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HHS Issues Medicare Coverage Expansion for Diabetes Prevention

With 30 million Americans diagnosed with Type 2 Diabetes, Medicare coverage expansion through the Diabetes Prevention Program could help improve health outcomes.

By Vera Gruessner

One of the most common chronic medical conditions found today is that of diabetes. Healthcare providers and payers need to work together to find ways that could help reduce the rates of diabetes nationwide. Recently, the Department of Health and Human Services (HHS) announced that it would be advancing Medicare coverage expansion for the Diabetes Prevention Program, according to a press release from the organization.

Diabetes Prevention Program

The Diabetes Prevention Program stems originally from the Affordable Care Act and is funded through this legislation.  HHS Secretary Sylvia M. Burwell State stated that the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) found that Medicare coverage expansion for the Diabetes Prevention Program would actually cut down on Medicare costs.

It is also expected that expanding the program would improve the quality of healthcare services. With 30 million Americans diagnosed with Type 2 Diabetes and two people dying from the disease every five minutes, Medicare coverage expansion through the Diabetes Prevention Program could help improve the health outcomes of patients around the country.

In addition to the 30 million Americans living with type 2 diabetes today, another 86 million people around the US have a condition called prediabetes, which puts them at risk for developing the chronic disease. Prediabetes consist of having blood glucose levels that are higher than normal but not high enough to be diagnosed with the  medical condition.

"This program has been shown to reduce healthcare costs and help prevent diabetes, and is one that Medicare, employers and private insurers can use to help 86 million Americans live healthier,” HHS Secretary Sylvia M. Burwell stated in the press release. “The Affordable Care Act gave Medicare the tools to support this groundbreaking effort and to expand this program more broadly. Today’s announcement is a milestone for prevention and America’s health.”

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These individuals are also at higher risk of heart disease and stroke. The majority with prediabetes are diagnosed with Type 2 Diabetes within 10 years. Since this prevalence is so strong, Medicare coverage expansion aimed at reducing these rates and preventing diabetes could go a long way toward decreasing healthcare spending overall.

Five years ago, CMS provided $11.8 million to the National Council of Young Men’s Christian Associations of the United States of America (Y-USA) through funding from the Affordable Care Act in order to help Medicare beneficiaries at high risk of diabetes learn ways to prevent the disease.

Medicare beneficiaries received weekly coaching sessions where they obtained dietary tips along with physical fitness advice and  recommendations for behavioral changes that would reduce their risk of diabetes.

Essentially, the program was meant to improve physical activity and nutrition among these patients with a goal of a 5 percent reduction in the weight for each participant. The Diabetes Prevention Program did show that the majority of Medicare beneficiaries were able to reduce about 5 percent of their overall weight, which does decrease their risk of a diabetes diagnosis in the future.

“The Diabetes Prevention Program can prevent disease and help people live healthier lives,” Dr. Patrick Conway, CMS Deputy Administrator and Chief Medical Officer, said in a public statement. “CMS’ partnership with CDC, NIH, and private sector partners to engage people in improving their own health was critical to the success of the Diabetes Prevention Program. We are now working to determine the best strategies for incorporating the Diabetes Prevention Program into Medicare.”

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The results also showed that more than 80 percent of Medicare beneficiaries enrolled in the program attended at least four weekly sessions. The Diabetes Prevention Program brought a savings of approximately $2,650 across a 15-month time span for each Medicare beneficiary participating in these weekly sessions. Spending seemed to consistently fall below budget within programs found across the country, according to a report from RTI International.

The American Medical Association (AMA) Find the Medicare coverage expansion for the Diabetes Prevention Program reassuring, according to a press release from the establishment. Andrew W. Gurman, M.D., President-Elect of the American Medical Association, finds that these advances will allow Medicare beneficiaries to have more direct access to necessary resources in order to prevent diabetes and reduce their risk.

“The AMA applauds the U.S. Department of Health and Human Services (HHS) for moving toward authorizing coverage for the National Diabetes Prevention Program (National DPP) to Medicare beneficiaries at high risk of developing type 2 diabetes,” Gurman said in a public statement. “Today’s announcement signifies an important step toward ensuring all Americans at risk for type 2 diabetes have access to the resources they need to prevent this debilitating disease.”

“Confirmed by HHS today, the Y-USA’s diabetes prevention program has been shown to provide significant cost savings for Medicare participants. These cost savings could benefit some of the more than 86 million American adults currently living with prediabetes.”

The AMA has focused on educating physicians to screen for prediabetes within their community and refer patients to much-needed programs aimed at reducing the risk of Type 2 Diabetes. The organization has positioned physician pilot sites aimed at referring prediabetic patients to the CMS Diabetes Prevention Program. The AMA has also positioned the savings afforded through this program via a diabetes prevention cost-savings calculator, which is available for use by employers and insurers.

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In order to achieve the Triple Aim of Healthcare, Medicare coverage expansion through this program should be able to cut overall healthcare spending, improving health outcomes, and boost patient satisfaction.

Image Credits: RTI International


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