Health-Plan and Employer-Based Wellness Programs to Reduce Diabetes Risk: The Kaiser Permanente Northern California NEXT-D Study

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Julie A. Schmittdiel, PhD; Susan D. Brown, PhD; Romain Neugebauer, PhD; Sara R. Adams, MPH; Alyce S. Adams, PhD; Deanne Wiley, BA; Assiamira Ferrara, MD, PhD

Suggested citation for this article: Schmittdiel JA, Brown SD, Neugebauer R, Adams SR, Adams AS, Wiley D, et al. Health-Plan and Employer-Based Wellness Programs to Reduce Diabetes Risk: The Kaiser Permanente Northern California NEXT-D Study. Prev Chronic Dis 2013;10:120146. DOI: http://dx.doi.org/10.5888/pcd10.120146

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Abstract

Primary prevention of diabetes is increasingly recognized by both health plans and employers as an important strategy to improve the health of insured populations. As a part of the Natural Experiments in Translation for Diabetes (NEXT-D) network, the Kaiser Permanente Northern California (KPNC) Division of Research is assessing the effectiveness of 2 health plan-initiated programs to prevent the onset of diabetes in patients at high risk. The first study evaluates a telephonic health-coaching program that provides counseling on healthful eating, active living, and weight loss to KPNC members. The second evaluation examines a postpartum glucose screening and educational diabetes prevention program for women with gestational diabetes mellitus that KPNC implemented in 2006. Identifying effective approaches to preventing diabetes will be of value to health care systems, policy makers, and public health officials seeking to understand the roles systems and employers can play in preventing chronic illness.

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Introduction

Population approaches to improving health care and outcomes for patients with diabetes have been widely implemented by health plans and integrated delivery systems (1–4). Diabetes prevention is also increasingly emphasized by employers, who are major purchasers of health care insurance. Most companies with 50 or more employees offer worksite wellness programs (5), and nearly half of companies with more than 750 employees offer health risk assessment and screening (6). As awareness of diabetes risk grows in the employer/purchaser community, health plans and delivery systems are also adopting an active role in health promotion (7,8), with most offering primary prevention services such as health education and lifestyle programs (9–11). Efforts by health plans and employers to identify populations at high risk for developing diabetes and to focus prevention efforts on these populations are a promising strategy for reducing the incidence of the disease.
Health coaching to encourage healthy lifestyle choices (12–15) is a population-based approach to wellness and diabetes prevention that is being explored by health plans and purchasers. Health coaching, often via telephone, uses nonphysician health care providers to give patients the support, information, and skills required to improve self-efficacy and healthy behaviors. Health coaching may improve physical health status and healthy lifestyle behaviors (12–15) and may particularly benefit patients with prediabetes (16), who can benefit from coaching on lifestyle issues critical to diabetes prevention (17).
Women who have had 1 or more pregnancies marked by gestational diabetes mellitus (GDM) are another key group of health plan enrollees at heightened risk for diabetes (18). As the incidence of GDM rises, health plans are more often implementing guidelines to improve management of GDM during pregnancy and to encourage postpartum glucose screening for early identification and treatment (18,19) of those women who develop diabetes as well as promoting prevention strategies for those with prediabetes (20). As with other types of programs designed to decrease the risk of diabetes in high-risk patients, the effectiveness of these resource-intensive programs when broadly implemented in real-world clinical populations remains a question of interest to health plans, purchasers, and other stakeholders.
Kaiser Permanente Northern California (KPNC) is an integrated medical delivery system covering an enrolled population of 3.3 million members. KPNC provides numerous wellness and prevention programs to members, many of which encourage participation through partnerships with purchasers. The Natural Experiments in Translation for Diabetes (NEXT-D) study provides a unique opportunity for KPNC researchers and operations leaders, partnering together using participatory research principles (21), to evaluate the effect of health-plan–based diabetes prevention programs on populations at high risk for developing the disease. We outline our plans to use quasi-experimental methods to evaluate 2 such programs focused on diabetes prevention: a Wellness Coaching program and a postpartum glucose screening and diabetes prevention program for women with GDM.