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Thank you for joining us today for a webinar on Using County-Level Data to Increase Access to and Enrollment in the Medicare Diabetes Prevention Program our presenter today is Boone Peng Ng, Ph.D, Assistant Professor at the University of Central Florida and Guest Researcher for the Centers for Disease Control and Prevention, or CDC. I am Michelle Knight with ICF next, and I will be your moderator for today's webinar. The information presented in this webinar is based on the guidance document titled Using County Level Data to Increase Access to and Enrollment in the Medicare Diabetes Prevention Program and accompanying brief both published by CDC. These documents will be available on the CDC website later this year, as well as this webinar recording, the PowerPoint slide deck, and the transcript. In the next 16 minutes we will share information to help you understand how to use county level data and information on where the Medicare Diabetes Prevention Program is currently offered so that you have the potential to increase access to the MDPP target eligible Part B beneficiaries to enroll in the program, and plan new locations for the MDPP. We will review national maps and state specific charts with county level estimates of the number of MDPP eligible Part B beneficiaries. We also will show you how to determine where the MDPP is currently offered in a specific locality using the Center for Medicare and Medicaid Services, CMS MDPP, resources. We will walk you through an example from the field and discuss how to use the information for program planning. Finally we'll wrap up by sharing additional resources. The information presented in this webinar is based on guidance document. A guidance document titled "Using County Level Data to Increase Access to Enrollment in the Medicare Diabetes Prevention Program" and the accompanying brief both published by CDC. In the next slide then we'll review the steps you can take to assist you in planning your MDPP activities. Take it away Boon. Thank you Michelle. Let's get started. You can plan your MDPP program using the following steps. The first step in the process is using national maps and state charts to review how to label CDC estimates of the number of MDPP eligible beneficiaries to understand the distributio. Step two involves using resources from the Centers for Medicare and Medicaid Services, CMS, to determine where the MDPP is currently offered in a state or locality. In step three you will use the information you have gained from steps one and two to conduct program planning to potentially increase awareness to, awareness of, and enrollment in the MDPP. The MDPP is a structured program aimed at preventing or delaying type 2 diabetes in Medicare beneficiaries with pre-diabetes. The MDPP is an expansion of the National DPP, and it includes an evidence-based set of services. The program includes 16 core sessions delivered over six-months in a group-based, classroom style setting. It uses a CDC approved curriculum, and provides practical training in dietary change, increased physical activity, and weight control strategies. The primary goal of the program is for participants to attain at least 5% weight loss. After the core sessions, participants attend less frequent monthly follow-up meetings called maintenance sessions over another six months, to help them maintain healthy behaviors. Finally participants may attend ongoing maintenance sessions for up to 12 additional months. Starting in 2018, the National Diabetes Prevention Program's Lifestyle Change Program became a covered preventive service for eligible Medicare beneficiaries through the MDPP. The program is based on research showing that people with pre-diabetes who take part in a structured program can cut the risk of type 2 diabetes by 58 percent or by 71 percent in people over age 60. The Diabetes Prevention Recognition Program which is the quality assurance arm of the National DPP, awards CDC recognition to organizations that deliver the lifestyle change program and meet quality standards and achieve the outcomes proven to prevent or delay the onset of type 2 diabetes. Note that only CDC's recognized organizations with preliminary or full recognition for an in-person lifestyle change program can apply to become MDPP suppliers and bill Medicare for the services they provide to eligible Medicare beneficiaries. An MDPP supplier is an organization that is recognized by CDC, and can bill for MDPP services provided to eligible beneficiaries. CMS provides several tools and resources for MDPP supplier organizations interested in becoming suppliers. Links to these resources can be found in the CDC guidance document. Many organizations are interested in becoming MDPP suppliers. There are a number of factors that influence the decisions to become an MDPP supplier. In this webinar we will focus mainly on making these decisions based on information regarding estimate of MDPP- eligible beneficiaries in a specific geographical area. We will show you the tools and methods that can help organizations determine whether applying to be an MDPP supplier is the best choice for them, based on estimates of the number of MDPP eligible beneficiaries and where the MDPP is currently offered. CDC works with health departments, their partners, and community organizations to increase access to enrollment in the MDPP. Partners may include national and community organizations, employers, public and private insurers, health care professionals, university community education programs, and businesses that focus on wellness. To aid in targeting eligible beneficiaries, CDC estimated the number of MDPP eligible Part B beneficiaries at the county level using urban and rural classifications. Eligible MDPP suppliers can achieve CDC recognition and CMS approval to be an MDPP supplier and offer the in person National DPP lifestyle change program. To be eligible for the MDPP, an individual must have all the following: Medicare Part B coverage through Original Medicare, which is a fee for service, or Medicare Part C coverage, Medicare Advantage. A result that indicates pre-diabetes from one of three blood tests hBa1c, fasting, glucose, or a glucose tolerance test within one year before the first core sesion. A body mass index, or BMI, of at least 25; if the person self-identifies as Asian, the BMI must be at least 23. No history of diabetes type 1 or type 2 except for gestational diabetes. No end-stage renal disease. The individual may have not previously received MDPP services. The MDPP benefit is available for coverage only once in a lifetime. Although both Part B and Part C beneficiaries are eligible, CDC researchers only estimated the number of MDPP eligible Part-B beneficiaries, which accounts for about 68 percent of total Medicare beneficiaries - due to the lack of availability of Part C data. CDC researchers estimated the number of MDPP eligible Part B beneficiaries for each county in the U.S. nationwide; they are about 5.2 million total MDPP eligible Medicare Part B beneficiaries. In step 1, you can use national maps and county level data developed by CDC to understand the distributions of MDPP eligible Part B beneficiaries in each county across the United States. If you'd like to learn how CDC estimated the numbers of MDPP eligible Part B beneficiaries you can refer to Appendix A in the CDC Guidance Document. The National Maps on the next few slides show the estimated number of people eligible to participate in the MDPP by county. The first map shows all U.S. counties; the second map highlights urban counties; and the third map highlights rural counties. This national map shows the estimated number of MDPP-eligible Part B beneficiaries in all U.S. counties. Counties are shaded based on the estimated number of MDPP-eligible Part B beneficiaries in that county. Darker shapes of blue represent higher numbers of eligible beneficiaries and lighter shapes represent lower numbers of eligible beneficiaries. For example, the lightest shade indicates counties with "up to 1,000" eligible beneficiaries and the darkest shade indicates "over 25,000" eligible beneficiaries. As you can see, those counties with the highest number of beneficiaries, over 25,000, tend to be clustered around large cities. The number of counties with insufficient data are labeled using a light gray diagonal line pattern. This pattern is easier to see in the CDC Guidance Document. This national map shows the estimated number of MDPP- eligible Part B beneficiaries in urban u.s. counties. The urban counties are shaded in blue and the rural counties are shaded tan. Most urban counties are estimated to have over 1,000 MDPP-eligible beneficiaries. This national map shows the estimated number of MDPP original Part B beneficiaries in rural u.s. counties. The rural counties are shaded in blue and the urban counties shaded tan. Most rural counties are estimated to have less than 2,500 MDPP-eligible Part B beneficiaries. In the next few slides we will show you how to transition from using the national maps to finding local information. The national map shows a distribution of MDPP-eligible Part B beneficiaries. State charts show county level estimates of the number of MDPP eligible Part B beneficiaries. Once you have reviewed the national maps to see the distributions of estimated numbers of MDPP-eligible Part B beneficiaries in your state or territory, you can refer to the state charts to see county-level estimates in your state or municipalities in the territory. Each state's chart shows the estimates of the number of MDPP-eligible Part B beneficiaries in each county in that state. You can choose your state's chart from Appendix B in the CDC Guidance Document. Here is a sample of Alaska's counties from the state charts in Appendix B of the Guidance Document. The chart shows the number of MDPP-eligible Part B beneficiaries in each county listed from the largest to smaller numbers. Dark red dots represent urban counties and blue dots represent rural counties. To see estimates of frequency and density-that is the number of eligible Medicare Part B beneficiaries per square mile - you can refer to Appendix C in the guidance document. Once you have the county-level information you need regarding MDPP-eligible Part B beneficiaries, you will want to know where the MDPP is currently offered in your area. CMS has two tools to help you find MDPP supplier sites in your area-the list of current MDPP supplier sites and the interactive MDPP supplier map. Both resources provide the MDPP supplier site's locations and contact information. In the next few slides, we will review how to use these tools. In this webinar we refer to "supplier sites"-but the more technical terms are "administrative locations" and "community settings." This is a screenshot of the current MDPP supplier sites in the U.S. The list allows you to locate supplier sites using several variables, or columns. The column options include the name of the initiative, organization name, location name, address, city, state, zip code, telephone, NPI, category and unique ID. You can sort or filter the list by each or column. For example, if you want to see the MDPP supplier site in Arkansas and can see where they are located, you could sort the list at the top of the "State" column, click the three dots to the right for the column options. From the column options, select "Sort Ascending". You can see the results on the next slide. Here is the list of MDPP supplier sites in the U.S., sorted by state, with MDPP supplier sites in Arkansas grouped together. In addition to sorting, you can filter MDPP supplier sites in the U.S. to get the MDPP supplier sites located only in Arkansas. Click the "Filter" tab, which is the blue tab on the top right of the list. Click on the button "Conditional Formatting." Next to "Conditions" use the pulldown menu to select "State." In the "Select a Comparison" pulldown menu, select "is" as the comparison to filter. For the state of Arkansas type "AR" in the blank "Description" field. Then select "Apply". Close the "Filter" window. You can see the result on the next slide. Here is the result of the filtering we described on the previous slide. You can see the list of MDPP supplier sites located only in the state of Arkansas. If you prefer to view and navigate the list offline or in a more familiar format, you can export the list into other formats such as a CSV or TSV file that is compatible with Microsoft Excel. click on the "Export" tab at the top. From the export page- if you like a PDF or print versions of the data, select the "Print" tab, choose your margins, and then click "Print." The CMS MDPP supplier map allows you to locate current MDPP supplier sites using a zip code. The tool is designed for individuals interested in participating in the MDPP and looking for the MDP supplier sites closest to them. Because you cannot search for supplier sites by county, you will need at least one city name or zip code for each county of interest. To use the tool we will follow these steps on the next three slides. In the sidebar on the left side of the map, type the zip code you want. Use the menu to specify a distance of 25, 50, 100, 250, or 500 miles from the that zip code. For this example, we selected zip code 72712, Bentonville, Arkansas and searched for MDPP providers within 25 miles. You can check the box for either Administrative Locations, which is the supplier's office, or community setting, where the program is held, if you want to narrow your search or you want to see all results, you do not need to select all the boxes. Select "Search." The search result shows where all MDPP supplier sites are located within 25 miles of the 72712-zip code. The large green dot on the map indicates the number of sites found in the search - these sites are listed below the map. The list provides contact information for each MDPP supplier site. Because not all counties have supplier sites the MDPP Supplier Map search can locate the closest supplier sites to the zip code you enter in the search, which may be in a neighboring county. Know that a program can have multiple supplier sites once you have clicked on the green dot on the map. In the previous line you can see black dots that shows the locations of the four sites in your range. Use the plus and minus button in the bottom right corner of the screen to zoom in and out on the map. Here you can see MDPP supplier sites you can zoom in further to see where the MDP supplier sites are located you went down to the street level. In this step you will compare the information from steps 1 & 2 for program planning purposes you should then be able to understand the distributions of the MDPP-eligible Part B beneficiaries in your state and where the MDPP's supplier sites are located. You can identify geographical areas where MDPP-eligible Part B beneficiaries have access to MDPP services, and other areas where they may not have access. In the next few slides we will discuss how state and local health departments can use the information in step 1 and step 2 to assist organizations to potentially increase MDPP availability and enrollment. To potentially increase MDPP availability, state, and local health departments can inform health care providers about the MDPP, its benefits to their patients 65 and older, and how to refer eligible patients to local MDPP services. Although a referral from a physician is not required to participate in the MDPP, a blood test is required. Healthcare providers play a crucial role in helping Medicare beneficiaries understand the risks of diabetes and options for lowering their risk. Only fourteen percent of adults aged 65 and older with diabetes are aware of their condition. State and local health departments can share tools with CDC, recognized organizations that have preliminary or full recognition, and offer an in-person lifestyle change program to help them to navigate the process to apply as an MDPP supplier, encourage these organizations to consider becoming MDPP supplier sites in areas where programs do not exist. To potentially increase awareness of MDPP it is suggested that state and local health departments encourage healthcare providers to help their Medicare patients obtain blood tests they need to become aware of their risk for type 2 diabetes and recommend that MDPP-eligible Part B beneficiaries participate in MDPP services. State and local health departments can also help MDPP supplier sites to identify ways to market their programs, such as learning where potential beneficiaries work, pray and play; using preferred marketing channels; developing motivating messages; and using community champions and influencers in message delivery. As a current MDPP supplier site, once you complete Steps one and two, you should understand the distributions of estimated MDPP eligible beneficiaries in your surrounding area, as well as where the nearest MDPP supplier sites are located. This can help you to prioritize where to target your MDPP awareness and marketing efforts. Existing MDPP supplier sites and health departments can explore which program supplements are needed to maximize participation and retention of MDPP eligible Part B beneficiaries. Supplements can include large-print materials, handicap accessibility, and physical activity adaptations to help address potential barriers to participation by eligible beneficiaries. Consider transportation issues as a potential barrier. Once you determine how you will use the information you have learned in Step one and Step two, it is important to tailor your efforts to the target populations. To do this, consider some general characteristics of the Medicare Part B population such as age, gender, race, ethnicity, health status, income, and independency. For information you can find a link to the publication "Working with Medicare Beneficiaries Guide for CDC Recognized Organizations" in the CDC Guidance Document. Consider whether your specific target population is living in an urban or rural area. Participants may face different challenges to enrolling and participating in the MDPP based on where they live, and how close they are to a program. Consider cultural, linguistic and literacy needs of the population you want to reach. Helpful resources include these webpages:CDC's National Prevention Information Network webpage on cultural competency. The Office of Disease Prevention, and Health Promotions web page on health literacy. Links to these webpages can be found in the CDC Guidance Document. Your state or local health department may also have useful data or resources. Consider other factors when you are doing program planning such as staffing, physical space, and handicap access to program facilities. In this fictional example, the Colorado State Health Department is conducting activities that they hope will increase access to, awareness of, and enrollment in the MDPP. The Health Department decides to use this Guidance Document to inform and enhance their efforts. In the next few slides we will look at the state of Colorado as we follow the mapping steps that we reviewed earlier. As you look at the screenshot of Colorado from the national map, note that darker shades represent counties with higher numbers of MDPP eligible Part B beneficiaries, and lighter shades represent counties with lower numbers. Health Department staff can review the Colorado map and can see that counties surrounding the city of Denver have the higher estimated numbers of MDPP-eligible Part B beneficiaries in Colorado. They also see that the majority of the counties along the Southern or Eastern borders of the state have relatively low numbers of MDPP eligible Part B beneficiaries meaning one thousand or less. Referring to the state chart for Colorado, on this slide the Health Department staff identify the three counties with the highest estimated numbers of MDPP eligible Part B beneficiaries, as El Paso County 10,455, Arapahoe county 8,553 and Denver County 6,837. They decide to initially focus on El Paso county, and want to know how many MDPP supplier sites exist within an accessible area - Remember the dark red dots represent urban counties and blue dots represent rural counties. Using the list of all current MDPP supplier sites, the health department staff select the "Filter" tab to filter the list to show supplier sites only for the state of Colorado. Click on the button "Conditional Formatting" next to "Conditions". Use the pulldown menu to select "State" from the drop down menu. In the "select a Comparison" pull-down menu, select "is" a the comparison to filter by. For the state of Colorado, type "CO" in the blank description field. Then select "Apply", close the "Filter" window. You will see the results on the next slide. Next do online search for the names of all cities and towns in El Paso County. Print out the list. Now that you have the list of supplier sites in Colorado on this slide scroll down the list to look for the names of cities and towns in El Paso County on the list you printed. You will discover that there's one MDPP supplier site in El Paso County - Kaiser Foundation Health Plan of Colorado, which is in the city of Colorado Springs. Another option that the health department can use is the "MDPP Supplier Map". that we showed you earlier to get this same information. In the next three slides, we will describe how the health department can use the information from Steps one and two for their MDPP program planning efforts. Because El Paso County has the highest estimated number MDPP-eligible Part B beneficiaries in the state and there is only one MDPP supplier site in the El Paso County area the Health Department sees an opportunity for adding new MDPP supplier sites. The staff members contact CDC-recognized organizations with preliminary or full recognition that offer an in-person lifestyle change program to encourage them to consider becoming MDP supplier sites. To search for CDC-recognized organizations, you can find a link to the lifestyle change program in the CDC Guidance Document health department. Staff can also provide tools to these organizations to help them assess the demand for MDPP services and navigate the MDPP supplier's application process. Health department staff provide information to health care providers in the El Paso County area about the MDPP and its benefits to their patients 65 and older. They inform health care providers how to refer MDPP eligible Part-B beneficiaries to local MDPP services and where the MDPP supplier sites are located. Since there is only one MDPP supplier site in the El Paso County area staff can use the "MDPP Suppliers Map" to find and share informations about MDPP supplier sites in accessible locations outside of the county. The health department can also connect health care providers with these MDPP supplier sites, if desired by the providers. Health department staff can work with existing and potential MDPP supplier sites to provide support based on their specific needs. The support may include addressing potential barriers to program participations for eligible beneficiaries> For example, the health, the State Health Department may have learned from MDPP supplier sites that transportation and scheduling of MDPP sessions presented barriers to full participation for some Medicare eligible Part B beneficiaries. To address this the MDPP supplier site may offer transportation and additional scheduling options. Consider social and contextual factors that can influence participation and retention in the MDPP, such as language, literacy level and culture. Health department staff and the MDPP supplier site can examine local data to determine the specific needs of local Medicare Part D beneficiaries and tailor their program materials accordingly. We hope this webinar has helped you to understand the steps you can take to inform MDPP planning efforts. Reviewing national maps for county-level CDC estimates of the number of MDPP eligible Part B beneficiaries, determining where the MDPP is offered in your state or local area using CMS resources, and using the information for program planning purposes-to potentially increase access to, awareness of, and enrollment in the Medicare Diabetes Prevention Program. For more information on the Medicare Diabetes Prevention Program here are some links to additional resources. You can find more resources listed in the CDC Guidance Document. On behalf of the CDC, I want to thank you for participating today in the "Using County Level Data to Increase Access to and Enrollment in the Medicare Diabetes Prevention Program" webinar. For more information we invite you to visit the CDC website at www.cdc.gov