Does Medicare Care About Preventing Diabetes?

We have an effective treatment for preventing diabetes. It cuts the risk by 60 percent in people with prediabetes. For every person on Medicare, it saves $2,650. In just 15 months. But Medicare can’t figure out how to make it available to the people who need it. This is the sad story of implementing the Diabetes Prevention Program for Medicare.

Reaching a Tiny Fraction of the Goal

Politico reports that the Medicare Diabetes Prevention Program enrolled only 200 people last year. The expectation was 110,000. This is a deeply disturbing shortfall. However, it’s not really surprising. That’s because Medicare has long been making it hard for people to get access to programs like this.

In 2016, John Batsis and Julie Bynum studied the reach of intensive behavioral programs for people with obesity in Medicare. In the first year, only 0.10 percent of people who needed such programs actually received them. After three years, the reach was still tiny – 0,60 percent. Medicare makes it hard to get these programs by making it hard to get paid for delivering the care. Only primary care providers can deliver the service under Medicare. But they don’t have the time, training, or financial incentives to do it. So, for the most part, they don’t.

A Stumbling Implementation of the MDPP

The Medicare Diabetes Prevention Program was supposed to fix the problem of limited reach. Medicare would reimburse other providers, like the YMCA, to deliver this program. But that hasn’t gone well either. Matt Longjohn, formerly the YMCA’s national medical director, explains:

Nonprofits just throw up their hands. The cost of keeping up with regulatory requirements leads them to leave the market.

The result is that CMS has certified too few providers to deliver its Diabetes Prevention Program. Ten states have none. Big cities like Dallas and Philadelphia have none. So it’s no surprise that CMS is missing its goals for enrollment. That also means that the $182 million in expected savings for Medicare won’t happen either.

Neglected Tools

This is profoundly sad. We have tools that can help people with obesity live healthier lives. But we’re not using them because we have health systems that are tuned for treating the diabetes, heart disease, liver disease, arthritis, and many other conditions that come when you neglect obesity care.

Does Medicare care about preventing diabetes? Actions speak louder than words. And the actions say no.

Click here for the report in Politico. For more on the reach of diabetes prevention programs in the U.S., this study in JAMA Network Open has comprehensive data.

LBJ Signs Medicare into Law, photograph by the White House Press Office / Wikimedia Commons

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October 23, 2019