Fighting a National Epidemic by Investing in Prevention

Recently, U.S. Secretary of Health and Human Services (HHS) Sylvia M. Burwell announced significant cost-savings from the National Diabetes Prevention Program (National DPP), and groundbreaking steps HHS will likely soon take to extend the program to Medicare beneficiaries at risk of developing type 2 diabetes.
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Robert E. Ratner, MD, FACP, FACE
Steven J. Stack, MD
Matt Longjohn, MD, MPH
Mike Payne, MSc, MBA

Recently, U.S. Secretary of Health and Human Services (HHS) Sylvia M. Burwell announced significant cost-savings from the National Diabetes Prevention Program (National DPP), and groundbreaking steps HHS will likely soon take to extend the program to Medicare beneficiaries at risk of developing type 2 diabetes. "Treating this disease isn't just a burden on families," she said. "It costs our nation $176 billion in direct medical costs every year."

The announcement highlighted the success of a three-year effort, funded by the Center for Medicare and Medicaid Innovation (CMMI) and led by the YMCA of the USA, to deliver the National DPP to nearly 8,000 at-risk Medicare beneficiaries in 17 communities.

The YMCA 's program is modeled after the Centers for Disease Control and Prevention's (CDC) National DPP, a proven, evidence-based lifestyle change program that helps patients adopt and maintain healthy lifestyles. The program focuses on eating better, increasing physical activity and losing a modest amount of weight to reduce a patient's chance of developing type 2 diabetes.

The Office of the Centers for Medicare and Medicaid Services (CMS) Actuary found that the project not only paid for itself, it actually saved Medicare $2,650 per beneficiary in just over 15 months.

With the announcement, the National DPP is eligible to become the first preventive service to receive full coverage using the CMMI 'expansion' mechanism, as outlined in the Affordable Care Act. The fact that Secretary Burwell has exercised this authority speaks to the urgency of addressing prediabetes in this country, a condition that has become a national epidemic, especially among America's seniors.

Of the 86 million American adults who currently have prediabetes, an estimated 22 million are seniors, and fewer than one in ten are aware they even have it. More than 50 percent of Americans over age 65 have prediabetes. Without intervention, up to one-third of those individuals will progress to type 2 diabetes within the next five years. In 2014, Medicare spent more than $15,700 per beneficiary with diabetes.

Today, Medicare reimburses providers to screen for, and to treat, individuals with diabetes. But evidence-based prevention programs such as the National DPP are not covered. That's why we applaud Secretary Burwell and her team at HHS for taking a bold step to fight one of the most prevalent -- but often preventable -- conditions in American medicine. Her commitment to this evidence-based preventive service will fill a critical gap in health care, while improving the health outcomes for millions of seniors, and potentially saving Medicare billions of dollars.

Each of our organizations is fortunate to have played key roles in testing, promoting, and scaling National DPPs in various settings over the last six years. The American Diabetes Association (ADA) and the American Medical Association (AMA) worked closely with the Y during the demonstration project. The Y was the first DPP provider to translate the program at the community level and has served more than 42,000 people at 1,500 sites in 45 states. As the nation's largest CDC-recognized provider of the National DPP, Omada has served more than 50,000 participants across the country with its digital version of the program.

Moving forward, our organizations are re-committing to leadership in the National DPP community. The ADA will continue to promote the National DPP for individuals with prediabetes. The AMA will continue to lead the charge to ensure America's physicians incorporate National DPP referrals into their clinical workflows, as they work with Medicare beneficiaries as well as other patients. The Y and Omada Health together will continue to apply their national footprints, expertise with scaling the program, learnings from active research programs, and experience working with health plans, employers, and physicians.

In the coming months, CMS will move into a rule-making phase to shape the mechanics of how this new preventive benefit will be rolled out to such a large population of seniors. The experience and expertise from our organizations will be essential to the success of this prevention benefit in Medicare. This includes robust strategies for building stronger awareness of prediabetes among patients and providers, efforts to motivate at-risk individuals to speak with their providers, increased physician screenings, and referrals into the National DPP as well as program oversight and quality assurance, and reimbursement. As leaders in the diabetes prevention community, we will continue to work to ensure all at-risk seniors have access to this life-changing prevention program.

As the Secretary said during the announcement, "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."

We couldn't agree more. Our seniors, and all Americans, deserve access to this evidence-based means to prevent diabetes and its complications. We encourage all health payers to follow Medicare's lead and take action to cover the National DPP. Expanding access to proven prevention programs such as the National DPP can help lower health care costs, but most importantly, will improve the health of the nation.

Dr. Robert Ratner is the Chief Scientific and Medical Officer for the American Diabetes Association. Dr. Steven Stack is the President the American Medical Association. Dr. Matt Longjohn is the National Health Officer at the YMCA of the USA. Mike Payne is the Chief Health Care Development Officer at Omada Health, a digital behavioral medicine company.