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Diabetes Prevention Program

In March, CMS announced its plan to expand the Diabetes Prevention Program following certification by the CMS Office of the Actuary that the program would decrease Medicare spending. Also released was an Independent Evaluation Report Summary on the results initially yielded by the program. CMS will spread the program from its pilot phase to the full Medicare program. Details on how to implement this expansion will be included in the 2017 Medicare Physician Fee Schedule Proposed Rule.

The program, supervised by the CMS Innovation Center, gave out over $11.8 million to the National Council of Young Men’s Christian Associations of the United States of America (Y-USA), as a way to gauge the Diabetes Prevention Program’s impact on Medicare beneficiaries. In the two-year period between 2013 and 2015, the Y-USA tied in with 17 local YMCAs across eight states, the Diabetes Prevention and Control Alliance, and seven other national non-profit organizations. This was done to sign up close to 7,000 Medicare beneficiaries carrying a high risk of developing diabetes into the prevention program.

The program aims to assist participants shed at least five percent of their bodyweight and slowly boost physical activity to 150 minutes a week. Each participant is given 16 weekly sessions along with additional eight monthly maintenance sessions stretching to cover 24 one-hour sessions. The program and its expansion are specified in the certification report issued by CMS.

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The assessed results from the YMCA of the USA Diabetes Prevention Program proved that the first two years of the program were successful. By March 2015, 6,874 beneficiaries were signed on with 5,696 of them taking part in at least four sessions. Patients who signed up shed an average nine pounds during the monitored period, and the results also demonstrated a lower number of inpatient hospital admissions, as well as fewer emergency room visits.

Also shown by the pilot was that the program can generate average Medicare savings of $2,650 per enrollee over the first five quarters. Considering these financial results, as well as the successful health results from the program, CMS has decided that expanding the Diabetes Prevention Program can bring about more savings and thereby help prevent diabetes. The program is the first in a wave of preventative services, as laid out by the CMS’s Innovation Center into the Medicare program, for inclusion into the Medicare program.

According to projections by HHS, the program will help the 30 million Americans suffering from diabetes, as well as another 86 million at risk of contracting it.