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In the midst of a daunting fiscal climate, the newly appointed Joint Committee on Deficit Reduction will spend this fall debating how to substantially cut federal spending during the next decade. And the escalating costs of health care in this country, particularly in the Medicare program, almost guarantee this super committee will be forced to consider policies that will affect the health care sector.
While reducing government expenditures and living within our means are necessary and important priorities, our laser focus on cutting and slashing programs can cause us to be shortsighted and make decisions that could cost us more in the long run by shifting costs rather than implementing real, sustained reform in the system. The 2010 health care law, for example, provides some real opportunities to invest in cost-saving measures that are proven to prevent chronic disease and can yield the long-term savings that our health care system needs.
The National Diabetes Prevention Program, which was authorized by the health care overhaul but remains unfunded, is one such program. The NDPP was intended by Congress to prevent one of the leading drivers of health care spending in our country — Type 2 diabetes.
The prevalence of Type 2 diabetes and its resulting costs are alarming and escalating. According to the Centers for Disease Control and Prevention, Type 2 diabetes affects almost 26 million people in this country. And based on fasting glucose levels (hemoglobin A1c) from 2005 to 2008, 35 percent of adults had prediabetes. That percentage of prediabetes jumps to 50 percent in adults 65 and older.
The costs associated with this preventable disease are astounding. The total economic burden of diabetes is an estimated $218 billion annually and will only continue to grow. Often referred to as a “gateway” disease, diabetes leads to countless other illnesses and conditions, such as blindness, heart disease, stroke, kidney failure and limb amputations, resulting in higher medical expenditures for those with diabetes.
The indirect costs associated with diabetes include increased absenteeism and reduced productivity. The correlation between obesity and the risk of developing diabetes — more than 85 percent of people with Type 2 diabetes are overweight — only compounds the economic burden of both conditions.
Put simply, preventing the onset of diabetes has the added benefit of saving health care dollars associated with costly medical complications and related conditions and also improves our country’s productivity.
The CDC-led NDPP, which is modeled after the Diabetes Prevention Program study sponsored by the National Institutes of Health, is one example of a successful and innovative approach that is proven to bend the curve on Type 2 diabetes.
The NDPP intervention is focused on changing the lifestyle behaviors of prediabetic overweight or obese adults through activities such as improving dietary choices, increasing physical activity and peer group activities — with the goal of reducing participants’ body weight during the course of the intervention.
The findings of the NDPP demonstrated that through these interventions, there was a reduced risk of developing Type 2 diabetes by 58 percent overall and by 71 percent in adults older than 60.
Given the clear benefits of these lifestyle modifications to reduce the escalating rates of Type 2 diabetes, the CDC is collaborating with YMCA of the USA and UnitedHealthcare to implement the NDPP in YMCAs across the country. In one year’s time, the YMCA has been able to scale the NDPP to 170 sites in 43 communities in 23 states. But there is more to be done.
Investing in proven prevention programs such as the NDPP is necessary to save funds over the long term.
A recent study by Ken Thorpe and Zhou Yang, published in September’s “Health Affairs,” used conservative estimates to show that offering the NDPP to overweight and obese prediabetic adults ages 60-64 could save the Medicare program as much as $2.3 billion over 10 years and as much as $9.3 billion over a lifetime. Those savings to the Medicare program could reach as much as $3.7 billion over 10 years and $15 billion over a lifetime if non-prediabetic, overweight adults who are at risk for cardiovascular disease were also enrolled in the program. Based on these potential savings, the article proposed that Medicare expand its wellness benefit to include reimbursement for programs similar to the NDPP.
Programs such as the NDPP have the right formula for success: a public/private partnership with years of government-sponsored data showing substantial positive effects on patients and reduced costs to the health care system. These kinds of programs should be scaled to achieve savings in the Medicare and Medicaid programs.
During times of budget constraints, our understandable inclination is often to cut and shift costs as opposed to redesigning and investing in system improvements that can yield long-term results. However, in the midst of these pressures, we simply cannot afford to lose sight of investing in what works.
Former Senate Majority Leader Tom Daschle (D-S.D.) is now a senior policy adviser at DLA Piper, whose clients include Novo Nordisk A/S, a health care company that focuses on diabetes care.