Medicare Diabetes Prevention Program Final Rules May Limit Beneficiary Access and Widen Health Disparities

Abstract

Introduction: 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 the estimated 48.3% of seniors with prediabetes. The MDPP is based on the widely disseminated National Diabetes Prevention Program (NDPP), which has lesser but still beneficial risk-reduction outcomes among racial/ethnic minority participants. We assess the extent to which the MDPP’s pay-for-performance reimbursement model may cover costs of service delivery to diverse Medicare beneficiaries. Methods: Denver Health Medical Center is a safety net healthcare system that provided the yearlong NDPP to 232 diverse Medicare beneficiaries between 2013-2017, primarily through grant funding. Based on their NDPP attendance and weight loss outcomes, we compared projected performance-based-payments (e.g., $160 for ?5% weight loss) to service costs. Results: Participating Medicare beneficiaries were 40.6% Hispanic, 31.6% non-Hispanic black, and 26.9% non-Hispanic white. Only 4.7% of beneficiaries achieved all attendance and weight loss outcomes associated with the maximum $470 payment for services in months 1-12. Overall beneficiary performance would result in an average reimbursement of $138.52 (SD=142.58). Program delivery costs were $800.64 per-participant, leaving an average gap of $662.12 per beneficiary served. Discussion: Numerous MDPP suppliers are needed to reach Medicare beneficiaries with prediabetes, yet insufficient reimbursement is a likely deterrent. Health disparities may also widen as suppliers serving diverse populations will likely receive especially low payments, threatening their MDPP delivery. Higher payments appear needed and are supported by strong return-on-investment findings. A risk-adjusted model that accounts for demographic differences in outcomes is also needed to promote health equity. Disclosure N. Ritchie: None. M. Gritz: None.