Medicare Diabetes Prevention Program Gets Off To Slow StartKaiser Health News


Several weeks ago, Medicare launched an initiative to avoid seniors and individuals with serious disabilities from developing Type 2 diabetes, probably the most common and expensive medical conditions within the U.S.

But the April 1 rollout from the Medicare Diabetes Prevention Program, a significant new benefit that could help millions of people, gets off and away to a rocky start, based on interviews with nearly twelve experts.

In basically several locations, experts said, Medicare's new prevention program – a yearlong series of classes about eating healthily, exercise and behavioral change for people at high-risk of developing diabetes – isn't ready to go yet. And there's very difficult way (no phone number or website) to understand where it's available.

A Medicare spokesman declined to indicate where the diabetes program is currently available, saying that officials had approved three providers to date.

In an initial for Medicare, community organizations for example YMCAs and senior centers will run the program, not doctors and hospitals. But many sites are experiencing Medicare's contracting requirements and are hesitant to assume demanding administrative responsibilities, said Brenda Schmidt, acting president from the Council for Diabetes Prevention and ceo of Solera Health, a company that assembles provider networks.

Medicare Advantage plans, an alternative choice to traditional Medicare run by private insurance providers, are now necessary to provide the Medicare Diabetes Prevention Program to countless eligible members. But they aren't doing active outreach since there are very few program sites available.

It's “too early” to discuss how Medicare Advantage plans will handle implementation given uncertainty about the program's accessibility, Cathryn Donaldson, director of communications for America's Medical health insurance Plans, said within an email.

Supporters urge patience. While Medicare's embrace of diabetes prevention is “transformational,” building an infrastructure of community organizations to deliver these services “hasn't been done before. It's going to take time,” said Ann Albright, director of the Division of Diabetes Translation at the U.S. Centers for Disease Control and Prevention.

In an itemized comment, a spokesman for that Centers for Medicare & Medicaid Services said about 50 in excess of 400 eligible programs are in the process of submitting applications. A web-based resource identifying approved programs is under development, and outreach to people with Medicare coverage is “planned for the coming months,” the statement said.

For people who want more timely information, here's a look at the Medicare Diabetes Prevention Program and why it's worth awaiting, even if takes awhile for any program to become available in your area.

Diabetes and older adults. Based on the CDC, a minimum of 23 million people age 65 and older have “prediabetes” – elevated glucose levels that put them at heightened chance of developing Type 2 diabetes.

In 5 years, without intervention, as much as one-third of this group will develop Diabetes type 2 – a leading cause of blindness, amputation and kidney disease in older adults, associated with a heightened chance of heart disease, stroke and dementia.

Program eligibility. The Medicare Diabetes Prevention Program is available to older adults and people with serious disabilities with Medicare Medicare part b coverage who have prediabetes – and it is free for individuals who qualify.

When the program opens up in your town, your doctor can refer you or you can sign up on your personal, so long as you have a bmi with a minimum of 25 (or a BMI of 23, if you are Asian), you haven't been previously identified as having diabetes, and your blood sugar levels are consistent with prediabetes.

This benefit is available only once to each qualified Medicare beneficiary, so it behooves you to make sure you're ready for the commitment it requires.

“The reason for this should be to improve your health and quality of life, long-term, to not lose vanity pounds,” said Marlayna Bollinger, executive director of San Diego's Skinny Gene Project, which works with people vulnerable to developing diabetes.

Evidence of effectiveness. Medicare is tweaking the National Diabetes Prevention Program, launched by the CDC this year. Inside a much-cited 2002 study published within the Colonial Journal of Medicine, researchers discovered that participants within an early form of the CDC program were 58 percent not as likely to build up diabetes than the usual placebo group. For people 60 and older, the reduced risk of developing diabetes was even more striking – 71 percent.

James Combs, 66, weighed 273 pounds when he enrolled in a course provided by Baptist Health in Lexington, Ky., in January 2021. Today, he weighs 210 pounds, no longer takes medication for high blood pressure, and reported “feeling fantastic.” (Combs enrolled before becoming entitled to Medicare, and his private insurance paid for this program.)

Medicare's model. Small categories of about eight to 20 people meet weekly, for around an hour or so, 16 times on the six-month period, then a couple of times a month for the following six months. Nutritionists, diabetes educators or any other coaches make use of a structured CDC-approved curriculum and foster group discussion and problem-solving.

Participants check how much they weigh each and every session and keep daily logs of what they're eating and their exercise. The goal is to have participants lose at least Five percent of the body weight and obtain 150 minutes of physical activity weekly.

“The objectives are very realistic and that boosts the likelihood of success,” said Kathleen Stanley, Baptist Health's coordinator for diabetes education and prevention.

A four-year pilot program involving nearly 8,000 seniors in 315 locations, sponsored by Medicare and coordinated by YMCA of the USA, found that savings were significant: an estimated $2,650 during the period of 15 months for every participant.

Medicare has additionally added a second year of monthly sessions, designed to reinforce lessons learned in the newbie, for people who meet weight reduction targets and regularly attend classes. (Those who don't aren't permitted to attend these sessions.)

Medicare pays up to $670 per participant for that two-year period if programs meet performance standards relating to weight loss and attendance. If not, payments are lower.

For the moment, Medicare doesn't plan to work with companies for example Omada Health Inc. or Canary Health that provide online versions of CDC's Diabetes Prevention Program. But advocacy groups are pressing with this option to in-person classes.

“Virtual delivery of the diabetes prevention program would be a great option, particularly for seniors in underserved areas,” said Meghan Riley, v . p . of federal government affairs for that American Diabetes Association.

Next steps. YMCA of america is one kind of several organizations that intend to participate in the Medicare Diabetes Prevention program but are adopting a cautious approach.

“We're still digging through Medicare rules and regulations and seeking to make sure problems in later life the implications,” said Heather Hodge, the Y's senior director of evidence-based health interventions.

She said 25 of the Y's 840 associations were while applying for Medicare certification and that as many as 50 may be offering the Medicare Diabetes Prevention Program after the year. (Each Y association encompasses multiple locations.)

Albright said the CDC was asking state health departments and 10 national organizations, including the American Diabetes Association, the nation's Alliance for Hispanic Health insurance and Black Women's Health Imperative, to advertise the brand new Medicare benefit. Once Medicare publishes a summary of programs that it is officials have approved, CDC will highlight this online, she said.

Angela Forfia, senior manager of prevention at the American Association of Diabetes Educators, suggested that older adults contact their neighborhood Agency on Aging, local health departments and senior centers within their area and express curiosity about the Medicare Diabetes Prevention Program.

“If Medicare recipients start to demand and ask for this, you will have more organizations step up and sign on being Medicare suppliers,” she suggested.

Meanwhile, seniors might want to learn should they have prediabetes. (About 9 from 10 people who do don't know it.) “Take our risk make sure see where you stand,” Albright advised (available at “It's a good conversation starter with your health care professional, who may want to follow up when you purchase a blood test.”