Expanded Medicare diabetes prevention program rolls out

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The Centers for Medicare & Medicaid Services is in the fourth day of an innovative new diabetes prevention program that aims to save lives — and as much as $182 million over 10 years by linking with community partners.

Healthcare settings, including skilled nursing facilities, can also offer the program, which accepts Medicare beneficiaries with high body-mass indexes or other risk factors for developing diabetes.

Nutritionists and dietitians play an important role in the program, which can be offered in approved health care and community settings. Nutritionists expect the program will create a better continuum of care for diabetes and increase referrals for medical nutrition therapy. But CMS has also certified lifestyle coaches who work in non-clinical settings, many with little to no previous Medicare experience.

Under a pay-for-performance model, all providers will be reimbursed based on patient attendance and weight loss benchmarks.

The CDC created the National Diabetes Prevention Program based on the results of the Diabetes Prevention Program Randomized Control Trial. The Centers for Medicare and Medicaid Innovation conducted a DPP model test that demonstrated cost effective risk reduction when lay health workers delivered the CDC-approved curriculum in YMCAs. In a 15-month period, the pilot saved about $2,650 per person enrolled.

CMS ultimately decided not to offer an online version of the program, which started Sunday. This has left some concerned about access.

America's Health Insurance Plans called on CMS to expand it so that beneficiaries can participate in virtual settings. The American Diabetes Association says more than 50% of people on Medicare have pre-diabetes and has pressed states to cover the program through Medicaid, Inside Health Policy reported last week.