Medicare could save up to $15 billion if it invested in diabetes and heart disease weight-loss prevention programs focusing on baby boomers, researchers from Emory University, Atlanta, wrote in Health Affairs. The authors propose offering a wider range of proven community-based weight-loss programs for individuals aged between 60 and 64 with pre-diabetes before they reach 65 when they enter the Medicare program.

Prediabetes means the person's blood sugar levels are not yet high enough for a type 2 diabetes diagnosis to be made, but they are higher than normal. Without intervention, prediabetes usually progresses to type 2 diabetes within ten years. Heart and circulatory system damage may already be starting in a person with prediabetes. However, the progression to type 2 diabetes is not inevitable. If the individual loses weight, eats a healthy and well balanced diet, and exercises regularly, his/her blood sugar levels will probably return to normal.

Co-author and lead researcher, Kenneth E. Thorpe, PhD, professor of health policy and management at Emory's Rollins School of Public Health, says their study's proposal should be carefully considered by Congress members who are trying to find ways of bringing down Medicare spending and reduce the federal deficit. Unfortunately, the government is failing to address the ever-increasing rates of chronic disease and obesity, he adds.

Thorpe said:

"The majority of health care spending is due to increasing rates of weight-related health issues like diabetes, cholesterol and high blood pressure so by the time many people become Medicare eligible, they are already battling these health issues. By focusing on weight loss and prevention, we could not only improve our country's bottom line, we could make a huge impact in the fight against chronic disease."

Thorpe and fellow researcher Zhou Yang, PhD, MPH, modeled their proposal on a program jointly developed by the YMCA, the CDC (Centers for Disease Control and Prevention), and the UnitedHealth Group.

At YMCAs across American, a qualified lifestyle coach assists overweight individuals who are at risk of developing diabetes type 2 - they are taught about healthy eating habits, and receive a fitness plan which raises their overall levels of physical activity. According to previous studies, people aged 60+ years who enroll into the program and other similar ones lose weight and eventually have a 71% lower risk of developing diabetes type 2.

The researchers set out to determine what the benefits might be if people aged 60 to 64 with signs of prediabetes were enrolled in a weight loss program. A 16-week program was estimated to cost the federal government approximately $590 million. They proposed that funding would come from the National Diabetes Prevention Program (part of the CDC) and the Prevention and Public Health Trust Fund.

This financial outlay would save Medicare about $2.3 billion over a decade and $9.3 billion in net lifetimes savings. Net lifetime savings means how much money would be saved from the time of enrollment until the end of the participants' lives - which the author says is about 13 years.

They then included overweight individuals with hypertension (high blood pressure) or high cholesterol into the program. These individuals not only have a high risk of developing diabetes, but also heart disease. By including these people in the program as well (70% participation rate), they estimated that Medicare savings would be another $1.4 billion in a decade and $5.8 billion in lifetime savings.

When the two groups were combined and added up, they worked out that Medicare would save $3.7 billion over a decade and up to $15.1 billion over the participants' lifetimes.

In an Abstract in the journal, the authors concluded:

"In this context we propose that Medicare expand its new wellness benefit to include reimbursement for this and other qualifying behavior change programs."



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