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Keeping Weight Off Tied to CMS Payments Under Diabetes Prevention Plan for Seniors

July 12, 2016

The Centers for Medicare & Medicaid Services (CMS) recently unveiled a plan in which providers offering the National Diabetes Prevention Program (DPP) would require seniors to show up at sessions, lose weight, and keep it off to be fully reimbursed. The program will start January 1, 2018.

This announced plan follows the March 2016 announcement from the US Department of Health and Human Services that Medicare would soon pay providers to offer the DPP. The CMS Innovation Center tested the program at 17 locations starting in 2012, before the CMS actuary certified the savings level this spring. Participants had an average weight loss of 5%, and those who attended the most sessions lost more.

The National DPP is a series of 16 weekly core sessions followed by monthly maintenance sessions. It is designed to get participants exercising at least 150 minutes per week in order to produce weight loss of 5% to 7%. The original program was delivered only in classroom environments, but the Centers for Disease Control and Prevention now recognizes digital formats.

The key features of the proposal include information for providers, payment disbursement and factors, and criteria for participation. CMS also seeks comment on fraud prevention and availability concerning the DPP.

Medicare has long been interested in the DPP because it spends $1 of every $3 on diabetes care; an estimated 50% of beneficiaries have prediabetes, so reducing the share that develop diabetes would save millions.

There had been speculation that CMS would try to get DPP running by early 2017, before the Obama administration ends. However, this proposal features several regulatory steps to ensure patient privacy, prevent fraud, and require payment based on results—all part of Medicare’s shift toward value-based reimbursement.

If payment for DPP starts on January 1, 2018, it will be 16 years after the publication of the National Institutes of Health study in the New England Journal of Medicine, which showed the program reduced the risk of diabetes 58% over 3 years. —Amanda Del Signore

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