Building a National Diabetes Prevention and Treatment System Kenneth E. Thorpe, Ph.D.

Emory University Partnership to Fight Chronic Disease kthorpe@emory.edu

The Challenge
Diagnosed diabetes prevalence increased from 2.8 to 8.3% over past 30 years Diabetes prevalence in Medicare has doubled to 23% over past 20 years and is leading factor driving up spending Rising treated chronic disease prevalence accounts for over 70% of growth in Medicare spending over the past decade.

Solutions from the ACA

Reduce the incidence of diabetes and related chronic conditions through evidence-based lifestyle interventions (from prevention fund) Improve disease detection (HRA) Add care coordination into traditional Medicare and unmanaged Medicaid using health teams (sections 2703 and 3502) Use the teams to link community based prevention and medical treatment

Proposal 1
Build community based lifestyle program using diabetes prevention program
Build through YMCAs, other not for profit community based entities Would cost under $100 million to scale and replicate nationally Fund next year through Prevention and Public Health Fund (less than 10% of next years funding level

Proposal 1
Include enrollment in the DPP style program as a covered benefit in Medicare and provide targeted subsidies to at risk adults at age 60 Would improve health of incoming Medicare beneficiaries Would reduce Medicare spending by $7 billion over the next decade

Proposal 2
Include care coordination into traditional Medicare using health teams that provide evidence-based:
Transitional care Health coaching Medication management and reconciliation Care coordinator24/7 Execution of the care plan

Proposal 2
 CMS could contract with home health, hospitals, FQHC, others to develop the teams  Could use existing 15 jurisdictions used to provide claims services  Would require a ten year investment of $40 billion  Low range of potential gross savings about $125 B (2% on $6 Trillion base)

Proposal 3
Use the CHTs as the key linkage between community-based prevention efforts, disease detection and care coordination Teams work with provider practices to execute new personalized care plans in Medicare to:
 Refer patients to DPP style programs  Assure patients up to date with screenings  Reduce spending (just cutting preventable readmissions in half saves $125 Billion over 10)

Conclusion
ACA has the statutory language to build national prevention, screening and treatment model for diabetes and other chronic conditions Use Prevention Fund to build a national DPP. Still allows HHS to spend 90% of next years funds on other investments. Future savings in Medicare depends on introducing care coordination into the program. This could be completed quickly and through the health teams.