Dive Brief:
- Diabetes prevention is set for a major push for the sake of both public health and reducing healthcare costs to protect the Medicare Trust Fund under the new 2017 Physician Fee Schedule final rule, CMS Acting Administrator Andy Slavitt highlighted in a CMS Blog post Wednesday.
- Additional changes around Medicare payments for primary care, care coordination, and mental healthcare are expected to make an additional $140 million in funding available to providers in 2017.
- The rule further finalizes coding and payment changes for care using the Psychiatric Collaborative Care Model that champions a coordinated approach shown to both reduce costs and improve behavioral health outcomes.
Dive Insight:
The expanded model of the Medicare Diabetes Prevention Program, set for January 2018, is notable not just due to the scope of its aim, but also because it marks the first time a prevention model from the CMS Innovation Center is being adopted under the CMS to reach all eligible beneficiaries, touted the CMS announcement.
Diabetes is a major population health target because it is estimated that more than a quarter of those over 65 have diabetes, and that Medicare will spend an extra $42 billion in 2016 alone because of that. Per beneficiary, that comes to about $1,500 more for Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more for physician and other clinical services for patients with diabetes than patients without, the CMS said.
The push to save on diabetes costs follows a grim outlook earlier this year from the Boards of Trustees for Medicare that bumped the predicted depletion date for Medicare's hospital insurance (HI) trust fund up by two years compared to its previous estimate, suggesting the program will be insolvent in 2028.
The new changes around mental health, aside from pushing coordination of care, also focus on access for behavioral and mental healthcare and aim to ultimately save money. Those follow other CMS updates from earlier this year that sought to ensure that mental health and substance use services would be covered on par with services for physical conditions for Medicaid and CHIP enrollees.