Diabetes among older adults is associated with significant health and cost burdens. Nearly a quarter of individuals age 65 and older have been diagnosed with diabetes, and one of every three Medicare dollars is spent on beneficiaries living with the condition. An estimated one-half of the Medicare population is prediabetic, meaning their blood sugar levels are high but not high enough to warrant a diabetes diagnosis.
To address this growing public health concern, in 2011 the Centers for Medicare & Medicaid Services (CMS) funded a pilot Diabetes Prevention Program (DPP) aimed at preventing prediabetic Medicare beneficiaries from developing diabetes. The program focused on lifestyle interventions like healthy eating and increasing exercise. Over a 15-month period, participants’ weight and diabetes risk dropped substantially. The pilot also yielded savings of $2,650 per enrollee, more than covering the cost of the program. This past March, CMS determined that the DPP reduces the incidence of diabetes among prediabetic Medicare beneficiaries and saves the program money, making it eligible to be a permanent Medicare benefit.
The Centers for Disease Control and Prevention (CDC) has identified hundreds of community-based organizations and online programs that have the capacity to implement DPPs. If Medicare decides to offer a diabetes prevention benefit, it will be important for CMS to ensure that beneficiaries in underserved urban and rural areas have access to DPPs. Outreach efforts should focus on reaching black and Hispanic seniors, as diabetes rates among these groups are much higher than rates among white seniors.
It will also be important for CMS to ensure that entities delivering DPPs have the capacity to validate patient outcomes (e.g., adherence with lifestyle interventions and achievement of weight loss goals) and have the technical capacity needed to bill Medicare. Finally, CMS will need to have the appropriate controls in place to readily detect program fraud and abuse. This summer, CMS will release more information about how the agency plans to expand the program, and we anticipate that they will address these issues.
CMS’ certification of the Diabetes Prevention Program is a big step forward for public health and for reducing the burden of chronic disease. A well-designed diabetes prevention benefit in Medicare could pave the way for investment in future prevention models.
Lynda Flowers is a senior strategic policy adviser with the AARP Public Policy Institute, specializing in Medicaid issues, health disparities and public health.
Olivia Dean is a policy analyst with the AARP Public Policy Institute. Her work focuses on public health, mental health, health disparities and healthy behavior.