March 23, 2016
Independent experts confirm that diabetes prevention model supported by the Affordable Care Act saves money and improves health
Today, the Department of Health and Human Services announced a significant step forward in building a health care system that works better, spends dollars smarter, and keeps people healthy. Secretary Sylvia M. Burwell announced that the independent Office of the Actuary in the Centers for Medicare & Medicaid Services (CMS) certified that expansion of the Diabetes Prevention Program, a model funded by the Affordable Care Act, would reduce net Medicare spending. The expansion was also determined to improve the quality of patient care without limiting coverage or benefits. This is the first time that a preventive service model from the CMS Innovation Center has become eligible for expansion into the Medicare program.
Currently, about 30 million Americans have type 2 diabetes, resulting in two deaths every five minutes in this country. Additionally, 86 million Americans have a high risk of developing diabetes, because one in every three adults has prediabetes, a condition that arises when blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Prediabetes means a person is at increased risk for developing type 2 diabetes, as well as for heart disease and stroke. Many people with prediabetes develop type 2 diabetes within ten years.
"This program has been shown to reduce health care 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. “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.”
In 2011, through funding provided by the Affordable Care Act, CMS awarded the National Council of Young Men’s Christian Associations of the United States of America (Y-USA) more than $11.8 million to enroll eligible Medicare beneficiaries at high risk for diabetes in a program that could decrease their risk for developing serious diabetes-related illnesses. Beneficiaries in the program attended weekly meetings with a lifestyle coach who trained participants in strategies for long-term dietary change, increased physical activity, and behavior changes to control their weight and decrease their risk of type 2 diabetes. After the initial weekly training sessions, participants could attend monthly follow-up meetings to help maintain healthy behaviors. The main goal of the program was to improve participants’ health through improved nutrition and physical activity, targeting at least a five percent weight loss for each individual.
The results of the Diabetes Prevention Program model are striking:
- Medicare beneficiaries enrolled in the program lost about five percent of their body weight, which is enough to substantially reduce the risk of future diabetes. Average weight loss was 4.73 percent of body weight for participants attending at least four weekly sessions. Participants who attended at least nine weekly sessions lost an average of 5.17 percent of their body weight.
- Over 80 percent of participants recruited attended at least four weekly sessions.
- When compared with similar beneficiaries not it the program, Medicare estimated savings of $2,650 for each enrollee in the Diabetes Prevention Program over a 15-month period, more than enough to cover the cost of the program.
Thanks to the Affordable Care Act, the CMS Innovation Center has demonstrated that investment in prevention of chronic conditions saves money and improves quality for patients. These findings are relevant not only to the Medicare program, but to employers and insurers who may want to initiate diabetes prevention programs in their populations.
“The Diabetes Prevention Program can prevent disease and help people live healthier lives,” said Dr. Patrick Conway, CMS Deputy Administrator and Chief Medical Officer. “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.”
The Administration supports expansion of the Diabetes Prevention Program. This certification is a critical step in expanding the Diabetes Prevention Program for Medicare beneficiaries with pre-diabetes. CMS is considering how it would expand this model broadly throughout the Medicare program. More information about how CMS could expand the Diabetes Prevention Program will be included in the CY 2017 Medicare Physician Fee Schedule proposed rule, which is anticipated to be released in Summer 2016.
To view the CMS Office of the Actuary certification of the Diabetes Prevention Program, please visit: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/Diabetes-Prevention-Certification-2016-03-14.pdf
To view the independent evaluation report, please visit: https://innovation.cms.gov/Files/reports/hcia-ymcadpp-evalrpt.pdf