CMS diabetes prevention program saved money, improved health

On March 23, the Department of Health and Human Services (HHS) announced that a diabetes prevention program being tested through the Centers for Medicaid & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation successfully reduced the risk for developing diabetes among participants, and resulted in a significant cost savings among a test group of Medicare beneficiaries.

The Innovation Center, established as part of the Affordable Care Act, was designed to test “innovative payment and service delivery models to reduce program expenditures … while preserving or enhancing quality of care” for patients on Medicare, Medicaid, or the Children’s Health Insurance Program.

Under this program, CMS awarded the National Council of Young Men’s Christian Association (YMCA) of the United States of America more than $11.8 million to enroll Medicare beneficiaries at high risk for diabetes into a program designed to reduce their risk for developing the disease. The program was tested at 17 participating YMCAs nationwide.

Program participants attended weekly meetings with a lifestyle coach where they learned strategies for long-term dietary change, increased physical activity, and behavior changes to control weight and risk for diabetes. After the initial weekly sessions, participants could continue to attend monthly follow-up meetings. The majority of participants were aged 65 to 74 and 61% were women.

The YMCA program was evaluated by an independent group of experts, and the results were “striking,” according to HHS.

After participating in the Diabetes Prevention Program, beneficiaries lost about 5% of their body weight. Participants who attended at least four sessions lost an average of 4.73% of their body weight, and those who attended at least nine sessions lost an average of 5.17% of their body weight. HHS notes that this amount can “substantially” reduce the risk of future diabetes.

In addition to the substantial reduction in weight loss, one of the other striking results was the level of patient engagement, according to Wanda D. Filer, MD, FAAFP, president of the American Academy of Family Physicians, and a family physician in York, Pennsylvania.

“I take care of quite a few patients on Medicare and a lot of time it can be challenging to get patients engaged in this sort of program,” Filer told Medical Economics. However, among participants in the Diabetes Prevention Program, more than 80% attended at least four weekly sessions.

Filer added that she would not be surprised if programs like this had other spill-over benefits for this patient population.

“Those who practice family medicine often have conversations with senior patients encouraging them to go to senior centers or get involved in the community, in part, because they can become very isolated,” she said. “These programs could have a positive benefit by getting patients out and engaged in terms of social and mental health wellbeing.”

Finally, Medicare compared spending among Medicare beneficiaries participating in this prevention program and those who were not. It estimated a savings of $2,650 per enrollee over a 15-month period, “more than enough to cover the cost of the program,” according to HHS. 

“What I am extremely appreciative of is that this provides us with solid evidence that we are beginning to move from a disease-based health care system to more of a focus on prevention and wellness,” Filer said. “In this kind of scenario we are trying to close the barn door before the horse is out, and that is somewhat unheard of in the past for Medicare.”