Diabetes Prevention Program First Under ACA to Gain Medicare Coverage

The Department of Health and Human Services announced an expansion of Medicare coverage to include the Diabetes Prevention Program for individuals at high risk of developing type 2 diabetes. The program, funded by the Affordable Care Act, is the first CMS Innovation Center preventive care model to be eligible for expansion into the Medicare program.

Under the expansion, Medicare will cover the costs of “lifestyle change programs,” in which trained counselors guide patients toward healthier eating habits and increased physical activity in an effort to prevent type 2 diabetes.

"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,” Sylvia M. Burwell, secretary, Department of Health and Human Services, said in a statement. “The Affordable Care Act gave Medicare the tools to support this groundbreaking effort and to expand this program more broadly. Today’s announcement is a milestone for prevention and America’s health.”

A 2011 pilot of the Diabetes Prevention Program, funded by the Affordable Care Act and run by the National Council of YMCAs, demonstrated reduced health care–related costs while simultaneously preventing diabetes. Medicare saved $2650 for each person enrolled in the prevention program over a period of 15 months. Beneficiaries enrolled in the program also lost about 5% of their body weight—enough to substantially reduce the risk of developing diabetes.—FRMC Editor

Reference

Department of Health and Human Services. Independent experts confirm that diabetes prevention model supported by the Affordable Care Act saves money and improves health. HHS.gov. Published March 23, 2016.