By Judith Graham
APRIL 19, 2018
Several
weeks ago, Medicare launched an initiative to prevent seniors and people with
serious disabilities from developing Type 2 diabetes, one of the most common
and costly medical conditions in the U.S.
But the
April 1 rollout of the Medicare Diabetes Prevention Program, a major new
benefit that could help millions of people, is getting off to a rocky start,
according to interviews with nearly a dozen experts.
In all
but a few locations, experts said, Medicare’s new prevention program — a
yearlong series of classes about healthy eating, physical activity and
behavioral change for people at high risk of developing diabetes — isn’t up and
running yet. And there’s no easy way (no phone number or website) to learn
where it’s available.
A
Medicare spokesman declined to indicate where the diabetes program is currently
available, saying only that officials had approved three providers to date.
In a
first for Medicare, community organizations such as YMCAs and senior centers
will run the program, not doctors and hospitals. But many sites are struggling
with Medicare’s contracting requirements and are hesitant to assume demanding
administrative responsibilities, said Brenda Schmidt, acting president of the
Council for Diabetes Prevention and chief executive officer of Solera Health, a
company that assembles provider networks.
Medicare
Advantage plans, an alternative to traditional Medicare run by private
insurance companies, are now required to offer the Medicare Diabetes Prevention
Program to millions of eligible members. But they aren’t doing active outreach
because there are so few program sites available.
It’s
“too early” to discuss how Medicare Advantage plans will handle implementation
given uncertainty about the program’s accessibility, Cathryn Donaldson,
director of communications for America’s Health Insurance Plans, said in an
email.
Supporters
urge patience. While Medicare’s embrace of diabetes prevention is
“transformational,” building an infrastructure of community organizations to
deliver these services “hasn’t been done before. It’s going to take time,” said
Ann Albright, director of the Division of Diabetes Translation at the U.S.
Centers for Disease Control and Prevention.
In a
written comment, a spokesman for the Centers for Medicare & Medicaid
Services said about 50 of more than 400 eligible programs are in the process of
submitting applications. An online resource identifying approved programs is
under development, and outreach to people with Medicare coverage is “planned
for the coming months,” the statement said.
For
those who want more timely information, here’s a look at the Medicare Diabetes
Prevention Program and why it’s worth waiting for, even if takes awhile for a
program to become available near you.
Diabetes
and older adults. According to the CDC, at least 23 million people
age 65 and older have “prediabetes” — elevated blood sugar levels that put them
at heightened risk of developing Type 2 diabetes.
In five
years, without intervention, up to one-third of this group will develop Type 2
diabetes — a leading cause of blindness, amputation and kidney disease in older
adults, associated with a heightened risk of heart disease, stroke and
dementia.
Program
eligibility. The Medicare Diabetes Prevention Program is available to older
adults and people with serious disabilities with Medicare Part B coverage who
have prediabetes — and it’s free for those who qualify.
Once
the program becomes available in your area, your doctor can refer you or you
can sign up on your own, so long as you have a body mass index of at least 25
(or a BMI of 23, if you’re Asian), you haven’t been previously diagnosed with
diabetes, and your blood sugar levels are consistent with prediabetes.
This
benefit is available only once to each qualified Medicare beneficiary, so it
behooves you to make sure you’re ready for the commitment it entails.
“The
purpose of this should be to improve your health and quality of life, long
term, not to lose vanity pounds,” said Marlayna Bollinger, executive director
of San Diego’s Skinny Gene Project, which works with people at risk of
developing diabetes.
Evidence
of effectiveness. Medicare is tweaking the National Diabetes Prevention Program, launched
by the CDC in 2010. In a much-cited 2002 study published in the New
England Journal of Medicine, researchers found that participants in an early
version of the CDC program were 58 percent less likely to develop diabetes than
a placebo group. For people 60 and older, the reduced risk of developing
diabetes was even more striking — 71 percent.
James
Combs, 66, weighed 273 pounds when he enrolled in a program offered by Baptist
Health in Lexington, Ky., in January 2016. Today, he weighs 210 pounds, no
longer takes medication for high blood pressure, and reported “feeling
fantastic.” (Combs enrolled before becoming eligible for Medicare, and his
private insurance paid for the program.)
Medicare’s
model. Small groups of
about eight to 20 people meet weekly, for about an hour, 16 times over a
six-month period, then once or twice a month for the next six months.
Nutritionists, diabetes educators or other coaches use a structured
CDC-approved curriculum and foster group discussion and problem-solving.
Participants
check their weight at each session and keep daily logs of what they’re eating
and their physical activity. The goal is to have participants lose at least 5
percent of their body weight and get 150 minutes of physical activity weekly.
“The
objectives are very realistic and that increases the likelihood of success,”
said Kathleen Stanley, Baptist Health’s coordinator for diabetes education and
prevention.
A
four-year pilot program involving nearly 8,000 seniors in 315 locations,
sponsored by Medicare and coordinated by YMCA of the USA, found that savings
were significant: an estimated $2,650 over the course of 15 months for each
participant.
Medicare
has also added a second year of monthly sessions, designed to reinforce lessons
learned in the first year, for people who meet weight loss targets and
regularly attend classes. (Those who don’t aren’t allowed to attend these
sessions.)
Medicare
will pay up to $670 per participant for the two-year period if programs meet
performance standards relating to weight loss and attendance. If not, payments
are lower.
For the
moment, Medicare doesn’t plan to work with companies such as Omada
Health Inc. or Canary Health that
offer online versions of CDC’s Diabetes Prevention Program. But advocacy groups
are pressing for this alternative to in-person classes.
“Virtual
delivery of the diabetes prevention program would be a great option,
particularly for seniors in underserved areas,” said Meghan Riley, vice
president of federal government affairs for the American Diabetes Association.
Next
steps. YMCA of the USA is among several organizations that plan
to participate in the Medicare Diabetes Prevention program but are adopting a
cautious approach.
“We’re
still digging through Medicare rules and regulations and trying to make sure we
understand the implications,” said Heather Hodge, the Y’s senior director of
evidence-based health interventions.
She
said 25 of the Y’s 840 associations were in the process of applying for
Medicare certification and that as many as 50 might be offering the Medicare
Diabetes Prevention Program by the end of the year. (Each Y association
encompasses multiple locations.)
Albright
said the CDC was asking state health departments and 10 national organizations,
including the American Diabetes Association, the National Alliance for Hispanic
Health and Black Women’s Health Imperative, to promote the new Medicare
benefit. Once Medicare publishes a list of programs that its officials have
approved, CDC will highlight this online, she said.
Angela
Forfia, senior manager of prevention at the American Association of Diabetes
Educators, suggested that older adults contact their local Area Agency on
Aging, local health departments and senior centers in their area and express
interest in the Medicare Diabetes Prevention Program.
“If
Medicare recipients start to demand and ask for this, you’ll have more
organizations step up and sign on to become Medicare suppliers,” she suggested.
Meanwhile,
seniors might want to learn if they have prediabetes. (About 9 out of 10 people
who do don’t know it.) “Take our risk test and see
where you stand,” Albright advised (available at www.doihaveprediabetes.org). “It’s a good
conversation starter with your health care professional, who may want to follow
up by ordering a blood test.”
KHN’s coverage of these topics is supported by Laura and John Arnold Foundationand Gordon and Betty Moore Foundation
Judith Graham: @judith_graham
No comments:
Post a Comment