CMS proposes new payment models for diabetes prevention and wellness

The Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt wants seniors and primary care providers to focus more on wellness and disease prevention. This week, Slavitt announced new CMS policies to improve the way care providers are reimbursed for wellness and prevention services, especially diabetes prevention.

The expanded Medicare Diabetes Prevention Program, scheduled to begin in 2018, is an outgrowth of earlier program efforts in disease management. High-risk beneficiaries will be given support services to encourage weight reduction and increased physical activity. CMS thinks the effort could reduce the per-person costs associated with the drugs and healthcare services needed by diabetic patients by more than $2,500 per person after 15 months in the program, Slavitt says.

The announcement dovetails with National Diabetes month. Diabetes affects about 26 percent of people age 65 and older and has become one of the biggest topics on CMS’ hit-list. Medicare beneficiaries with diabetes cost the healthcare system 86 percent more per year than those who don’t have the disease—about $7,300 more per person.

The elevated costs don’t stop there: Diabetes is also an entry-disease to life-threatening and expensive conditions, including amputation, kidney failure and heart disease, Slavitt says.

Topics: Clinical , Medicare/Medicaid