Why Prevention and Control of Chronic Diseases at the CDC and CMS Needs Increased Investment

By Katie Adamson, Vice President, Health Partnerships & Policy at the YMCA of the USA

The U.S. spends more money treating sick people than it does on trying to prevent people from getting sick. Right now, 90% of the $4.1 trillion the nation spends on health care is spent treating people with physical disease or mental illness. If increased investment was placed into prevention and control of chronic disease, the resulting human and economic impact would likely be immense. Type 2 diabetes presents one of the most telling case studies of what would be gained if we invest adequately in prevention, and what devastating losses will result if we do not.

The economic and human costs of diabetes treatment in the US are staggering. According to the Centers for Disease Control and Prevention (CDC), one in four health care dollars today goes to caring for people living with diabetes. The American Diabetes Association (ADA) found that people diagnosed with diabetes incur average medical expenses of $16,752 per year, of which $9,601 is attributable to diabetes. The last time ADA examined the total cost of diagnosed diabetes was in 2018, and that cost was $327 billion annually – a figure that was 26% higher than their analysis 5 years prior. Diabetes also takes an enormous personal toll on individuals and their families, including hospitalizations, and complications from the disease can include blindness, limb loss, and kidney failure. These complications contribute to missed work or an inability to work due to disabilities.

But we know we can avert these costs and complications if we invest in the most-tested lifestyle health program to date that proved we could lower the chances of developing type 2 diabetes by more than half.  With 96 million Americans living with prediabetes, including half the Medicare population, we cannot afford to foresake this investment.

From 1996-2001, the U.S. government made its biggest ever investment in a randomized clinical trial of a lifestyle health program known as the Diabetes Prevention Program to find out if it could prevent or delay the onset of type 2 diabetes. The program helped participants lose a modest amount of weight by adopting lifestyle changes, primarily dietary changes and increased physical activity. That investment paid off. It showed conclusively that a lifestyle health program could reduce the risk of developing type 2 diabetes in adults overall by 58%, and by 71% in older adults.  These findings, and translational research, led to the establishment of the National Diabetes Prevention Program which has helped bring this program to scale in communities across the country by recognizing organizations that meet the program standards and achieve the required outcome.

As a result of the YMCA’s pilot with the Centers for Medicare and Medicaid Innovation and other evidence the CDC has provided from the National DPP, the Centers for Medicare and Medicaid Services (CMS) in 2017 launched the Medicare Diabetes Prevention Program (MDPP) expansion project, providing coverage for the program for Medicare recipients. Unfortunately, the expansion project didn’t look like the original Diabetes Prevention Program clinical trial or the pilot the YMCA undertook with CMMI/Medicare. And while some improvements to the program have been made by CMS, many more are needed to make the program workable and equitable. The project’s current design discourages organizations from becoming suppliers, prevents participation of virtual providers in the program, and disincentivizes suppliers from working with high-risk populations that have a harder time achieving the program’s weight loss goal without additional social supports like transportation, child care and access to healthy food.

In the recently released White House Strategy on Hunger, Nutrition and Health, the administration committed to making the MDPP expansion project a permanent benefit in Medicare. We applaud this decision, with the important caveat that other changes must accompany the program being made permanent to achieve its goals.

Twenty years following the biggest federal investment in testing a lifestyle health model to prevent chronic disease, the YMCA and a host of other patient advocacy groups, physician and allied health professional organizations and companies with diabetes prevention programs, implore Congress and the administration to make the urgent and necessary MDPP administrative fixes. We also ask that Congress triple the investment in the CDC for this and other chronic disease prevention and control programs addressing hypertension, cancer, arthritis, obesity and Alzheimer’s to further build the nationwide capacity to deliver these life changing interventions. We believe fixing the MDPP and making it a viable long-term program would be one of the biggest chronic disease prevention wins in our nation’s history. This would help save countless lives, improve health and longevity for all Americans, and save billions of dollars in our health care system.