Reimbursement for the Medicare Diabetes Prevention Program Should be Increased

Based on positive results from the Diabetes Prevention Program (DPP) study carried out between 1996 and 2002, Medicare started offering a version of the Diabetes Prevention Program to Medicare beneficiaries in April 2018. The program is called the Medicare Diabetes Prevention Program (MDPP). However, there are currently very few MDPP providers in the U.S. That means that many Medicare beneficiaries don’t have access to an MDPP. One reason for the limited number of MDPP providers is the cost of delivering the program. The cost is often more than the Medicare reimbursement. MDPP reimbursement should be increased to entice more providers to offer the MDPP.

The DPP study showed that the intensive lifestyle intervention (ILI) employed in the study could lower the risk of type 2 diabetes by 58% for people with prediabetes. But more importantly, the study showed that for persons over 60, the risk reduction was 71%. Because of the DPP study results, CMS carried out its own test.

The CMS investigators concluded that by using the DPP methodology, Medicare could save $278 per participant per quarter of each year. Because of the savings, Medicare started offering the MDPP in April of 2018. However, a study published on June 12, 2020, indicates that MDPP providers are in short supply. For example, In July 2019, it [was] estimated that there was one MDPP “site per 100,000 Medicare beneficiaries nationwide.”

One of the reasons for the lack of MDPP providers is the cost of delivering the program compared to the Medicare reimbursement. For example, in 2019 the maximum reimbursement was $470 per participant for the first MDPP year, while the cost of delivering the program was typically in excess of $500 per participant per year.

So adjustments should be made in the MDPP reimbursement to attract more MDPP suppliers. If adjustments are made in the reimbursement that improve return-on-investment (ROI), providers will see that they can improve the health of their patients while realizing a net income.

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Counseling for Prediabetes Should be Heightened in Primary Care

Prediabetes is a condition where an individual’s blood glucose is abnormally high, but not high enough to be called type 2 diabetes. But prediabetes raises the risk of type 2 diabetes. Because of the nature of prediabetes, a healthcare provider -- especially one in a primary care setting -- can collaborate with the patient to determine if there is a need to treat the condition. Being over 40 years of age, overweight or obese, for example, can raise the risk of type 2 diabetes in a patient with prediabetes. If the patient is at high risk of getting type 2 diabetes, the provider should counsel the patient or make a referral.

The provider should counsel the patient on ways to make lifestyle changes to treat the prediabetes, or refer the patient to an organization that can provide the counseling. While the referral rate for prediabetes treatment is unknown, counseling for prediabetes in a primary care setting is relatively low. The level of counseling for prediabetes should be increased.

Approximately 88 million adults in the US have prediabetes. And the CDC’s Diabetes Prevention Program study has shown that addressing prediabetes using intensive lifestyle intervention (ILI) can reduce the incidence of type 2 diabetes. Based on the results of the Diabetes Prevention Program  study, the CDC established the Diabetes Prevention Program (DPP) to help individuals treat prediabetes.

Counseling high risk patients with prediabetes or referring the patients to an organization that offers prediabetes counseling is recommended by the US preventive services task force (USPSTF) . However, one study showed that only about 40% of patients with prediabetes were counseled by a healthcare provider to control or lose weight, increase physical activity, or decrease the fat or calories in the diet.

The investigators further stated that “participants who were counseled to adopt healthy lifestyle reported high adherence to weight control and diet modification.” So while ILI, used by the DPP, can reduce type 2 diabetes cases by treating prediabetes, providers often don’t counsel patients who have the condition.

Since patients are more often in a primary care setting than any other healthcare setting, primary care providers can be an important factor in helping to decrease the number of type 2 diabetes cases by counseling patients who have prediabetes.

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