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Preventing Chronic Disease Can Reduce Medicare 10%

Posted: Tuesday, January 08, 2013

Roughly a quarter of Medicare beneficiaries have diabetes -- a number that has doubled in 15 years -- and more than 90% of spending is associated with patients with chronic conditions, said Ken Thorpe, PhD, health policy professor at Emory University in Atlanta, in a conference call with reporters.

But rather than address this cohort of troublesome patients as a way to curb Medicare spending, Washington policymakers eyeing Medicare as a way to reduce federal spending are focusing their efforts elsewhere.

"Really none of the proposals on the table that I've seen really address this," Thorpe said. "It's very narrowly focused on cutting provider payments. That's not a long-term solution." The real growth in Medicare spending is coming from chronic disease, he said.

In his report "Lessons for Reform to Original Medicare" released Thursday, Thorpe turned to programs already used by Medicare Advantage -- which, unlike traditional Medicare, is operated by private insurers -- to see how Medicare Parts A and B can save money.

He found that by focusing on preventing chronic disease and better coordinating care, Medicare can save 5% to 10%.

"That's fairly conservative," said Thorpe, a former senior health adviser under President Bill Clinton. "It would translate into hundreds of billions of dollars."

The best known lifestyle modification program is the Diabetes Prevention Program, a public-private partnership that establishes programs for people at high risk for type 2 diabetes. A randomized trial of the program found lifestyle intervention reduced diabetes prevalence by 58% -- a reduction largely due to a 5% to 7% weight loss among participants, Thursday's report noted.

Thorpe said Medicare would save money if it made programs such as the Diabetes Prevention Program a covered benefit under traditional Medicare.

"Enrolling one cohort of overweight, pre-diabetic seniors into the program would generate a net savings of about $2 billion over 10 years and more than $7 billion during the lifetimes of those participating in the program," the report said.

Private health plans such as UnitedHealthcare and some Blue Cross plans provide the Diabetes Prevention Program intervention to at-risk adults.

Traditional Medicare provides no care coordination, unlike Medicare Advantage, which has the chronic-condition special needs plans (C-SNPs) that provide coordinated care to patients with certain chronic diseases.

"Per-enrollee use of services was generally lower among diabetic patients enrolled in the C-SNPs compared with those in traditional medicine," the report said. Although physician office visits were slightly higher for those in the plans, hospital days were markedly lower as were hospital outpatient visits.

Reducing hospital readmissions by half could save Medicare from $200 million to $300 million in the next decade, according to Thorpe.

Source:, MedPage Today.

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