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CMS Diabetes Prevention Program Cuts Spending, Boosts Outcomes

A Medicare diabetes prevention program can significant reduce the costs of chronic disease management while improving patient outcomes.

By Jacqueline LaPointe

- A comprehensive chronic disease management program that focuses on preventative care for diabetes and prediabetes is a successful way to reduce costs and improve patient outcomes, HHS announced this week, and should be implemented in communities nationwide. 

Chronic disease management programs

The program, modeled on a successful initiative overseen by the National Council of YMCAs, helped patients reduce an average of five percent of their body weight while generating $2650 in savings for the Medicare system.

If similar strategies are rolled out across the country, the National Diabetes Prevention Program (DPP) could decrease net Medicare spending and help the 86 million Americans affected by prediabetes to halt the progress of the metabolic disease.

"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,” said HHS Secretary Sylvia M. Burwell.

Nine out of 10 Americans who have prediabetes do not even know they have it. Without making significant changes to their lifestyle choices, 15 to 30 percent of those patients will develop Type 2 diabetes in five years.

In 2011, CMS awarded the National Council of YMCAs of the US (Y-USA) over $11.8 million to foster preventative care programs for Medicare beneficiaries at high risk of crossing the diabetes threshold.

Participants had access to weekly meetings with a lifestyle coach, who trained individuals on how to control weight, increase physical activity, and improve long-term dietary and behavioral habits. After the training sessions ended, participants could attend monthly follow-up meetings for continued support.

Patients who attended at least four weekly sessions - more than eighty percent of participants - lost an average of 4.73 percent of their body weight.  Participants who followed the program for more than four sessions reduced their weight by an average of 5.17 percent, exceeding the 5 percent weight loss target.

The program also saved Medicare an estimated $2,650 per participant over a 15 month period compared to beneficiaries not enrolled in the program. The savings covered the cost of the program.

“The National DPP, which the Y-USA’s program is modeled after, is a proven, evidence-based lifestyle change program that has been shown to reduce the incidence of Type 2 diabetes,” said AMA President Andrew W. Gurman, MD.  The AMA has also worked with the Y-USA, as well as other organizations, to address chronic disease management for diabetes and develop educational materials for patients and providers.

“The AMA has been focusing its efforts over the last two and a half years on increasing awareness of prediabetes and encouraging more physicians to screen their at-risk patients for prediabetes and refer them to Centers for Disease Control and Prevention (CDC)-recognized diabetes prevention programs in their communities,” Gurman added.

The HHS announcement marks the fact that the Office of the Actuary in the Centers for Medicare & Medicaid Services has certified that the initiative can measurably reduce Medicare spending, a critical step towards expanding the program, said Burwell.

“The Affordable Care Act gave Medicare the tools to support this groundbreaking effort and to expand this program more broadly,” she stated. “Today’s announcement is a milestone for prevention and America’s health.”

The administration is strongly in favor of bringing these preventative care strategies to more patients, added CMS Deputy Administrator and Chief Medical Officer Dr. Patrick Conway.

“The Diabetes Prevention Program can prevent disease and help people live healthier lives,” he said. “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.”

This is the first time that a preventative care model developed by the CMS Innovation Center has become eligible for expansion into the broader Medicare ecosystem.


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