What the 7% Solution?

A 7% Solution #4
by Eric Schoch

Doing the numbers

While Schenetzke was willing to pay for the program at the Y’s non-member rates, the key to widespread participation is making such programs part of the health-care reimbursement system. The IU scientists say the research makes it clear that even modest weight loss significantly reduces the risk of diabetes (16 percent for every two pounds of weight loss), and that the results would be cost effective.

“We know we can prevent diabetes, we know we can reduce that incidence significantly by almost 60 percent. The question is, How do the costs of the program get covered?” says Marrero. “The program is cost effective, it can save money. It’s all that and a bag of chips, as my dad used to say.”

If current trends continue, it’s projected that the $205 billion spent on direct total medical costs for diabetes patients in the United States in 2007 will grow to $338 billion by 2020.
“It’s big-ticket, big-dollar expenditures stuff. If we don’t stop, it will blow us out of the water,” says Marrero.

The economics of reimbursing the costs of diabetes prevention would work. In a 2006 study, Ackermann and colleagues reported that according to their model of costs, reimbursements, and health-care outcomes, if Medicare were permitted to reimburse for group diabetes prevention programs starting at age 50, a combination of coverage by the federal program, private insurers, and relatively small payments by patients or employers would more than pay for itself for both insurers and Medicare.

Medicare cannot yet reimburse for programs targeting people under age 65, but UnitedHealth Group isn’t waiting. It’s implementing diabetes programs through the prevention program with the YMCA and through a diabetes control program with the Walgreens pharmacy chain.
“We want people to understand this is prevention that will be paid for. We are buying outcomes, because if we do not get that 5 to 7 percent weight loss, we will not get the risk reduction,” said Deneen Vojta, senior vice president of the UnitedHealth Center for Health Reform and Modernization, at the April diabetes conference.

As the IU research starts to be implemented on a national scale, Ackermann nonetheless sees the problem as much larger than effectively preventing diabetes among high-risk people willing and able to participate in an intensive 16-session program at the YMCA. The diabetes risk is increasing in every age group in parallel with obesity trends, Ackermann points out, and that tide must be reversed.

“We need environmental policies and social policies and things that go along with [such policies] that make it the norm to live a healthier life, easier to eat healthy foods, easier to be physically active in the workplace and around the home,” Ackermann says. “Our society needs to change, and if this program is the only thing making that change, it’s going to take a long time. I don’t think it can by itself.”

Nevertheless, the IU School of Medicine-tested program suggests that, with the right tools people can be convinced to change, just enough, to make a difference.

Eric Schoch is a science writer in the Office of Public and Media Relations at the IU School of Medicine in Indianapolis.

http://research.iu.edu/magazine/index.php?option=com_content&view=article&id=111:a-7-solution&catid=45:fall-2010-volume-xxxiii-number-1&Itemid=78

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