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Medicare looks to expand diabetes model after YMCS pilot saves millions, HHS says

Model tested at the YMCA saved Medicare about $2,650 for each person enrolled, enough to cover the cost of the program.

Susan Morse, Senior Editor

An $11.8 million federal diabetes prevention model tested at the YMCA saved Medicare about $2,650 for each person enrolled, enough to cover the cost of the program, according to an announcement Wednesday by Health and Human Services Secretary Sylvia M. Burwell.

Enrollees lost an estimated 5 percent of body weight, enough to significantly reduce the risk of developing diabetes, Burwell said.

The success of the program means the Centers for Medicare and Medicaid Services is now considering how to expand the model broadly throughout the Medicare program. Employers and insurers may want to initiate diabetes prevention programs in their populations, Burwell said.

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Certification by the independent Office of the Actuary at CMS  certified that the program reduced net Medicare spending, makes this possible.

"This program has been shown to reduce healthcare costs and help prevent diabetes, and is one that Medicare, employers and private insurers can use to help 86 million Americans live healthier," Burwell said of the number of people in this country who are at risk of developing diabetes.

Currently, about 30 million of Americans have type 2 diabetes, resulting in two deaths every five minutes, according to Health and Human Services.

This is the first time that a preventive service model from the CMS Innovation Center has become eligible for expansion into the Medicare program.

More information will be included in the CY 2017 Medicare physician fee schedule proposed rule, which is anticipated in the summer of 2016.

[Also: More discounts for diabetes care in new health plans]

"We are now working to determine the best strategies for incorporating the Diabetes Prevention Program into Medicare," said Dr. Patrick Conway, CMS deputy administrator and chief medical officer.

The Affordable Care Act funded the $11.8 million that in 2011, CMS awarded to the National Council of Young Men's Christian Associations of the United States of America.

When compared with similar beneficiaries not in the program, Medicare estimated savings of $2,650 for each enrollee over a 15-month period, HHS said.

Participants attended weekly sessions with a lifestyle coach who trained them in strategies for long-term dietary change, increased physical activity, and behavioral changes. The weekly sessions were followed by monthly meetings.

The YMCA program targeted at least a five percent weight loss for each individual. The average weight lost was 4.73 percent of body weight for participants attending at least four weekly sessions. Over 80 percent of participants recruited attended at least four weekly sessions.

Participants who attended at least nine weekly sessions lost an average of 5.17 percent of their body weight.

The American Medical Association applauded the model in a statement released by AMA President-Elect Andrew W. Gurman, M.D.

"Today's announcement signifies an important step toward ensuring all Americans at risk for type 2 diabetes have access to the resources they need to prevent this debilitating disease," Gurman said. "Research shows that up to one-third of these individuals will develop type 2 diabetes within five years unless they lose weight through healthy eating and increased physical activity."

The AMA has been working the Y-USA to increase the number of physicians who screen patients for prediabetes and refer them to diabetes prevention programs offered by the local YMCAs, he said.

The AMA has also developed a diabetes prevention cost-savings calculator to highlight the potential benefits for employers and insurers, he said.

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Worldwide Diabetes, a nonprofit education foundation, also expressed appreciation for the federal training model, but couched its praise due to another recent government initiative regarding competitive bidding for diabetes testing supplies.

"The diabetes community is thrilled that HHS is focusing on diabetes and, specifically, on diabetes prevention in an effort to save lives and save money for the program," said Jaime Davidson, MD, past president of Worldwide Diabetes. "However, it is extremely ironic that while Medicare is working to prevent diabetes, CMS stubbornly pursues its Competitive Bidding Program for diabetes testing supplies, a program that has been shown to increase hospitalizations and mortality among Medicare beneficiaries already facing diabetes."

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