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Government announces plans for Medicare to cover diabetes prevention

Industry News | Apr 14, 2016



On March 23, U.S. Secretary of Health and Human Services Sylvia Mathews Burwell announced a new Diabetes Prevention Program that will be offered to eligible beneficiaries enrolled in Medicare. The program, Fortune magazine explained, involves teaching pre-diabetic patients how to live healthier lifestyles with the goal of thwarting the development of Type 2 diabetes. For the first time, Medicare providers will not only be reimbursed for the cost of treating those who already have diabetes, but they will also be reimbursed for the cost of efforts to prevent it from forming altogether.

According to the U.S. Department of Health and Human Services, Burwell's announcement included explanation that the program will be funded by the Affordable Care Act and is also expected to decrease overall Medicare spending.

"The new program involves teaching pre-diabetic patients how to live healthier lifestyles"

Why this is a big deal
The department praised this plan for being the first preventive service model to ever be eligible for expansion under Medicare. According to HHS, one third of adult Americans are pre-diabetic, meaning their blood glucose levels are above average and at risk of developing into full blown Type 2 diabetes within 10 years.

Kaiser Health News, a nonprofit publication focused on health care policy and politics, reported Burwell made her historic announcement at a Washington D.C. YMCA, surrounded by the type of exercise equipment one needs to fight diabetes development. She said every five minutes, two people in America die from diabetes. Additionally, America spends $176 billion per year on diabetes treatment.

Mike Payne, the head of medical affairs for Omada Health - which has been recognized by the Centers for Disease Control and Prevention for its digital diabetes prevention program - spoke with Fortune about the huge significance of this new initiative. He said 97 percent of U.S. medical costs go toward treatment of illnesses that have already developed, and only 3 percent of spending goes toward prevention.

"The move by Medicare is a big deal, signaling a shift towards preventing illness instead of waiting for patients to become sick enough for more costly care," Payne said.

According to Fortune, at least 22 million of the 86 million pre-diabetic adults in the U.S. are over 65 years old. A prevention program under Medicare could affect a lot of people.

"This program will improve the health of seniors across the country."

Proof diabetes prevention programs really work
Before Burwell announced this plan, the Centers for Medicare & Medicaid Services spent several years working with the National Council of Young Men's Christian Associations of the United States of America to run a diabetes prevention trial program.

HHS said the Y-USA was awarded an $11.8 million grant that allowed the organization to work with eligible Medicare beneficiaries on making lifestyle changes - mainly eating healthier and increasing physical activity - that would reduce their chances of developing diabetes. Those in the program received lifestyle coaches who met with them once a week in the beginning and once a month as time went on.

HHS reported program participants lost an average of 5 percent of their body weight, and a 5 percent loss can significantly lower a person's chances of developing diabetes. Even more, each beneficiary who participated in the program saved about $2,650 in medical costs over 15 months.

This program is slated to simultaneously save money on healthcare costs and improve the health of seniors across the country. HHS emphasized that the findings of its trial program should not only be considered significant for Medicare. Any employer or healthcare provider should take note and consider implementing its own prevention program.