By Surabhi Dangi-Garimella, Ph.D.
With more than 25% of Medicare beneficiaries over 65 years suffering from diabetes, the Centers for Medicare & Medicaid Services (CMS) deployed a Medicare Diabetes Prevention Program (MDPP) in 2018, with interventions that encourage behavioral changes within the prediabetes Medicare population. While the program saw participating beneficiaries achieve program goals, enrollment has been low and health service providers have been hesitant to join MDPP.
This pilot program is expected to test the hypothesis that by promoting healthy behavior changes, Medicare can prevent diabetes among its enrollees and reduce annual diabetes-related costs (estimated to be $42 billion in 2016).
The MDPP Program
The concept of MDPP is ideal—an expansion of the National Diabetes Prevention Program, which is a public-private partnership that was launched in 2010, the program promotes healthy eating and physical activity among prediabetics. The MDPP intervention includes a minimum of 16 sessions of a CDC-approved curriculum led by a lifestyle coach, with practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control. The core sessions are followed-up with monthly meetings to help participants stay on track. Services are rendered in community and healthcare settings.
Has MDPP Seen Success?
The results have been a mixed bag. Per the first performance report for MDPP (April 2018-December 2019) that was recently released by CMS, only 2,248 Medicare beneficiaries were enrolled in the program.
- On average, participants lost 5.1% of their starting weight, with maximum weight loss observed among those who were enrolled in the program for 7-9 months (6.3%)
- About half the participants met the 5% weight-loss goal
- 65-75% met the goal of 150 minutes of weekly physical activity
Data are currently limited to estimate utilization benefits of MDPP and it’s also very early to understand its impact on diabetes prevention. The bigger issue that the program faces is the limited number of participants and the lack of organizations willing to provide diabetes prevention services.
According to Kaiser Health News, organizations find that Medicare’s low reimbursement of $704 per participant over two years is inadequate. Additionally, billing rules are cumbersome, and organizations are not allowed to offer online classes (the COVID-19 pandemic was an exception). Consequently, private Medicare Advantage plans have not promoted this program among their beneficiaries.
CMS has now proposed a rule change to encourage participation and sustain the program:
- Shorten the MDPP service period to one year, eliminating the second year of follow-up
- How will this affect beneficiary outcomes?
- Waive the $599 provider enrollment Medicare application fee
- Increase performance payments to service providers based on beneficiaries achieving 5% weight loss and continuing to attend core interval sessions
- $635 if participant achieves 5% weight loss and attends 13 sessions over one year
- $661 if participant achieves 9% weight loss
- $335 if 5% weight loss is not achieved
However, the rule change has continued to ignore service providers’ requests to allow online counseling and classes. This could change with the passage of the Prevent Diabetes Act, which is designed to increase virtual access to MDPP for those living in rural, minority, and medically underserved locations.
Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brings her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.
