Type 2 diabetes widely afflicts the U.S. adult population, with more than one-third of adults at risk. In addition to the impact on patients and families, diabetes imposes a substantial burden on Medicare. According to the Centers for Medicare & Medicaid Services (CMS), one in four Medicare patients has diabetes, and treating diabetes consumes one-third of Medicare spending.
More than 30 years of research shows that improving diet, exercising more, and losing weight can reduce the prevalence and incidence of Type 2 diabetes. But until now, few studies tied such lifestyle interventions to health care savings.
In 2012 CMS provided an $11.8 million award to the YMCA to test whether a specific education program could reduce diabetes prevalence and incidence and reduce the cost of care. The award allowed the YMCA to implement the Centers for Disease Control and Prevention’s National Diabetes Prevention Program (DPP) at more than 250 locations in 11 states.
An Educational Diet and Exercise Program Designed to Help Patients Lower the Risk of Becoming Diabetic
Individuals with pre-diabetes aged 65 and over were invited to participate in the YMCA program, which was intended to help participants lose 5 percent of their total body weight and to gradually increase their physical activity to 150 minutes per week. Prediabetics have blood sugar levels that are higher than normal, making them at higher risk for developing diabetes. The CDC reports that losing 5 to 7 percent of body weight reduces the risk that prediabetes will progress to diabetes by 58 percent.
More than 7,600 individuals enrolled in the Diabetes Prevention Program. Of those participants, about 60 percent were covered under fee-for-service Medicare, while the remainder were covered by Medicare Advantage.
The Diabetes Prevention Program consisted of one-hour educational and support sessions as well as coaching and group discussions to facilitate changes to diet and exercise. The program curriculum covered 16 areas, including eating healthy, increasing exercise, managing stress, and improving motivation. Following the core curriculum sessions, participants were welcome to attend maintenance sessions to help them continue their new lifestyle habits. Participants could attend up to 24 sessions over 12 months.
Tracking Program Impacts on Health Care Spending
The CMS Innovation Center engaged our experts to track the program and determine its impact on health care spending, hospital admissions, and unnecessary emergency room visits. Researchers reviewed the results of more than 3,300 Medicare beneficiaries enrolled in the program between February 2013 and December 2015.
We compared the results to Medicare beneficiaries who were at least 65 years old and had been diagnosed with prediabetes, but were not enrolled in the DPP program.
Our analysis of Medicare claims from January 2010 through December 2015 found that Medicare saved $278 per per program participant per quarter over the first three years of the program—chiefly because participants were less likely than nonparticipants to be admitted to the hospital or visit the emergency room. Program participants also lost an average of 9 pounds.
The study also found that cost savings were highest during the first year of participation and decreased after the program ended. Part of that initial savings was due to participants tending to lose the most weight during the first three to six months of the program.
Saving Lives and Reducing Health Care Expenditures
This groundbreaking study is among the first to show a direct link between lifestyle interventions and reduced health care spending. A substantial body of research has shown that interventions to help people lose weight decrease the likelihood of developing Type 2 diabetes. We now know that these programs can also lower health care costs.
As a result of this study, CMS is expanding the model and will begin testing the expanded model for Medicare beneficiaries in 2018.