Nina Brown-Ashford: DPP Will Improve Care and Costs for Prediabetes Patients

Nina Brown-Ashford, MPH, CHES, deputy group director at the CMS Innovation Center, discusses how Medicare’s Diabetes Prevention Program will help improve population health and contain the high costs of diabetes care.

Transcript (slightly modified)

How does CMS anticipate the DPP will improve population health and help control costs?

We know that diabetes affects about 25% of elderly Americans, 65 years of age and older. When you look at the entire US population, those 18 to 79 years old, this number is expected to double. The prevalence of diabetes is expected to double by 2050. CMS estimated that the cost attributable to diabetes among the fee-for-service non-dual eligible population and what they found was that individuals with diabetes cost about $42 billion more to the healthcare system than those without diabetes. When you look at that across the different aspects of Medicare, about 20 million of that is attributable to Medicare Part A, 17 million to Medicare Part B, and about 5 million to Medicare Part D.

On a per beneficiary basis, we know this disparity in diabetes continues to exist. So Medicare will spend about $1500 per beneficiary more on Medicare Part D spending, about $3100 more for hospital and facility-based services, and about $2700 per beneficiary more for physician and other clinical services. The good part, is that we know that type 2 diabetes is preventable and with the Medicare Diabetes Prevention Program (DPP), that was certified by the CMS Office of the Actuary and noted for expansion by the secretary, we found in that healthcare innovation award trial a savings of about $2650 per beneficiary attributable to implementation of the DPP program.

The DPP program and the Medicare Diabetes Prevention Program expansion will give beneficiaries access to is a 12-month lifestyle intervention consisting of 16 core sessions, that are about an hour in length, over the first 6-months of the program. After that they will then have additional access to monthly sessions for the last 6-months of the program. If they achieve and maintain a 5% weight loss, they’ll then be eligible for monthly on-going maintenance sessions within the next 2 years of the program.

What’s the current status of the DPP’s implementation?

DPP is being implemented as an additional preventive service. The great thing about that is that it means there is no cost-sharing to Medicare beneficiaries. So like all of the other preventive services, they’ll be able to access DPP as an additional preventive service benefit. CMS finalized the proposal of a number of policies, really establishing the program in the 2017 physician fee schedule. The final rule finalizes a number of aspects of the benefit relating to the overall benefit description, it outlines enrollment requirements and beneficiary eligibility. Also, additional eligibility and criteria that suppliers will need to follow in order to enroll in Medicare once the benefit goes live on or after January 1 of 2018.