The dream treatment
Lifesaver offered old Americans fails
Why are so many Americans so unhealthy?
Could it be because the health-care industry and average Americans themselves just don’t want to make the effort to fix the problem?
One has to wonder after examining enrollment, or more accurately the lack thereof, in the Medicare Diabetes Prevention Program (MDPP) that offered free health coaching to U.S. seniors diagnosed with prediabetes in a country suffering from an epidemic of that disease and the often the related conditions of obesity and metabolic syndrome.
Along with helping to save lives, this free program was intended to save the government tens and possibly hundreds of millions of dollars on the costs of treating diabetics enrolled in Medicare, the government-funded health insurance program for American seniors.
Thus a free, prediabetes treatment program was developed in 2018 in the wake of that study. It was expected to immediately attract 65,000 to 100,000 Medicare recipients with 50,000 per year expected to enroll in the program in the years to follow.
By now, if the projections had been anywhere close to reality, somewhere between 250,000 to 300,000 Americans should have been aided by the plan. But as of April of last year, total enrollment since the beginning of the program totaled 9,015 people.
‘Pathetic’
This might be an understatement.
“Over 6 Years, a much-ballyhooed program enrolled only about 9,000 people out of millions eligible,” the trade publication reported, and not because of a lack of candidates.
When the program was envisioned, officials estimated that approximately 16 million overweight or obese Medicare enrollees with prediabetes would be eligible to participate.
“The MDPP is a lifestyle change program that promotes weight loss and exercise among
Medicare beneficiaries who are at high risk of developing type 2 diabetes,” that report says. “The MDPP core sessions focus on changing eating habits and encouraging physical activity. The maintenance sessions provide additional strategies for maintaining weight loss. Lifestyle coaches lead the sessions and, in some cases, provide supplemental support to participants between sessions via email, text, or telephone.”
Apparently, not many American seniors were interested in making an effort to change their unhealthy lifestyles or were happy with the lifestyles they were living, unhealthy or not.
The report does, however, indicate that the program didn’t get much support from the medical community, either. Health-care organizations, community organizations, state and local health departments; and YMCAs were all encouraged to enroll as providers for the program, and 1,139 did so, according to the report.
But only 414, or 36 percent, followed through on becoming approved providers, and of those only 357 actually participated in the program despite the government’s offer of payments of up to $768 per beneficiary, conditioned on attendance and weight-loss targets being met, the report said.
Outside of the Northeast, the program attracted only a handful of providers per state. As for participants in the program, few appeared to have gotten much help from their family doctors. Referrals from physicians brought in only about 4,500, according to the report.
Missing men
And if the overall turnout was “pathetic,” as MedPage put it, the participation of American men was even worse. Only 24 percent of MDPP beneficiaries, or fewer than 2,200 participants, were male, according to the report.
The good news was that the few who did participate had some success in losing weight, gaining fitness and keeping diabetes at bay.
Those who met the “5 percent weight loss goal had a 36 percent lower rate of diabetes incidence than MDPP beneficiaries who did not meet the 5 percent weight loss goal,” according to the report.
“Over the first 6 years of the program, more than half of beneficiaries (52.5 percent) achieved at least 5 percent weight loss, and 24.2 percent of beneficiaries achieved at least 9 percent weight loss,” it said.
“As part of the MDPP curriculum, lifestyle coaches work with beneficiaries to track how many physical activity minutes are completed each week of the program. The Centers for Disease Control (CDC) curriculum emphasizes recording physical activity minutes beginning in Session 5, and the program’s goal is for beneficiaries to achieve at least 150 minutes of physical activity per week. The percentage of beneficiaries who reported that they met the physical activity goal of 150 minutes was 60 percent by Session 6, 69 percent by Session 16, and 72 percent by
Session 22.”
One-hundred fifty minutes of exercise per week is not a high bar. It amounts to less than 22 minutes per day. And this physical activity, according to the report, came with benefits beyond weight loss.
“Beneficiaries also report a myriad of other shorter-term benefits…including improved behavioral health and other health outcomes,” said the report, which blamed the low provider participation in the program on government red tape and a lack of profits.
“Many of the MDPP suppliers and national partners we interviewed noted that current Centers for Medicare & Medicaid Services (CMS) administrative processes make it difficult to focus on recruitment as a good deal of staff time is dedicated to billing, submitting reports, and coding claims,” the report said. “One partner organization noted that the billing process is especially burdensome for small community-based organizations.
“Several suppliers also noted that the current level of reimbursement for the program does not cover the costs to run the program and requested that CMS consider increasing the
reimbursement rate.”
The report doesn’t provide much information on why individual participation in the program was so low, but did note that “some beneficiaries encountered challenges with the self-referral process.
“For instance, one beneficiary said they did not know where to begin, whereas another mentioned contacting multiple MDPP delivery sites before finding one that was responsive and accepting new participants.”
Some help from physicians might have helped there, but doctors showed little interest in engaging with the program.
Thus, the first-year enrollment of between 65,000 and 100,000 Medicare participants expected “because of pent-up demand,” actually amounted to 2,248 participants. And the 50,000 per year expected to enroll in the program in subsequent years failed to show.
Yearly enrollment never came within a sniff of those predictions even though the program was in 2022 shortened from 24 months to 12 months to encourage more enrollment. That didn’t help.
“The total number of new enrollees per year was highest in 2019, with 1,536 new MDPP beneficiaries,” the report said. “The overall number declined in 2020 to less than 1,000 because of the Covid-19. The number of new enrollees has been steadily growing since 2021.”
But by 2023, the program still hadn’t witnessed a year that reached the 2019 enrollment level.
Though the program could be considered a failure, it did help to compile some scary numbers on the level of physical inactivity among Americans 65 and older.
At Session 1, it reported, 86 percent of program enrolles admited they had failed to meet the physical activity goal of 150 minutes per week or less than 22 minutes per day. That’s a rather startlingly low number given that participants were given credit for physical activity for everything from “joining a gym and taking classes, to taking stairs more than elevators…(to) taking walks with their spouse or dog or using a pedal machine.”
A lot of their inactivity can obviously be blamed on technology that has taken physical activity out of almost every aspect of American life while encouraging a sedentary lifestyle tied to staring at television, computer and phone screens.
And this problem has only been compounded by urban planners who, in the 1960s, began designing communities more to suit motor vehicles than people and then let motor vehicles take over urban design.
Traffic in many places now discourages people from walking anywhere, either because they feel walking is unsafe or because in many, if not most cities and suburbs, it is easier to drive than follow convoluted safe-walking routes to get anywhere.
As a result, Americans have become addicted to motor vehicles to the detriment of public health, but it would appear from the Medicare findings that most don’t care. It appears they’d rather be fat and self-delusionally happy than engage in the minimal amount of physical activity considered necessary to stay healthy.
But then again, it’s not all their fault. The American medical community now promises medications to fix everything and anything, so why would anyone want to get sweaty and maybe even tired by engaging in exercise?
Categories: Commentary, News
