Abstract | BACKGROUND: The Centers for Medicare and Medicaid Services recently issued final rules for the Medicare Diabetes Prevention Program ( MDPP), offering an unprecedented opportunity to provide lifestyle intervention to Medicare beneficiaries with prediabetes via a pay-for-performance model. The MDPP is based on the widely disseminated, yearlong National Diabetes Prevention Program ( NDPP), which has lesser but still beneficial risk-reduction outcomes among minority and low-income participants. OBJECTIVES: We compare projected payments based on outcomes of a diverse sample of Medicare beneficiaries to service delivery costs, and explore resulting implications for MDPP access and sustainability. METHODS: We delivered NDPP in a safety-net health care system from 2013 to 2017 and conducted an analysis of service cost, beneficiary performance, and projected MDPP reimbursement. RESULTS: Among 1165 total participants, 213 (18.3%) were Medicare beneficiaries. Participating beneficiaries were 40.6% Hispanic, 31.6% non-Hispanic black, and 26.9% non-Hispanic white and 69.5% low-income. Overall beneficiary performance would result in an average reimbursement of $138.52 (interquartile range=162.50). Program delivery costs were $800 per participant, leaving an average gap of $661 per beneficiary. CONCLUSIONS: Findings from delivering the NDPP to diverse and undeserved patients show a large gap between service costs and projected reimbursement. Although many MDPP suppliers are needed to reach all Medicare beneficiaries with prediabetes, insufficient reimbursement may be a deterrent. Health disparities may also widen as suppliers serving diverse and low-income populations will likely receive especially low payments, threatening access. Higher payments are supported by strong return-on-investment findings and seem needed to reduce diabetes prevalence and related disparities.
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Authors | Natalie D Ritchie, Robert M Gritz |
Journal | Medical care
(Med Care)
Vol. 56
Issue 11
Pg. 908-911
(11 2018)
ISSN: 1537-1948 [Electronic] United States |
PMID | 30312286
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S.)
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Topics |
- Aged
- Centers for Medicare and Medicaid Services, U.S.
- Cost-Benefit Analysis
- Diabetes Mellitus
(ethnology, prevention & control)
- Female
- Health Expenditures
- Health Promotion
(economics, organization & administration)
- Health Status Disparities
- Healthy Lifestyle
- Humans
- Male
- Medicare
(economics, organization & administration)
- Middle Aged
- Minority Groups
- Poverty
- Prediabetic State
(ethnology, therapy)
- Reimbursement, Incentive
- Safety-net Providers
(economics)
- United States
- Weight Reduction Programs
(economics, statistics & numerical data)
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