A program to help people at risk for diabetes has improved the health of participants and saved health costs, so it is being proposed for expansion into Medicare. Others think it will inspire employers and insurers to follow suit.
HHS Secretary Sylvia Mathews Burwell made the Medicare announcement Wednesday, the sixth anniversary of the signing of the Affordable Care Act, at the Anthony Bowen YMCA in Washington, D.C.
It's the first time that a project from CMS' Innovation Center, which was created by the Affordable Care Act, has been proven successful enough to be part of the Medicare program. The ACA allows such certified programs to be expanded without approval of Congress.
The CMS is expected to provide more information about the expansion and potential funding in the 2017 Medicare Physician Fee Schedule set for release this summer.
Burwell said she hopes the program will result in more wellness programs.
“I think the data and information is probably the most important step that we're making,” she said.
Kenneth Thorpe, a health economist at Emory University who proposed expanding the Diabetes Prevention Program nationally more than four years ago, said he predicts private insurers will act.
"Medicare often times is the pioneer for other plans following suit, in terms of reimbursement and coverage decisions,” he said.
The program (PDF) began when the CMS awarded nearly $12 million through the ACA to the National Council of YMCAs. People with higher than normal blood sugar levels were enrolled and attended weekly training sessions on nutrition, exercise and overall healthy living.
Those who attended at least four sessions reduced their body weight by about 5%. Weight loss has been proven to reduce the risk of developing diabetes. Medicare estimated a savings of $2,650 per participant, which is beyond the cost of the program.
The American Medical Association said in a statement that it has encouraged physicians to screen more patients for diabetes and refer them to prevention programs.
“As part of our ongoing efforts to improve the health of the nation, we 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,” the statement read.
The National Coalition on Health Care said it also supports the administration and called on Congress to fund more prevention and chronic care programs.
About 86 million Americans are at high risk for developing diabetes and also for heart disease or stroke, according to the Centers for Disease Control and Prevention. The diabetes epidemic cost the nation about $245 billion in medical expenses and lost productivity in 2012.
Bob Herman contributed to this report.
