Medicare Pays for Prevention – Finally!

man-in-wheelchairThe Centers for Medicare & Medicare Services has announced Medicare (that is, taxpayers) will pay for lifestyle-intervention program that prevents type 2 diabetes:

In 2011, through funding provided by the Affordable Care Act, CMS awarded the National Council of Young Men’s Christian Associations of the United States of America (Y-USA) more than $11.8 million to enroll eligible Medicare beneficiaries at high risk for diabetes in a program that could decrease their risk for developing serious diabetes-related illnesses. Beneficiaries in the program attended weekly meetings with a lifestyle coach who trained participants in strategies for long-term dietary change, increased physical activity, and behavior changes to control their weight and decrease their risk of type 2 diabetes. After the initial weekly training sessions, participants could attend monthly follow-up meetings to help maintain healthy behaviors. The main goal of the program was to improve participants’ health through improved nutrition and physical activity, targeting at least a five percent weight loss for each individual.

The results of the Diabetes Prevention Program model are striking:

  • Medicare beneficiaries enrolled in the program lost about five percent of their body weight, which is enough to substantially reduce the risk of future diabetes. Average weight loss was 4.73 percent of body weight for participants attending at least four weekly sessions.  Participants who attended at least nine weekly sessions lost an average of 5.17 percent of their body weight.
  • Over 80 percent of participants recruited attended at least four weekly sessions.
  • When compared with similar beneficiaries not it the program, Medicare estimated savings of $2,650 for each enrollee in the Diabetes Prevention Program over a 15-month period, more than enough to cover the cost of the program.

After years and years of jawboning about preventing disease and reducing health spending by catching health problems early, the federal government has finally approved one intervention that actually appears to achieve this goal!

Reviewing the research summary, it looks like 15 months of lifestyle intervention cost about $495. Gross savings of $2,650 indicates a very impressive payback of $2,155 over 15 months, or $1,740 per year.

So, why did it take so long? Indeed, a previous clinical trial of a diabetes prevention program was conducted from 1996 through 2001. The review of literature on that trial indicates diabetes incidence dropped by 58 percent.  Yet, Medicare took fifteen more years to decide to cover the treatment. (The effect of lifestyle intervention persists. After 15 years, the incidence of diabetes in the intervention group was still 27 percent lower than in the control group.)

Despite all the rhetoric, government control of health spending generally appears to achieve the opposite of this desirable outcome: It increases acute spending after diseases are full blown. For example, increased enrollment in Medicaid is associated with more visits to emergency departments, as patients have limited access to primary care.

The diabetes prevention program appears to be the exception that proves the rule. Here are a couple of reasons that might explain the phenomenon. First, to lobby the government effectively for health spending, you have to have either an innovative technology or a lot of employees (like hospitals do). The “Y” has neither. Second, the government’s budget planning is very short term, prioritized by the interests of lobbyists who want their paybacks immediately. A health prevention program that will benefit patients and taxpayers over the long term does not present adequate incentives for politicians to fund.

I wonder if we will see Medicare pay for many more low-tech, cost-effective interventions in the future.

Comments (11)

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  1. Ron Greiner says:

    Do you really think the YMCA saved Medicare $2,650 a year on each of 5,000 males who attended a once a month YMCA meeting?

    FINALLY, today the media is talking about how the 35 million uninsured can purchase health insurance outside of Obamacare’s Open Enrollment. No one cares about the uninsured in America and this information is not being shared by the non-profit think tanks, the media or any politicians.

    CBS News – ​Priced out of Obamacare, some opt for short-term plans

    –The reason behind the surge in demand for these health care products comes down to one word: cost. The average monthly premium for a family of three on a short-term plan is about $283, or about $500 less per month than coverage through a major medical plan,–

    Health insurance for 1/3 of the Obamacare price!!! Of course they lie and say that the consumer will owe IRS fines but the story says – WHO CARES – the savings is much grater than the IRS fine.

    John, you should lead a revolt and let the uninformed public know that there are alternatives to Obamacare. If the word got out people would switch to STM and Obamacare would die quicker. Do it for FREEDOM and the American way John. (By the way, my STM covers Rx)

    • I believe the evidence-based research conducted independently and published.

      • Ron Greiner says:

        Maybe the YMCA did the research.

        I don’t believe the weight loss with a once a month meeting either. But then again I ran 6 Richard Simmons Anatomy Asylums with 30,000 members, mostly female.

        Once a month meetings and the Medicare program saves thousands per year per person, right.

        Evidence-based – I’m sure!

  2. Allan (formally Al), but due to the lefts propensity to disrespectfully and disruptively alter facts I will now refer to myself as Allan and the former Al Baun can keep his newest name. says:

    John, this could have been done by private Internists years ago, but Medicare prevented it with all the red tape. They are so interested in preventing the Internist from earning an extra dollar that they let millions flow through their fingers. If Medicare did’t exist in the fashion it does many of these so called “disease management” ideas would be functioning yesterday in private offices at low cost. Though Medicare helps the elderly get good medical care it also causes road blocks when it comes to care that doesn’t meet Medicare’s specifications. Innovation is lost.

  3. Barry Carol says:

    It hardly takes a college degree to recognize that if your goal is to lose weight, you should eat less in terms of calorie count and exercise more. You don’t need a paid expert to teach you that. Also, most people know that smoking is bad for your health as warning labels have appeared on cigarette packs since 1964. We’re already seeing a secular change toward less consumption of soda and more consumption of bottled water instead. People moved in that direction on their own and that’s a good thing though who knows how long it will take to show up in better health.

    Obesity in America was something like half the current level back in the 1980’s. I saw an eye opening chart a couple of years ago in a Philadelphia academic medical center that showed typical portion sizes of various foods then vs. now. Portion sizes are much higher now than they were then. There are also many thousands more fast food restaurants that sell generous portions of high calorie junk food at modest prices. When I was in high school in the early 1960’s, there was only one fast food restaurant that I was aware of in the entire county.

    One possible reason for the increase in portion sizes is to create a perception of value in response to higher menu prices which, in turn, reflected increases in the minimum wage among other things. As politicians push to raise the minimum wage to $15 an hour and recognizing that actual food and drinks only account for about one third of revenue for the typical restaurant, there could be an unintended consequence of increasing portion sizes further as menu prices rise while inviting customers to take leftovers home to consume later.

    Various doctors have recommended for decades that I include more fiber in my diet. While I know their recommendation makes perfect sense and would probably be helpful if I did it, I just don’t like most fruits and vegetables and wouldn’t eat many of them even if you paid me. Ah, life is complicated.

  4. Ron Greiner says:

    Barry, Richard Simmons says – NEVER say diet. If you were exercising properly you could shove any type of food in your mouth and be healthy.

    I hope you are exercising properly.

  5. Jimbino says:

    a program that could decrease their risk for developing serious diabetes-related illnesses.

    In proper English, one says, “at risk of diabetes,” “a 20% chance of rain,” “a low probability of success.” The construction “at risk for …,” common as it is, is erroneous and needs to be nipped in the bud.

  6. Ron Greiner says:

    News About Obamacare Has Been Bad Lately. How Bad?

    New York Times 04/13/2016

    “Should we be worried about a health insurance apocalypse?”

    What does the NYT know that we don’t?

  7. PJohnson says:

    Good luck with “preventative medicine”. Other than vaccines I haven’t ever seen it work. Certainly not lifestyle changes – including weight reduction and exercise. A lofty goal. But a near impossibility or so rare it’s a headline. There has been one exception: converting smokers to e-cigarettes has many success stories. BUT the stigma of smoking – including vaping -is so great that rational thought is out the window.