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AMA Urges Payers to Cover Chronic Disease Management Program

The AMA has called on private and public healthcare payers to cover a chronic disease management program that would help treat and prevent the progression of prediabetes.

By Jacqueline LaPointe

- The American Medical Association (AMA) has asked private and public healthcare payers to include the National Diabetes Prevention Program as a covered benefit to advance chronic disease management strategies for beneficiaries with prediabetes.

The AMA has called on payers to cover chronic disease management program for prediabetes patients

In a press release on its website, the AMA explained that healthcare payers should consider covering the Centers for Disease Control and Prevention’s (CDC) evidence-based program to help reduce the financial and healthcare challenges related to prediabetes.

“We have a proven way to help these people make necessary lifestyle changes that can help them avoid developing the disease, but health coverage for these programs is limited and varies by location and insurer,” said Andrew W. Gurman, MD, AMA’s President. “We urge both private and public healthcare payers to offer the diabetes prevention program under their health plans to give more people access to these proven programs.”

The AMA has developed the National Diabetes Prevention Program coverage policy to help more than 86 million Americans who are currently living with prediabetes. While the chronic disease is prevalent, approximately 90 percent of those with prediabetes do not know that they have it and that they are likely to develop type 2 diabetes.

The healthcare industry group has also called on hospitals to provide the National Diabetes Prevention Program to its patients and support efforts to use community benefit funds to cover the costs of enrolling individuals, whether virtually or in-person.

Under the policy, the AMA plans to partner with other industry groups, such as the American Hospital Association, to create and share guidance on financing the chronic disease management initiative using community benefit dollars.

The recent announcement aims to build on the push by Department of Health and Human Services (HHS) to authorize Medicare coverage for the National Diabetes Prevention Program, which was reported earlier this year. AMA has supported the call for expanding the program, but it has encouraged the federal agency to formally enable coverage under Medicare to provide more preventative services to beneficiaries with prediabetes.

By covering Medicare beneficiaries, HHS Secretary Sylvia M. Burwell explained that the National Diabetes Prevention Program could decrease net Medicare spending and prevent the progress of the metabolic disease.

Additionally, the AMA noted that its new chronic disease management policy will expand its continuous efforts to prevent type 2 diabetes. The association has dedicated resources over the last two and a half years to spreading awareness of prediabetes and helping more physicians screen at-risk patients.

The National Diabetes Prevention Program was actually modeled on its 2013 Y-USA initiative, reported the press release. Y-USA encouraged more physicians to screen patients for prediabetes and refer them to prevention programs at local YMCAs that were part of the initiative.

In addition to Y-USA, the AMA has collaborated with the CDC to increase awareness of prediabetes among care teams and physicians through the Prevent Diabetes STAT campaign. The program offers tools and resources to providers on treating and stop the progression of prediabetes.

The AMA has also developed a diabetes prevention cost-saving calculator to demonstrate how employers and insurers can benefit from improving patient outcomes while also decreasing healthcare costs.

“As part of its efforts to improve the health of the nation, the AMA will continue to support and advocate for policies aimed at reducing the incidence of type 2 diabetes and reducing the fiscal burden associated with the disease,” stated the press release.


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