YMCA

Medicare Inches Toward Better Obesity Care

With much fanfare Wednesday, CMS announced that Medicare will begin paying the YMCA and other providers to deliver lifestyle coaching known as the Diabetes Prevention Program (DPP) to people at risk for developing diabetes. The program is for people with excess body weight and prediabetes – high blood sugar that has not yet progressed to diabetes.

This great news represents important progress toward delivering better access to evidence-based obesity care and reducing the burden of chronic disease in America. The problem it addresses can hardly be overstated. Nearly 70% of U.S. adults have excess weight and nearly half of all adults have prediabetes. A landmark study in 2002 showed that the DPP can cut the risk of developing diabetes by nearly 60%.

CMS spent five years and $12 million dollars figuring out that the DPP works for Medicare members. In fact, they found that the program saved $2,650 for every person who enrolled in it. Participants lost an average of 5% of their weight, which is well known to provide significant health benefits and to prevent diabetes.

As thrilling as it is to have Medicare finally move on providing this needed care, we can’t help but wonder: what took so long?

The effectiveness of the DPP was documented in that landmark NEJM publication 14 years ago. Five years ago, both CMS and the U.S. Preventive Services Task Force certified that it was an effective preventive service.

Medicare has been paying primary care doctors to deliver the program ever since 2012 – but only in theory. In reality, using primary care doctors might be the dumbest possible way to deliver this program. They don’t have time and CMS can’t afford them. So 99% of the people in Medicare who need this vital prevention program aren’t getting it. Susan Creekmore told USA Today about her frustration in trying to enroll in a diabetes prevention program after she learned she had prediabetes:

It’s disgraceful that I’m trying to be proactive in my healthcare, the program is available and no one offers it. One of the hospitals said, “Come back when you have diabetes,” and I said. “That’s the point. I don’t want to get diabetes.”

So yes, this is great news. It’s just a little slow in coming.

“Bureaucracy defends the status quo long past the time when the quo has lost its status.” – Laurence J. Peter

Click here to read more from the New York Times and here for more from NPR.

YMCA, photograph © Doug McCaughan / flickr

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March 24, 2016

4 Responses to “Medicare Inches Toward Better Obesity Care”

  1. March 24, 2016 at 8:44 am, Kathleen Roberts said:

    This is GREAT NEWS as I’ve been wanting to join the YMCA!! I have physical limitations that prevent weight training, etc. and most “silver sneakers” facilities don’t have a pool!! When is this to go into effect?!
    Thanks!!

  2. March 24, 2016 at 10:44 am, Adam Tsai said:

    This is indeed great news. The CMS press release doesn’t specify how it will pay for the program (can primary care physicians offer it in their offices, what kinds of providers (RDs, psychologists) can lead it, etc. Sounds like that information is coming in the summer?

  3. March 24, 2016 at 11:10 am, Ted said:

    Thanks for the perspective, Kathleen. My understanding is that it will go through a rule making process and come into full effect in 2017. The wheels of government grind slowly.

  4. March 24, 2016 at 11:13 am, Ted said:

    Thanks for your perspective, Adam. CMS is already paying PCPs to do this in their offices — they just pay them so little that very few actually do it. This will be more for low cost providers like YMCA. And yes, we’ll have more details later. But it will follow the outline of what they’ve been doing in their demonstration project with the Y.