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Burwell Announces Expansion of Diabetes Prevention Program

By Andrew Siddons, CQ Roll Call

March 23, 2016 -- The Department of Health and Human Services (HHS) on Wednesday announced that it would expand coverage of a diabetes prevention program to all Medicare beneficiaries, potentially saving billions of dollars in health care spending.

The current $11.8 million pilot program administered by local YMCAs enrolls eligible beneficiaries in weekly meetings that teach participants about healthy diets, physical activity, and other lifestyle changes that can decrease the risk of developing diabetes in adulthood.

"Treating this disease isn't just a burden on families. It costs our nation $176 billion in direct medical costs every year," HHS Secretary Sylvia Mathews Burwell said at the YMCA Anthony Bowen in Northwest Washington.

According to HHS, participants in the program lost 5 percent of their body weight, and Medicare estimates that the savings is $2,650 per enrollee over a 15-month period. The Office of the Actuary in the Centers for Medicare and Medicaid Services (CMS) has officially certified that expansion of this program would reduce net Medicare spending. It is the first prevention program to earn this certification from CMS, setting the stage for expansion to all Medicare beneficiaries that would occur after a rulemaking process by CMS later this summer, Burwell said.

About 30 million Americans have type 2 adult-onset diabetes. Another 86 million with a condition known as prediabetes, where blood glucose levels are higher than normal but not yet at diabetic levels, are at risk of developing the disease, according to HHS.

The pilot program was started in 2011 with funding from the previous year's health care overhaul, and so far has had nearly 8,000 participants in 45 states. The YMCA estimates that attendees, who are mostly aged 45 to 64, average more than 2.5 hours of physical activity per week.

Burwell hopes the expansion of Medicare coverage to include more health and wellness programs aimed at preventing diabetes will encourage more employers and private insurers to do the same. She said she believed it would be an attractive proposition for many private companies.

"Many companies are already leading in this space," she said. "You see that both in terms of CEOs who are taking steps in their own companies to boost wellness and prevention efforts, [and] we also see it terms of some of the insurers that are taking steps."

The announcement coincided with the sixth anniversary of the health care overhaul being signed into law, which Burwell described as a historic achievement. She said that Wednesday's announcement built on the administration's efforts to focus health care on prevention.

"If we can invest in prevention of diabetes before it develops, we can improve people's health, their quality of life, and save money," she said.

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