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CMS expanding Medicare Diabetes Prevention Program

CMS is also proposing to simplify the current performance-based payment structure for MDPP.

Jeff Lagasse, Associate Editor

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The Centers for Medicare and Medicaid Services is proposing to extend the rule allowing all suppliers under the Medicare Diabetes Prevention Program (MDPP) to use specific MDPP COVID-19 Public Health Emergency flexibilities, including the optional virtual delivery of the MDPP set of services through distance learning.

CMS is also proposing to simplify the current performance-based payment structure for MDPP by allowing fee-for-service payments for beneficiary attendance, while keeping the payments for beneficiary weight loss.

Type 2 diabetes affects more than a quarter of Americans aged 65 and older and costs billions to treat each year – numbers that will continue to rise without intervention, according to CMS.

The Medicare Diabetes Prevention Program (MDPP) Expanded Model aims to slow this trend by preventing the onset of Type 2 diabetes for people with prediabetes. More specifically, MDPP is a year-long group-based program that provides training and education in a bid to empower patients to manage their health.


CMS estimates that Medicare spent $42 billion more just in 2016 on beneficiaries with diabetes than it would have spent if those beneficiaries did not have diabetes; per beneficiary, Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes.

Fortunately, type 2 diabetes can usually be delayed or prevented with health behavior changes. CMS touts the Medicare Diabetes Prevention Program expanded model as a structured behavior change intervention that aims to prevent the onset of Type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. This model is an expansion of the Diabetes Prevention Program (DPP) model test, which was tested through the Center for Medicare and Medicaid Innovation's Health Care Innovation Awards.

The MDPP's clinical intervention consists of a minimum of 16 intensive "core" sessions of a Centers for Disease Control and Prevention (CDC) approved curriculum furnished over six months in a group-based, classroom-style setting that provides training in long-term dietary change, increased physical activity, and behavior change strategies for weight control.

After completing the core sessions, less intensive follow-up meetings furnished monthly help ensure that the participants maintain healthy behaviors, CMS said. The primary goal of the expanded model is at least 5% weight loss by participants.

The National DPP is based on the results of the Diabetes Prevention Program study funded by the National Institutes of Health. The study found that lifestyle changes resulting in modest weight loss sharply reduced the development of Type 2 diabetes in people at high risk for the disease.


Medicare Advantage patients fare better on diabetes outcomes than their counterparts in traditional fee-for-service Medicare, according to study findings published in February.

This has implications for older Americans especially, since data from the Centers for Medicare and Medicaid Services indicates that nearly one third of people aged 65 and older have Type 2 diabetes – a chronic condition that significantly worsens health status. With half of those eligible now enrolled in a Medicare Advantage plan, policymakers are focused on assessing the clinical impact of the MA model on such diseases.

The spending on care for diabetes is significant at over $240 billion annually, with the Medicare program responsible for nearly 60% of that spending, according to the American Diabetes Association. And patients with diabetes typically have greater healthcare needs and higher spending leading up to their diagnoses.

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