Weight Loss Program For Near-Elderly Could Yield Medicare Savings - Health Affairs (blog)

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Medicare could save up to $15 billion over the lifetimes of a group of baby boomers if the federal government  made community-based weight loss programs available to people age 60 or older who were at risk for diabetes or heart disease, according to a study in the September 2011 issue of Health Affairs. The program—potentially implemented in partnership with YMCAs across the country—could offer help with the very real problem of weight gain and pare the federal budget at the same time.

Under the plan put forward in the study, people not yet eligible for Medicare would receive coaching on healthy eating and a fitness plan that often delivers results. Most people enrolled in such plans lose about 5–6 percent of their body weight and keep the weight off, a payoff that can forestall the development of diabetes and heart disease and often leads to years of better health.

"Diabetes is expensive to treat," says lead study author Kenneth E. Thorpe, a professor at the Rollins School of Public Health, Emory University. "Most of the growth in health care spending is linked to rising rates of diabetes, cholesterol, and high blood pressure—all conditions that weight loss can help reduce. Why not shift the focus to keeping people healthy?"

The proposal advanced in the new study comes at a time when members of Congress must enact changes in Medicare to tame rising spending and narrow the federal budget deficit. Under this proposal, Medicare could proactively prevent disease—and contain costs—by identifying people on the cusp of developing a costly chronic illness and subjecting them to a proven intervention—weight loss.

For the federal government, the proposal offers a tangible way to shift from the traditional system of paying for chronic diseases after they have already taken hold, Thorpe says. Currently, Medicare generally starts to cover Americans at age 65.  By then, many enrollees have already gained excessive amounts of weight and developed diabetes, a disease that cannot be cured and requires ongoing treatment. "It seems to me that Medicare has an incentive to reach out earlier and improve the health of people who will be coming into the program," Thorpe says.

Thorpe and his colleague Zhou Yang, an assistant professor at the Rollins School, modeled the proposal on a program developed by the Centers for Disease Control and Prevention, the YMCA of the USA, and— most recently—the private insurance company UnitedHealth Group. Under that program, which is conducted in partnership with YMCAs across the country, a trained lifestyle coach helps overweight people at risk for diabetes eat healthier food and increase physical activity. Studies of this program and others like it have found that participants age 60 and older lose weight and reduce the risk of developing diabetes by up to 71 percent.

To size up the impact of the proposal, Thorpe and Yang first studied a scenario that would enroll people in a weight loss program who are age 60-64 and not yet eligible for Medicare but are showing signs of a silent prediabetic condition. Most people who are prediabetic are unaware they have the condition, which is defined by borderline high levels of blood sugar and is often triggered by weight gain. If left unchecked, the vast majority of these people  will go on to develop diabetes, a serious sugar-processing disorder.

The authors estimated that the 16-week program would cost the federal government $590 million, and proposed two sources of funding: the Centers for Disease Control and Prevention's National Diabetes Prevention Program and the Prevention and Public Health Trust Fund.  However,  the investment would eventually end up saving Medicare an estimated $2.3 billion over the next ten years or $9.3 billion in net lifetime savings, the amount saved from the time of enrollment until the death of participants, which, according to the authors, is an average of 13 years.

Next, the team expanded the program to include overweight people who had high blood pressure or high cholesterol.  These people may have prediabetes but also face a high chance of suffering from heart disease in the future. Using this scenario, the researchers estimated that Medicare would eventually save $1.4 billion in ten years and accrue $5.8 billion in net lifetime savings, assuming a 70 percent participation rate.

Thorpe and Yang also ran an analysis in which they included both groups—those in the prediabetic category and those with high blood pressure or high cholesterol. In this case, they estimated Medicare savings of up to $3.7 billion over the next ten years and up to $15.1 billion over participants' lifetimes.

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13 Sep, 2011

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