MedicalResearch.com Interview with:
Maria L. Alva, DPhil
Public Health Economics Program
701 13 Street, NW, Suite 750
Washington, DC 20005
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Diabetes affects more than 25 percent of Americans over 65. The estimated economic cost of diagnosed diabetes is $245 billion a year. In spite of this we have almost no evidence of the impact of programs geared to stave off the cost of diabetes.
The Y-USA received a Health Care Innovation Award of $11.8 million from the Centers for Medicare & Medicaid Services to offer a diabetes prevention program to individuals 65 and over with prediabetes. The goal of the Y-USA model is to get participants to lose 5 percent or more of their body weight and gradually increase their physical activity to 150 minutes per week. The program lasts a year. The curriculum comprises sixteen weekly core sessions about healthy eating, exercise and motivation followed by eight monthly maintenance sessions.
Epidemiological data from other studies have shown that the risk of diabetes increases with increased levels of BMI. There is mounting evidence that it is possible to prevent or delay diabetes through life-style intervention. It is unclear, however, whether weight-loss interventions can yield reductions in medical spending.
The objective of our analysis was to establish whether the -USA Diabetes Prevention Program reduces health care spending and utilization among fee-for-service Medicare beneficiaries.
MedicalResearch.com: What are the main findings?
Response: We found that the participation in the program was associated with lower Medicare spending and that savings were highest in the first year ($364 per person per quarter). The impact of the program decreased after that. We find that the overall weighted average savings per member per quarter during the first three years of the intervention period was $278. Total decreases in inpatient admissions and emergency department visits were also significant over 3 years, with nine fewer inpatient stays and nine fewer ED visits per 1,000 participants per quarter. This program shows both statistically significant and economically relevant savings.
MedicalResearch.com: What should readers take away from your report?
Response: Readers should take away from this report two things.
First, results from the first 2 years of this evaluation informed CMS policy that Medicare will include diabetes prevention programs as a covered benefit in 2018. Historically, there has been a tendency not to reimburse patients for preventive services either because most of the evidence available came from small observational studies or because savings were assumed to only accrue in the long run; and when consumers are able to shop around, insurance companies are unable to lock customers into longer contracts and to internalize those savings.
Our study shows that the biggest benefits happen within a year of participation, that is when participants are actively engaged in the program. This could be a strong argument for insurance companies to reimburse for preventive programs like this, provided the results we find in the Medicare FFS population are generalizable to other populations. We were able to collect data on 3,319 FFS Medicare beneficiaries enrolled in over 200 different YMCAs and to follow participants medical spending and utilization for up to 3 years. This study was therefore both big in size and had good follow up.
Second, participants were a relatively healthy group of individuals (despite having pre-diabetes). Their spending was roughly $1,400 per quarter pre-innovation which is much lower than the spending of the average Medicare beneficiary. Our comparison group was designed to have the same low spending rates pre-innovation. We performed a sub-analysis for a subset of healthier individuals, which showed slightly larger savings, compared to those for the full sample. It is therefore possible that those who are relatively better off might be able to benefit more from prevention programs than individuals with an already high level of medical utilization.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: There should be a trend for increasing grant funding levels that could support more ambitious demonstrations for prevention interventions, especially outside the clinical setting. Also, we did not analyze Medicare part D data, the prescription drug benefit part of Medicare so we are unable to say whether the diabetes prevention program reduces spending on drugs or not. These type of direct cost benefit analyses have to be made to inform policymakers on how best to allocate taxpayer dollars.
MedicalResearch.com: Is there anything else you would like to add?
Response: These opinions are solely those of the authors and do not necessarily reflect the opinions of RTI or CMS.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
doi: 10.1377/hlthaff.2016.1307Health Aff March 2017 vol. 36 no. 3417-424
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