participant, or $46.25/month. Medical and pharmacy costs were consistently lower for participants in the post-program year. Pharmacy savings were statistically significant during the last 6 months, with a 24-month cumulative adjusted savings of $408. These cost estimates do not include the cost of the program. Results suggest that a virtual DPP can change the pattern of utilization and reduce costs in a Medicare population. Disclosure V. Chiguluri: None. D. Barthold: None. R. Gumpina: None. C. Castro Sweet: Employee; Self; Omada Health, Inc.. J. Pieratt: None. T.A. Cordier: Employee; Self; Humana Inc.. Stock/Shareholder; Self; Humana Inc.. R. Matanich: None. A. Renda: None. T.G. Prewitt: None.

Introduction: Blood glucose control is critical to slowing the onset of T2DM complications for individuals. National guidelines encourage clinicians and payers to ensure patient HbA1c lab results are less than 8.0%. Understanding the longitudinal patterns of HbA1c control among individuals with lab results over 8.0% is therefore an important undertaking. This study aims to characterize the proportion of individuals returning to HbA1c control within a one year period after an uncontrolled result. Population and Study Design: Medicare Advantage (MA) patients with a large, national health and wellness company residing in Florida with a diagnosis of type 2 diabetes were included if they had an HbA1c lab value greater than or equal to 8.0% in 2016. Patients had at least one year of continuous coverage prior to the uncontrolled result and were followed until disenrollment, death, or a controlled HbA1c lab value, up to a maximum of one year. Cox regression stratified by initial HbA1c value (8.0-8.9%, 9.0-9.9%, 10.0-10.9%, 11.0-11.9%, 12.0%+) was used to assess the adjusted proportion of persons returning to control over the one year follow-up period. Confounders in the model included: demographic factors, supply of insulin, and comorbidities. Results: The study cohort consisted of 28,026 persons who met the inclusion criteria (50.7% female, 57.4% white, mean age 71.9 years). Overall, 50.5% (95% CI: 50.0%, 51.1%) of persons achieved HbA1c control within the 1 year follow-up. Inability to return to control was driven by higher initial Hba1c [8.0-8.9% return rate: 61.6% (60.9%, 62.4%) vs. 9.0-9.9%: 39.4% (38.1%, 40.7%) vs. 12.0+%: 27.7% (25.1%, 30.2%)]. Implications: MA patients with HbA1c results greater than 9.0% experienced challenges resuming controlled status suggesting increased attention to this population may be warranted. Disclosure T.A. Cordier: Employee; Self; Humana Inc.. Stock/Shareholder; Self; Humana Inc.. V. Chiguluri: None. H. Hines: None. S.H. Clark: None. G. Haugh: None. R. Gumpina: None. V. Gopal: None. T.G. Prewitt: None.

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