Virtual Care Scores a Big Win in Diabetes Prevention

After a long, long wait, diabetes prevention programs may soon be able to include virtual care.

CMS has included in its proposed 2026 Physician Fee Schedule a provision allowing the Medicare Diabetes Prevention Program (MDPP) to be delivered virtually, opening the door not only to chronic care management companies like Omada Health, Virta Health, Dario Health and CVS Health but also hospitals and health systems looking to expand their care management platforms.

The provision, which would allow virtual programs through the end of 2029, replaces language that primarily restricts the MDPP to in-person treatment, with some exceptions. CMS officials said the three-year plan would allow the agency to measure and compare outcomes for beneficiaries, including weight loss, against in-person and distance learning models.

The proposal is a huge win for telehealth advocates and healthcare providers who want to reach more people at risk of developing Type 2 diabetes, especially those who have problems accessing in-person treatment.

In the proposal, CMS is also prohibiting using AI to replace live health coach interactions. And the agency suggests using Bluetooth-enabled scales to send weight data to care providers.

The original Diabetes Prevention Program was developed by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), and focused on in-person classes and one-on-one coaching. Based on that model, which was administered by the Centers for Disease Control and Prevention, CMS created the National Diabetes Prevention Program for Medicare beneficiaries in 2018.

The MDPP is a year-long program designed to help people diagnosed with prediabetes or with an elevated chance of developing Type 2 diabetes. The program focuses on coaching participants on lifestyle choices, including more exercise, better nutrition and behavior changes to support healthy living. Medicare covers the program, which consists of 16 weekly sessions over six months, followed by six monthly sessions over the remaining half-year.

The program has proven successful in improving diet, physical activity and healthy habits, as well as helping participants meet a weight loss goal of 5%.

CMS restricted the MDPP to in-person treatment until 2020, when the COVID-19 public health emergency prompted the agency to allow virtual delivery through distance learning programs. Subsequent rule changes have, among other things, expanded opportunities for telehealth, but the proposed 2026 PFS is the first time that CMS has signaled support for online-only programs.

Several groups, including the Alliance for Connected Care and American Telemedicine Association, have long lobbied to allow virtual care providers to take part in the program, but CMS has argued that there isn’t enough proof that telehealth will improve clinical outcomes.

The proposed 2026 PFS represents a marked change in strategy, indicating the federal government is becoming more open to trying out new ideas like virtual care and digital health.

This past March, the third annual Evaluation of the Medicare Diabetes Prevention Program by RTI International and Amico Consulting made a strong case for expanding opportunities for virtual care. That caught the attention of the Center for Connected Health Policy.

In its analysis of the report, CCHP noted:

• 34% of MDPP beneficiaries attend the program primarily virtually, and another 7% use a mix of virtual and in-person modes.
• 58% of those attending virtually had a perfect attendance rate, while 66% of those attending a mix of virtual and in-person classes completed all 22 sessions.  Only 39% of those attending in person, meanwhile, attended all of the courses.
• Those attending virtually saw an average weight loss of 5.3%, while those attending in person saw an average weight loss of 4.6%
• 56% of those attending virtually hit the targeted weight loss of 5%, while less than half of those attending in person hit that goal.

One problem with the program has always been participation. According to the report, only a little more than 9,000 people participated in MDPP as of April 2024, while roughly 16 million Americans age 65 and older are eligible to participate.

Should the proposal make it into the final rule, advocates say it’s up to the MDPPs to prove that virtual care can either equal or improve the results seen in in-person care. Supporters have long said the ability to connect with patients via telehealth and digital health gives providers more freedom to model program around a patient’s needs and schedule, and it opens up the program to patients who can’t or don’t want to attend in-person classes.