Sometimes even doctors need help with their health care.
North Carolina pulmonologist Don Graham knew more about diabetes than most people, but that didn’t prevent him from getting prediabetes. A busy job and poor diet led to him to gain weight—putting him on the path to diabetes.
Graham’s success is no accident but the result of scientific research and a structured regimen pioneered by the Centers for Disease Control (CDC). The CDC’s National Diabetes Prevention Program, now offered by more than 530 organizations nationwide, is part of efforts aimed at battling the growing incidence of diabetes through an increased focus on prevention. By focusing on prevention over treatment, programs such as these hit the sweet spot in health care policy: They not only improve the patient experience by keeping patients healthier (thereby requiring less care), they also help cut waste in health care by removing one of its prime drivers – obstacles to quality patient care.
Combating diabetes is an increasingly urgent priority. The number of people diagnosed with diabetes doubled between 1990 and 2005, and an estimated 107,000 Medicare beneficiaries will develop diabetes next year. Among younger Americans, 40 percent of Americans born between 2000 and 2011 will develop diabetes. In addition, roughly 33 percent of adults in the U.S. have prediabetes, and the vast majority (more than 90 percent) of those individuals are unaware of their condition.
The cost of diabetes is moreover staggering – an estimated $245 billion in 2012. One of every 10 health care dollars spent in the United States goes to diabetes treatment, and for adult diabetics, overall medical costs are more than twice as high as those without it. Costs also tend to increase with time as complications develop.
Effective diabetes prevention programs, however, have the potential to reverse these trends.
One hallmark of the CDC’s approach is its reliance on scientific rigor. In developing the National Diabetes Prevention Program, the CDC used the highest scientific standard: randomized controlled trials. The CDC found that if people with prediabetes lose 5 percent to 7 percent of their body weight and exercise moderately, they can reduce their risk of developing diabetes by up to 58 percent. Among people over 60, the decline is 71 percent. Weight loss helps reduce blood pressure and allows the body to use insulin more effectively.
The program also relies on community organizations like the Y-USA (formerly called the YMCA) to reach patients. The typical program is year-long and includes an initial 16 weekly small-group sessions, followed by monthly maintenance sessions led by a trained coach. These programs provide motivational support to keep patients on track with healthy eating, exercise, and behavior modifications. Large insurers and large employers ranging from UnitedHealth Group to Winn-Dixie are now covering the cost of diabetes prevention.
Another critical component of effective diabetes prevention is quality reporting by health plans. By reporting on health plans’ success, Medicare’s “star ratings” put pressure on plans to encourage screenings and referrals to prevention programs. Such reporting is already in place for other preventive measures such as breast cancer screenings, colorectal cancer screenings, and flu immunizations.
The promise of prevention is why Senators Al Franken (D-MN) and Susan Collins (R-ME) introduced the bipartisan Medicare Diabetes Prevention Act of 2013 (S.452). Their legislation would provide Medicare coverage for preventive services that identify people at risk for developing diabetes and then provide them with referrals to the CDC’s National Diabetes Prevention Program. The House version of this bill was introduced by Rep. Susan Davis (D-CA), which also had bipartisan support.
According to an analysis by Avalere Health for Third Way, Medicare coverage for the Diabetes Prevention Program and quality reporting would save Medicare $5.6 billion over 10 years, thanks to reduced costs of treating diabetes and its complications. Within two years, moreover, these cost savings would more than pay for the cost of diabetes prevention programs. This result is remarkable for a prevention program because they generally save lives, not necessarily dollars.
And while a few skeptics question whether the savings will materialize, the Congressional Budget Office could easily put that issue to rest if it agrees with existing studies showing budgetary savings.
By encouraging the trend toward prevention, such as by enacting the Diabetes Prevention Act, Congress would not only prevent diabetes, but also blaze a new path on health policy.
The result would be good news not just for patients like Don Graham, but for millions of Americans.
David Kendall is senior fellow for health and fiscal policy at Third Way.