Monday, March 28, 2016

Using Diabetes Prevention to Reduce Costs and Improve Outcomes



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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