The CDC has provided almost $7 million in funding to establish DPPs for research purposes, which means the number of pre-diabetes individuals helped by these programs will be very limited (CDC, 2012). While these programs will probably provide free or nearly-free diabetes preventive services to a large number of individuals, most underserved patients will not benefit from these programs.
S. 452 is worded in such a way that establishing DPPs under Medicaid will be optional for states (Sebelius, 2010). As of 2010, 43 states covered the expense of screening Medicaid patients for diabetes, but only 13 states provided reimbursement for obesity preventive services. This suggests that states are willing to pay for screening, but not preventive services like lifestyle interventions; however, if only a few states implement DPPs for Medicaid recipients, this will provide a proof-of-principle experiment in a real-world setting and establish the overall healthcare savings such programs can provide.
In an effort to promote preventive services, ACA provision 4106 offers state-run Medicaid programs enhanced federal matching dollars if they eliminate requirements for preventive services cost-sharing (Sebelius, 2010). However, the preventive services that qualify for an enhanced federal match must meet certain evidence-based criteria determined by the U.S. Preventive Services Task Force. The National Institute of Diabetes and Digestive and Kidney Diseases (NDIC, 2012), and the CDC (2012), have stated that DPPs have the potential to reduce the incidence of type 2 diabetes by up to 58%, thus the empirical evidence for implementing preventive care for persons who are at risk for developing diabetes already exists. The U.S. Preventive Services Task Force issued a recommendation that individuals with blood pressure above 135/80 should be screened for diabetes (Norris, Kansagara, Bougatsos, and Fu, 2008).
There is considerable evidence for a growing momentum to prevent diabetes in the United States, based on ACA provisions emphasizing preventive medicine, empirical support for the efficacy of DPPs, and considerable ongoing investment into additional DPP efficacy research. What'd. 452 does, is attempt to make these DPP services available to underserved populations through Medicaid. In light of the massive expansion in Medicaid roles predicted to occur in the coming years (Kaplan, 2012), it makes good financial sense to implement Medicaid coverage for preventive service programs if they have a proven record of reducing healthcare costs. With the potential for up to $48 billion in healthcare savings nationally by 2021, this amounts to an average of $1 billion in annual savings for each state. The more populous states, like California and New York, would of course experience greater savings. That is an awful big carrot to ignore by states facing big funding deficits.
CDC (Centers for Disease Control and Prevention). (2012). National Diabetes Prevention Program. Funded Organizations. CDC.gov. Retrieved 17 Apr. 2013 from http://www.cdc.gov/diabetes/prevention/foa/index.htm.
Civic Impulse, LLC. (2013). S. 452: Medicare Diabetes Prevention Act of 2013. GovTrack.U.S.. Retrieved 17 Apr. 2013 from http://www.govtrack.us/congress/bills/113/s452.
DPPRG (Diabetes Prevention Program Research Group). (2003). Costs associated with the primary prevention of type 2 diabetes mellitus in the diabetes prevention program. Diabetes Care, 26, 36-47.
Green, Lawrence W., Brancati, Frederick L., Albright, Ann, and PPDWG (Primary Prevention of Diabetes Working Group). (2012). Primary prevention of type 2 diabetes: Integrative public health and primary care opportunities, challenges and strategies. Family Practice, 29, i13-i23.
Kaplan, Louise. (2012). A primer on Medicaid and its expansion in 2014. Nurse Practitioner, 37(12), 7-8.
Medicaid.gov. (n.d.). Prevention of Chronic Disease. Medicaid.gov. Retrieved 17 Apr. 2013 from http://www.medicaid.gov/AffordableCareAct/Provisions/Prevention.html.
Medicare Diabetes Prevention Act of 2013, S. 452, 113th Cong. (2013).
NDIC (National Diabetes Information Clearinghouse). (2012). Diabetes Prevention Program (DPP). NDIC, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Retrieved 17 Apr. 2013 from http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram/.
Norris, S.L., Kansagara, D., Bougatsos, C., and Fu, R. (2008). Screening for type 2 diabetes in adults: U.S. Preventive Services Task Force recommendations. Annals of Internal Medicine, 148(11), 846-854.
Pear, Robert. (2011, Apr. 2). Cust leave patients with Medicaid cards, but no specialists to see. New York Times, A1. Retrieved 17 Apr. 2013 from http://www.nytimes.com/2011/04/02/health/policy/02medicaid.html.
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