Medicare Diabetes Prevention Program May Cost More than Projected Payments

A diabetes prevention program may cost some healthcare providers more than what they will see in reimbursements, a recent analysis found. 

The Medicare Diabetes Prevention Program (MDPP) is a 12-month intervention program aimed at adults with an indication for prediabetes. The first six months include intensive “core” sessions in a classroom setting that educate and train attendees on long-term dietary change, increased physical activity, and behavior change strategies for weight control. The last six months include monthly follow-up meetings. The primary goal is 5% weight loss. All MDPP beneficiaries are eligible for the core services program. Those who meet the weight loss and attendance goals are eligible for an additional year of maintenance sessions.

For the financial analysis of MDPP, researchers enrolled a diverse population sample in the National Diabetes Prevention Program (NDPP) from 2013 to 2017.  

Out of 1,165 total enrollees, 213 (18.3%) were Medicare beneficiaries, who were 40.6% Hispanic, 31.6% non-Hispanic black, and 26.9% non-Hispanic white; 69.5% were low-income. Researchers calculated that beneficiary performance would yield an average $138.52 reimbursement. Program delivery costs were $800 per participant, suggesting an estimated $661 gap per beneficiary. 

The findings were published online and will appear in the November issue of Medical Care. 

Nearly half of seniors (48.3%) have prediabetes, according to the study, but the financial gap may turn suppliers away from the program, ultimately increasing health disparities, the researchers say. 

“Health disparities may also widen as suppliers serving diverse and low-income populations will likely receive especially low payments, threatening access,” they wrote. 

But money saved on reducing the prevalence of diabetes nationwide may offset that cost, according to the researchers: “Promising return-on-investment results support the actuarial establishment of increased payments for MDPP suppliers. Specifically, a recent report calculated an average reduction in Medicare Part A and B expenditures of $278 per quarter, or $1112 per member per year, over the 3 years following NDPP enrollment relative to a comparison group of beneficiaries. Thus, … our full cost of $800 per participant would be recouped within a year with savings of $312 and additional savings in the following 2 years, for a cumulative return on investment of 2.96.” 

Ultimately, the authors concluded, “Our findings suggest that CMS will need to refine the MDPP performance payment methodology to ensure benefit access and sustainability, as well as reduce diabetes-related health disparities. 

A 12-Month Lifestyle Intervention Program Improves Body Composition and Reduces the Prevalence of Prediabetes in Obese Patients 

Health Care in a Multi-Payer System: Spillovers of Health Care Service Demand among Adults under 65 on Utilization and Outcomes in Medicare 

Osteoporosis-related Fractures Pose Significant Financial Burden on Medicare Beneficiaries 

Sources: CMS: Medicare Diabetes Prevention Program Supplier Enrollment; Medicare Diabetes Prevention Program (MDPP) Expanded ModelMedical Care