NPR recently
published a story titled "Diabetes Prevention Program Will Save Medicare
Money, HHS Says." The article can
be found here http://www.npr.org/sections/health-shots/2016/03/23/471583523/hhs-says-diabetes-prevention-program-will-save-medicare-money
This story provides some brief information about a YMCA program that was
created to prevent diabetes through educating individuals who are in a
prediabetic stage. This is a year long
program in which individuals need to apply and be qualified for enrollment.
Once in the program, there is a 16 week education portion of the program where
the client attends a weekly session and then attends monthly follow up sessions
for the remainder of the year. More information regarding this program and the
risk factors that qualify individuals can be found at the YMCA website https://www.ymcapkc.org/diabetesprevention/ NPR reports that the YMCA has had 42,000
participants who lost an average of 5.5% of their body weight, which can
significantly reduce the risk of Diabetes and a number of other health issues.
The department of Health and Human Services audited this program and found that
the results qualify this program for coverage by Medicare through the
Affordable Care Act (ACA).
The Issue
Type 2 Diabetes is
becoming a more and more prevalent issue as the population of the United States
continues to live sedentary lifestyles and obesity becomes more common.
Diabetes has many complications, and can lead to a number of issues. Medical
spending for patients with Diabetes is costly, according to the article
"One of every three Medicare dollars is spent on patients with
diabetes…" By providing education and preventative care for Diabetes
spending can be reduced and the overall health of the participants and the
population can be improved.
Service Delivery
Several systems
already exist in order to deliver this intervention. The YMCA is a nationwide
organization that offers health and wellness programs in communities. By having
this program in YMCAs across the country it can be made available to
communities in diverse areas and to populations through an organization that
already exists and is trusted by the individuals in the community.
The ACA is a law that regulates health care
and the way it is provided to the public, according to the law prevention
programs can qualify for Medicare coverage. This means that participants should
be able to attend this program at no cost to them, if they qualify for the
service. This can be overseen by the Department of Health and Human Services in
order to be sure that Medicare is taking the appropriate steps to reimburse
facilities for providing this service.
Because this is the
first preventative program to qualify for health care coverage, there will need
to be new systems created in order to deliver this intervention through
Medicare. A reporting system will need to be created, as well as a method to
monitor the claims being made to Medicare using the procedures that already
exist.
How can we support the creation of policy
Sharing the results
of this program reported by the YMCA and HHS can help to support the creation
of policy. Many medical facilities try
to use evidence based practice, seeing these results could encourage more widespread
changes in the way preventative care for Type 2 Diabetes is provided, in order
to cause a greater effect on clients as well as reducing costs to insurance.
This is also the first preventative program to meet the requirements for
Medicare coverage that are described in the ACA, which means it will be
important to follow up with the facilities to ensure that reimbursement is
occurring and that service delivery is occurring properly. If there are issues
in reimbursement or delivery, there may need to be additional policies created.
Implications for OT
Occupational
therapists often work with the diabetic population at many different stages in
the disease from the initial stages where the individual is learning how to
cook appropriate meals and learning how to manage medications to the later
stages where the individual may experience effects such as neuropathy that can
lead to issues including amputation.
These issues can be avoided for many patients through prevention. A more
wide spread effort for prevention could reduce the number of patients requiring
OT services because of Diabetes or Diabetes related complications to health.
An OT can also be
used within this program as one of the leaders responsible for providing
intervention. OTs are well qualified to
assess current barriers to success and provide ways to overcome these barriers
as well as giving education and support resources. An OT would be able to work
with the participants of this program in order to learn the information and
skills that can help them to be healthier and prevent type 2 Diabetes rather
than working to help overcome the issues of diabetes later.
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