How Can Medicare Advantage Plans Implement Diabetes Prevention Given Reimbursement Levels?

May 7, 2019

Diabetes prevention is a priority nationwide, and a mandate in Medicare. Medicare Advantage (“Part C”) plans must offer the same services as Medicare Parts A and B, and often offer more services. A major challenge is funding the mandatory and additional services. The Diabetes Prevention Program (DPP) is a required service in Medicare that offers an opportunity for cost reduction in Medicare Advantage plans. If implemented well, the DPP can lead to cost savings and the ability to offer more services to beneficiaries.

On the surface, the parts seem to be in place for the DPP to be effective in Medicare. The science backs the effectiveness of the DPP.  The DPRP has established the infrastructure for DPP administration. The MDPP Expanded Model requires Medicare to cover the DPP. Why, then, do only 1 to 11% of eligible patients participate in a DPP, and how can Medicare Advantage plans to implement low-cost diabetes prevention?

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