Innovation in Medicare Reimbursements Could Signify Move Towards Prioritizing Preventive Health

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By Steven Chan


Recently, the Department of Health and Human Services announced a game-changing innovation in Medicare policy, reimbursing a prevention program.  The Diabetes Prevention Program (DPP), run by the YMCA, has been certified by the Office of the Actuary for the Centers for Medicare & Medicaid Services (CMS) to be cost-effective in achieving better health outcomes and quality of patient care while reducing spending for the medical system. CMS is exploring ways to integrate DPP into Medicare, which could start private insurers on path to do the same. Allowing Medicare reimbursements for a prevention program marks a true “milestone for prevention and America’s health,” says HHS Secretary Sylvia M. Burwell. As health insurers move away from a fee-for-service, reimbursing prevention programs provides new avenues for insurance providers to promote general health and well-being for their customers, and keep control of their bottom line.

The YMCA program was studied through a federal grant under the Affordable Care Act, so it is also a significant win for the Obama administration.  The program includes weekly coaching sessions on behavior change strategies to increase physical activity and maintain a healthy, balanced diet. To help participants stay on track, the lifestyle coaches provide monthly maintenance sessions. While most participants lost weight, the health effects increased the more sessions a person attenend. When compared with similar Medicare beneficiaries not enrolled in the program, estimated Medicare savings over the 15-month period amounted to $2,650 per enrollee. Despite the short evaluation period, the health outcomes and cost savings have been very promising and warrant further consideration for its potential long-term benefits.

HHS Secretary Burwell captured the importance of this innovation by proposing how “this program has been shown to reduce health care costs and help prevent diabetes, and is one that Medicare, employers and private insurers can use to help 86 million Americans live healthier.” CMS continues to offer innovative approaches to building a stronger healthcare system for all, and given time, this shift towards building and rewarding a preventive care model may prove to have an immensely positive impact on population health.

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