The American Diabetes Association
estimates that the average cost for a person diagnosed with diabetes is about
$7,900 per year in the United States. Studies have shown the cost of preventing
diabetes is well worth paying for a program which can help patients who have
been identified as prediabetic. The National Diabetes Prevention Program (DPP)
is based on the results of a DPP study funded by the National Institutes of
Health (NIH).
The study found that lifestyle changes resulting in modest weight
loss sharply reduced the development of type 2 diabetes in people at high risk
for the disease. A study presented by CMS showed that over the course of 15
months, Medicare-eligible individuals who participated in a version of the DPP,
the Y-DPP, avoided $2,650 in healthcare costs. Additionally, the average cost
of the DPP is $500 per person even without a disease specific diagnosis, and in
Ohio we’ve seen the cost as low as $279 to $300 per person to enroll in a
year-long DPP. Enrollment in a DPP by high-risk
individuals results in important health benefits and represents a good value
for money out of the patient’s pocket.
Medicare began covering the cost of
patients enrolling in the Medicare Diabetes Prevention Program (MDPP) as of
April 1, 2018. This program is an expanded model of a structured intervention
with the goal of preventing type 2 diabetes in individuals with an indication
of prediabetes. The program consists of 16 intensive “core” sessions of a
Centers for Disease Control and Prevention (CDC) approved curriculum, over six
months in a group-based setting that provides practical training in long-term
dietary change, increased physical activity, and behavior change strategies for
weight control. After the core sessions are completed, less intensive follow-up
meetings continue monthly in order to maintain the patient’s healthy behaviors.
The primary goal of the MDPP is for at least 5 percent weight loss by
participants. The final rule on MDPP coverage by Medicare appears in the
November 2, 2017, Federal Register and can be downloaded from the Federal Register here.
Additional information and resources can be found on the CMS MDPP website here.
To read more about steps to prevent
your patients from being diagnosed with type 2 diabetes, see the presentation
from the American Medical Association, hosted by OACHC on March 27, 2018, here.
Resources:
·
Clinical Diabetes and Endocrinology20151:9
·
AADE (American Association of Diabetes
Educators) DPP
Economic costs of diabetes in the U.S. in
2012. Diabetes Care. 2013;36:1033–46.
