The Medicare Greenlight--Lifestyle Interventions

By Xyla Joelle L. Fernandez

Dec 14, 2016 09:52 AM EST

The Medicare Diabetes Prevention Program (MDPP) model is a 12-month intervention provided by trained community health workers or health professionals in community and health care settings. For the first six months, the benefit covers at least 16 weekly, hour-long sessions. For the second six months, the benefit covers at least six monthly maintenance sessions. 

The goal of the program is to prevent the onset of type 2 diabetes among Medicare beneficiaries diagnosed with pre-diabetes by providing a structured behavioral change intervention to be covered as an additional preventive service with no Medicare cost sharing. The reimbursement structure for the MDPP has not yet been finalized, but CMS has reported that they plan to tie provider organization payments for MDPP services to the number of Diabetes Prevention Program sessions attended and the achievement and maintenance of minimum weight loss.

The new model was based on a pilot of a program developed by the YMCA. The YMCA received an $11 million CMS Health Care Innovation Award for two program components: hiring and training lifestyle coaches to deliver the program's curricula and implementing the MDPP among eligible participants. The MDPP curriculum was delivered over a 10 to 12 month period in groups of eight to 15 participants - followed by eight monthly maintenance sessions.

The curriculum includes 16 sessions that cover topics related to diet, exercise, and healthy lifestyle changes. The results showed a drop in costs by $2,650 per person - a cost reduction greater than the cost of the services. 

For specialty provider organizations, this is an opportunity to provide their current consumers with a new and much needed service - and more. Beyond those consumers, the market is large. An estimated 29.1 million people, or 9.3% of the U.S. population has diabetes. The estimated cost of diabetes treatment is $322 billion per year, with one of every three dollars being spent by Medicare.  It is also an opportunity to build a prototype for the new model of wellness programs, focused and tied to performance, that we are likely to see again soon.

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