Very Brief Blog: New Report that Medicare's New Diabetes Prevention Counseling is Underfunded

Last year, CMS finalized rulemaking to create a novel national benefit for diabetes prevention counseling classes for qualified and at-risk patients (e.g. borderline blood sugar or obesity).   This is one of the first projects completed by the Medicare Center for Innovation, and although the idea is simple enough, executing it took literally hundreds of pages of rulemaking spread over two years.  Enrollment (for a novel class of pre-diabetes education providers) began in April 2018.

A new report suggests the program may be so underfunded as to be hard for the service to actually be delivered.

See a trade journal report at Health Payer Intelligence here, and a peer-reviewed, open-access economics article here.   The authors delivered a real-world diabetes prevention program to underserved beneficiaries from 2013 to 2017; real costs averaged $800 per participant, but the current funding level and rules would net a provider only $138 per participant. 

Since this is a 2018 program, following the agency's routine data practices, Medicare might not have to release annual national Part B utilization data for the new DPP codes until November 2019, or release provider-specific code use until May 2020.

Virtual DPP?

Medicare declined to allow CDC-accredited DPP providers who use virtual classes and materials to participate in its program. 

Likely, that technology may be more cost-effective than the brick and mortar classes described by Ritchie et al.  See an article on Virtual DPP here.   (Disclosure: I've worked as a consultant for Omada, which probably has the best-validated virtual program in the Medicare-age population.)

This isn't the first negative spin on the program.  Early press in Spring 2018 carried headlines like "Diabetes Program Stumbles at Roll-out," here, here.