CMS study finds National Diabetes Prevention Program eligible for Medicare coverage

ALEXANDRIA, Va. — Health and Human Services Secretary Sylvia Burwell announced Wednesday that the National Diabetes Prevention Program (National DPP), a network of community-based lifestyle intervention programs, will be eligible for Medicare coverage as part of new Medicare regulations that the Centers for Medicare and Medicaid Services will roll out later this year. 

 

The coverage for the National DPP marks that first time since the passage of the Affordable Care Act that Medicare coverage has been extended to a preventative health program. The announcement came the same day that CMS published an independent evaluation report that tracked the efficacy of DPPs for Medicare beneficiaries at 17 local YMCAs over the course of 15 months. 

 

Medicare beneficiaries enrolled in the program who attended at least four weekly sessions saw an average weight loss of 4.73% of body weight, and over 80% of participants attended at least four sessions. CMS estimated that over a 15-month period, the program saved $2,650 per enrollee, which more than covers the programs costs.

 

"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,” said HHS Secretary Sylvia M. Burwell. “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.”

 

The American Diabetes association, which has long supported the National DPP efforts, said that the decision highlights the important of preventative care for those at risk for developing type 2 diabetes. 

 

"The evidence shared today confirms the National DPP delivers cost savings to individuals who are at risk for developing diabetes and to our health care economy,” the ADA’s CEO Kevin Hagan said. “Most importantly, the National DPP showed improved health outcomes for participating individuals, demonstrating that interventions like the National DPP can help prevent many of our country's seniors from developing type 2 diabetes and its horrible complications, which can include blindness, amputation, heart disease, stroke and kidney failure."

 

The Diabetes Advocacy Alliance, a 21-member coalition of organizations — of which the YMCA is a member — also welcomed the decision, noting that it had worked with the ADA to expand access to programs under the National DPP. 

 

“The human and economic toll of diabetes is devastating but today's announcement is a huge step forward in our efforts to change the trajectory of this disease,” DAA co-chair Dr. Henry Rodriquez said. “The DAA is committed to working with federal health agencies to educate Medicare patients and providers about the value of the National Diabetes Prevention Program so that seniors at risk of developing diabetes can take steps to prevent or delay its onset.”

 

Currently, more than 800 organizations — including community-based organizations, health systems and pharmacies are listed in the list of recognized organizations that is maintained by the Centers for Disease Control and Prevention, though not all in the registry have been fully recognized. The standards for a diabetes recognition program can be found here.