November: College football, falling temperatures and leaves, my mother’s birthday, Thanksgiving, holiday shopping, American Diabetes Month.
Diabetes affects nearly 30 million Americans, among them my mother-in-law, my cousin’s tween-age daughter, and NASCAR Driver Ryan Reed. Throughout American Diabetes Month, the American Diabetes Association has engaged in a variety of activities to generate greater attention to – and understanding of – the disease and what we, as a nation, need to do to improve prevention, care, and treatment.
What’s at stake?
According to the most recent estimates released by the Centers for Disease Control and Prevention (CDC), diabetes is the seventh leading cause of death and can lead to serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. The 2012 annual cost of diabetes and undiagnosed diabetes, gestational diabetes, and prediabetes was $322 billion, a 48 percent increase in just five years.
Of significant concern to individuals, families, communities, and the nation is the stark reality that nearly 26 percent of Americans age 65 and older have diabetes and an additional 400,000 individuals in the Medicare population are diagnosed each year. Compounding these challenges is that the CDC reports 86 million Americans – one out of every four people – have prediabetes and are at high-risk for the disease (http://www.cdc.gov/features/diabetesfactsheet). Ninety percent of individuals with prediabetes don’t know they are at risk. Among Americans age 65 and older, 50 percent have pre-diabetes and are at-risk for developing type 2 diabetes. One out of three Medicare dollars is spent on diabetes.
What are the solutions?
Despite these grim statistics – there is hope. The CDC’s National Diabetes Prevention Program (National DPP) has demonstrated success in effectively delivering lifestyle interventions (e.g., healthier eating habits, daily physical activity) to at-risk individuals that prevent the development of type 2 diabetes. United Healthcare provides coverage for the National DPP to all its enrollees and reports it saves four dollars for every dollar invested in the program. In a clinical trial on which the National DPP is based, participants over the age of 60 reduced their risk for type 2 diabetes by 71 percent.
Given the especially positive results in seniors, the success experienced in the commercially insured population, and the burden this disease places on individuals, families, our health care system, and the Medicare budget, the natural next step would be to expand access to this program to those in the Medicare program. Senator Al Franken (D-MN), Senator Susan Collins (R-ME), Representative Susan Davis (D-CA) and Representative Peter King (R-NY) agree. They have introduced the Medicare Diabetes Prevention Act (MDPA, S. 1131/H.R. 2102) a bipartisan measure that could greatly improve the health outcomes and reduce the incidence of diabetes among our nation’s seniors.
Diabetes is preventable and expensive, particularly among the nation’s seniors. The MDPA tackles both of these challenges at once: prevents the disease and saves the federal government money. Specifically, the MDPA directs the Secretary of Health and Human Services to develop criteria for a diabetes prevention program that is aligned with the National DPP standards and provides Medicare coverage for programs that meet the requirements. Seniors that participate in the program would not be subject to a copayment, eliminating a potential barrier to participation. In addition to helping prevent diabetes among Medicare beneficiaries at-risk, an analysis of the bill found that it would save the federal government $1.3 billion over 10 years.
With so many intractable problems lacking clear solutions, the Congress has the opportunity to hit the policy trifecta with the MDPA: bipartisan, evidence-based, and cost-saving. Indeed, if enacted, the MDPA will help decrease the number of Medicare beneficiaries at high risk of developing diabetes, improving quality of life and preserving resources for the nation’s seniors.
Ilisa Halpern Paul is President of the District Policy Group, a boutique health policy and government relations consulting practice within Drinker Biddle & Reath, LLP. The views expressed are the author’s own. Jerrica Mathis contributed to this column.