DIABETES PREVENTION & THE MEDICARE DIABETES
PREVENTION ACT
ERIN KIBBEY, BS, RN, CCRN
FERRIS STATE UNIVERSITY
OBJECTIVES
▪ Diabetes – prevalence & costs
▪ Diabetes Prevention Program (DPP) – landmark study
▪ Medicare Diabetes Prevention Act of 2013 (MDPA)
▪ Implications of proposed legislation
▪ Key stakeholders
▪ Political strategies
DIABETES – PREVALENCE, COSTS, & PREVENTION
▪ 25.8 million people in the United States
▪ $174 billion dollars per year
▪ 1 in 3 adults in the United States will have diabetes
by the year 2050
▪ 6 in 10 diabetics have at least one related
complication
▪ Northern Michigan prevalence of 15.2% compared
to state and national rates of 7.5% to 9.0%
Prevention is possible!
(ADA, 2011; Centers for Disease Control and Prevention, 2011; Michigan Department of Community Health, 2011; National
Diabetes Education Program, 2011a; Northwester Michigan College-Research Services, 2012; Orleans & Cassidy, 2011)
DIABETES PREVENTION PROGRAM (DPP)
▪ Landmark study in 2002
▪ Community prevention
▪ Lifestyle interventions
▪ 58% reduction in risk for developing diabetes
▪ 10 year follow up – reduction in incidence of
diabetes by 43%
(Diabetes Prevention Program Research Group, 2002, 2009; National Diabetes Education Program, 2011a, S.B. 452)
DIABETES
PREVENTION
PROGRAM (DPP)
STUDY RESULTS
(Berenson et al., 2009; Diabetes Prevention
Program Research Group, 2002; Franken,
Lugar, & Rockefeller, 2012; Rockefeller, 2012b)
MEDICARE DIABETES PREVENTION ACT OF 2013
(MDPA)
▪ Federal legislation to amend Social Security Act
▪ March 5, 2013 Senator Al Franken (Democrat) introduced Senate Bill 452
▪ Identical bill introduced as H. R. 962 to House of Representatives on same date by
Representative Susan Davis (Democrat)
▪ Previously introduced in 2012
▪ Bipartisan support
Goal: Reduce incidence of diabetes
among Medicare beneficiaries
(S. 3463, 2012; H. R. 962, 2013; S. 452, 2013)
IMPLICATIONS OF PROPOSED LEGISLATION
Creates
Jobs
PREVENTION
COST SAVINGS
▪ 7 out of 10 eligible for Medicare have
diabetes or pre-diabetes
▪ Spending estimates 2011-2020 for
Medicare recipients with diabetes & prediabetes is $1.7 trillion paid by federal
government
▪ Improved access for seniors to national
diabetes prevention program
▪ Potential reduction in 3 million prediabetic individuals from developing
diabetes
▪ $191 billion in national savings over 10
years
▪ $61 billion in federal government savings
over 10 years
▪ Expansion of programs in community
settings
▪ Savings of $4 for every dollar spent
investing in program
▪ Focus on keeping people healthy
▪ Cost-effective way to improve quality of
care
(Academy of Nutrition and Dietetics, 2013; Berenson et al., 2009; Franken, A., Lugar, R., Rockefeller, J., IV., 2012; UnitedHealth Center for Health
Reform & Modernization, 2010)
KEY STAKEHOLDERS & THEIR POSITIONS
Payers
Health Care Pro’s
Structural Leaders
Patients
Communities
Federal Government
American Public
Health Association
Physicians or
Providers
Lifestyle coaches,
Nurses/Diabetic
nurse educators
Researchers/Task
Force
American Diabetes
Association
Seniors
Families of
patients
YMCA
Non-profit
organizations
Departments of
Public Health
Insurance
Companies
Prevention & Public
Health Funds
Diabetes Advocacy
Alliance
Centers for Disease
Control & Prevention
Policymakers
(ADA, 2012; American Public Health Association, 2012; CDC, 2012; Diabetes Advocacy Alliance, 2012; HHS, 2004; McGinnis, 2002; )
POLITICAL STRATEGIES
Raising
Awareness
Voicing
Support
Recruiting
Supporters
SUMMARY
Diabetes is costly and prevalent
Prevention is key
Diabetes Prevention Programs support good outcomes
MDPA helps efforts to reduce costs and prevalence
Multiple key stakeholders support legislation
Several political strategies can be aimed at passage of MDPA
REFERENCES
Academy of Nutrition and Dietetics. (2013). The preventing diabetes in Medicare act. Retrieved from
http://www.phcnpg.org/docs/Legislation/Issue%20Brief%20Preventing%20Diabetes%20Medicare%20Act%20PPW%202013.pdf
American Diabetes Association [ADA]. (2011). Diabetes basics: Symptoms. Retrieved from http://www.diabetes.org/diabetesbasics/symptoms/?loc=DropDownDB-symptoms
American Diabetes Association [ADA]. (2012). American Diabetes Association applauds the introduction of the Medicare Diabetes Prevention Act.
Retrieved from http://www.diabetes.org/for-media/2012/medicare-diabetes-prevention-act.html
American Public Health Association. (2012). Legislative update. Retrieved from http://action.apha.org/site/MessageViewer?dlv_id=33542&em_id=28621.0
Berenson, R. A., Holahan, J., Blumberg, L. J., Bovbjerg, R. R., Waidmann, T., Cook., A., & Williams, A. (2009). How we can pay for health care reform.
Retrieved from Urban Institute website: http://www.urban.org/UploadedPDF/411932_howwecanpay.pdf
Centers for Disease Control and Prevention [CDC]. (2011). Chronic disease prevention and health promotion: Diabetes. Retrieved from
http://www.cdc.gov/chronicdisease/resources/publications/AAG/ddt.htm
Centers for Disease Control and Prevention [CDC]. (2012). National diabetes prevention program. Retrieved from
http://www.cdc.gov/diabetes/prevention/foa/index.htm
Diabetes Advocacy Alliance. (2012). Letter of support to cosponsors of S. 3463. Retrieved from https://www.aace.com/files/views/090512-medicarediabetes-prevention-act.pdf
Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England
Journal of Medicine, 346(6), 393-403. doi: 10.1056/NEJMoa012512
REFERENCES CONTINUED
Diabetes Prevention Program Research Group. (2009). 10-year follow-up of diabetes incidence and weight loss in the diabetes prevention program
outcomes study. The Lancet, 374(9702), 1677-1686. doi: 10.1016/S0140-6736(09)61457-4
Franken, A., Lugar, R., Rockefeller, J., IV. (2012). The Medicare Diabetes Prevention Act of
2012. Retrieved from http://www.franken.senate.gov/files/documents/120731_Medicare_Diabetes_Prevention_Act.pdf
McGinnis, J. M. (2010). Diabetes and physical activity: Translating evidence into action. American Journal of Preventive Medicine, 22(4S), 1-2. Retrieved
from http://www.thecommunityguide.org/diabetes/dm-AJPM-c-diabetes-and-pa.pdf
Medicare Diabetes Prevention Act of 2012. S. 3463, 112th Cong. (2012).
Medicare Diabetes Prevention Act of 2013. H. R. 962, 113th Cong. (2013).
Medicare Diabetes Prevention Act of 2013 [MDPA]. S. 452, 113th Cong. (2013).
Michigan Department of Community Health. (2011). The impact of diabetes in Michigan: The diabetes burden report and the Michigan diabetes action
plan 2011-2014. Retrieved from http://www.michigan.gov/documents/mdch/2011_Impact_of_Diabetes_365234_7.pdf
National Diabetes Education Program (2011a). Diabetes prevention program fact sheet. Retrieved from http://www.ndep.nih.gov/media/dpp-fact-sheet508.pdf
National Diabetes Education Program (2011b). Power to Prevent: A Family Lifestyle Approach to Diabetes Prevention. Retrieved from
http://www.ndep.nih.gov/media/power-to-prevent-508.pdf
Orleans, C. T., & Cassidy, E. F. (2011). Health and behavior. In A. R. Kovner & J. R. Knickman (Eds.), Jonas & Kovner’s health care delivery in the United States.
(pp. 205-231). NY: Springer Publishing Company.
REFERENCES CONTINUED
Rockefeller, J. (2012a). Rockefeller takes aim at diabetes in WV - Bill would extend new prevention program to Medicare. Retrieved from
http://votesmart.org/public-statement/733500/rockefeller-takes-aim-at-diabetes-in-wv-bill-would-extend-new-prevention-program-tomedicare#.UVhCjpOcfUV
Rockefeller, J., IV. (2012b). Statements on introduced bills and joint resolutions. Retrieved from http://votesmart.org/public-statement/732727/statementson-introduced-bills-and-joint-resolutions#.UU8u7ByW_ng
UnitedHealth Center for Health Reform & Modernization. (2010, November). The United States of diabetes: Challenges and opportunities in the decade
ahead (Working Paper No. 5). Minnetonka, MN: UnitedHealth Group. Retrieved from
http://www.unitedhealthgroup.com/hrm/UNH_WorkingPaper5.pdf
U.S. Department of Health & Human Services [HHS]. (2004). Diabetes: A national plan for action. Retrieved from
http://aspe.hhs.gov/health/ndap/ndap04.pdf