• Federal authorities have reported that the Medicare Advantage program has furthered its success in the past year.
• USA Today, The Hill and other news outlets reported on the Health and Human Services announcement.
• Medicare Advantage enables patients to pick among private health plan options as their Medicare coverage.  This provides beyond conventional Medicare’s one-size-fits-all approach.
• Since its inception, seniors have increasingly flocked to Medicare Advantage.  But the 2010 health reform law threatens to reverse this program’s popularity in the near future.

The HHS announcement again confirms that market-based models really work.  Medicare Advantage proves the point.

• The MA program’s good news — for now — is that average MA plan premiums have fallen 7 percent from a year ago.  Meanwhile, MA enrollment has risen 10 percent during that time period.
• More seniors have voluntarily opted for Medicare Advantage’s private insurance coverage.  Giving these consumers wider choice and greater competition has led to high satisfaction, lower cost and more covered lives.
• HHS reported that MA premiums have dropped 16 percent and enrollment has risen 17 percent since 2010.
• Seniors have 26 private health plan options to choose from, on average, through Medicare Advantage.  These private plans integrate doctor and hospital care, prescription coverage and preventive care benefits.
• Since MA came about in the 2003 Medicare Modernization Act, program costs have typically been less than the government had predicted.

The 2010 health law could very well spell trouble for seniors in MA plans.  Health reform built in drastic cuts to Medicare Advantage that have yet to take effect.

• Health plans that participate in Medicare Advantage have worked hard to offer attractive, affordable coverage packages.  But federal action is making deep cuts that will undermine the MA program.
• In 2015, cuts to MA funding start up.  That law slashes $200 billion from MA alone.
• The Congressional Budget Office has predicted stark effects from that degree of cutting.  MA enrollment will drop from 11.7 million seniors in 2011 to 7.5 million in 2018 — a decrease of more than a third of all participants.
• CBO also said MA premiums will rise on account of the cuts.

Forcing seniors out of a popular Medicare option makes no sense.  It’s wrong to disrupt the elderly’s existing health coverage, to diminish the quality and affordability of their coverage, and to push them back into one-size-fits-all Medicare.  While the MA program is still making gains, its losses due to unnecessarily deep cuts will soon begin.  Medicare needs more market reforms, not fewer.

• The Agency for Healthcare Research and Quality finds that U.S. healthcare costs are concentrated on a small slice of patients.  USA Today recently ran a story on these findings.

• This fact indicates that Americans don’t necessarily overspend on their medical care.  In 2009, Americans devoted a total of $1.26 trillion to health care.

• Heavy spending on a few may skew the picture of the many.  And even for the few, the cost concentration has lessened.

AHRQ’s study gives a clearer picture of how American healthcare dollars get allocated.

• The 1 percent of Americans receiving the most medical care explains 22 percent of the nation’s healthcare costs.  The other 99 percent accounts for 78 percent of the healthcare pie.

• The sickest 5 percent consumed half of the nation’s health costs in 2009.  Fully 95 percent split the other half of the overall U.S. health spending.

• In dollar terms, each of the people with the most health expenses in the 1 percent averaged $90,000 per person in health costs.  Those in the top 5 percent of most expensive patients each accounted for $36,000 per person.

• By comparison, in 1996, 28 percent of total health spending went to the top 1 percent.

This report also shows who demands the most in U.S. health spending.

• AHRQ looks at those in the top 10 percent of healthcare consumers, based on expense, for two years running, 2008 and 2009.

• In short, these patients are elderly women in public healthcare programs.  These high-cost patients rely on Medicaid and Medicare, putting ever-greater strain on these already-financially-challenged public health programs.

• Though not a huge proportion of Medicare or Medicaid populations, those patients eligible for both programs absorb a significant share of the programs’ financial resources.

As ARHQ shows, most Americans needing healthcare don’t impose an inordinate amount of costs for their care.  Health leaders have called for better coordination of care, which becomes especially important as age, illness and government health program reliance converge.  Care coordination improves quality while controlling costs.

• The Gallup polling company’s Healthy Behaviors Index – a component of the Gallup-Healthways Well-Being Index — shows that those with health coverage have healthier habits than do those without insurance.
• The survey focuses on adults between 18 and 64 years old.
• Healthy lifestyles and having health coverage combine to benefit Americans with longer, healthier lives.

The Gallup-Healthways Index tracks how the insured consistently practice healthier living.

• More than age, sex, education, employment, income or ethnicity, being insured correlates more closely with specific healthy conduct.
• This survey asks if respondents smoke, exercise regularly and eat healthy foods.
• Working-age adult Americans, 80 percent of whom report having health coverage, develop healthy habits.
• Those with insurance smoke at dramatically lower rates than do the uninsured — 20 percent versus 36 percent, respectively.
• The insured eat at least five servings of fruits and vegetables four or more days in a week.  Fifty-six percent reports doing so, compared with half of the uninsured.
• Fifty-three percent of the insured exercise for half an hour or longer at least three days a week.  Fifty-one percent of the uninsured exercise that regularly.

This survey doesn’t claim that insurance status causes healthy behavior.  It examines how the two factors relate to each other.

• Insured Americans consider their overall health as better than the uninsured rate their own overall health.
• It’s clear there’s room for job-based wellness to further the level of healthy living.  Only 8 percent of American workers believe strongly that their workplace takes steps to boost their physical health.
• In the next few years, employers will gain greater incentives for adopting workplace wellness programs.

There’s no denying that health insurance coverage and healthier behavior are related.  Health leaders believe that wellness initiatives can enhance healthy habits.  As such programs expand in the workplace, more Americans will likely adopt better habits.  And the fact that most Americans with private health coverage obtain it through a job bodes well for long-term health and wellness.

 (The Healthcare Leadership Council is a member of the Diabetes Advocacy Alliance.)

Washington, DC –America cannot stop the growing wave of type 2 diabetes—and its complications and costs—unless the recommendations for screening are broad enough to identify patients who are at risk for the disease. Screening people at high risk for diabetes can identify those with prediabetes, who can be referred to low-cost, community-based diabetes prevention programs.  Screening can also identify those who have diabetes but do not know it, and get them into treatment as early as possible.

Those were the views expressed today by the Diabetes Advocacy Alliance™ (DAA) —a diverse coalition of 18 organizations that has come together to change how the nation approaches the health and economic burdens posed by diabetes—in welcoming the January 2012 issue of the policy journal Health Affairs focused on the topic of diabetes.

“One of the most critical health challenges in 2012 is to fully address the grave danger that diabetes poses to the health of Americans and the health of the US economy—and diabetes screening guidelines that are multiple risk-factor based are an important part of that,” said Martha Rinker, Chief Advocacy Officer of the American Association of Diabetes Educators, which is a DAA co-chair organization.

“Diabetes is a public health crisis that threatens to overwhelm our health system,” Rinker said. “Some 79 million Americans are on the verge of diabetes and another 7 million have undiagnosed diabetes.  We could very likely prevent millions of those people from experiencing the terrible complications of diabetes—such as heart disease, stroke, blindness, chronic kidney disease, amputation, and even death—if we institute expanded diabetes screening guidelines that identify more people who are truly at risk for this disease.”

The DAA applauded an article in the current issue of Health Affairs, titled “The U.S. Preventive Services Task Force Should Consider a Broader Evidence Base in Updating Its Diabetes Screening Guidelines.” The article calls for the government’s preventive services task force to consider a broader range of evidence—as well as a body of new evidence on the benefits of diabetes screening—when the group next updates its recommendations on screening for type 2 diabetes.  The authors also recommend that primary prevention of type 2 diabetes be added as an important near-term health outcome when assessing the value of screening.

Currently, the U.S. Preventive Services Task Force (USPSTF), an independent panel of primary care providers who are experts in prevention and evidence-based medicine, calls for screening for type 2 diabetes only in those individuals who have high blood pressure and may be at risk for cardiovascular disease.  USPSTF does not call for screening in individuals who have other risk factors, such as being overweight or having a family history of diabetes, which put them at high risk for type 2 diabetes itself.

USPSTF recommendations offer guidance to physicians and other primary care providers on providing appropriate preventive care, and health insurers often consider them in making decisions about whether or not to cover preventive services. Under the provisions of the Affordable Care Act, insurers will be required to offer all preventive services that receive an “A” or “B” designation from USPSTF with no cost-sharing requirements.

“The recommendations of the U.S. Preventive Services Task Force overlook the importance of screening many of the individuals and subgroups, such as many minority groups, who are at very high risk for type 2 diabetes,” said Michael Duenas, O.D., Chief Public Health Officer of the American Optometric Association, a DAA member co-chair organization.  “With the unprecedented focus on prevention shepherded in by health care reform, the time is right to adopt multiple risk factor-based screening guidelines that can help address a disease that is largely preventable.”

The Health Affairs report says that high quality clinical trials and new modeling studies provide evidence for the short- and long-term benefits of screening individuals at high risk for type 2 diabetes. It also recommends that USPSTF take into account studies that show the impact of screening and treatment in populations particularly at high risk for diabetes, including African Americans, Latino Americans, families with a history of diabetes, and others.

“Screening is the first step in preventing or delaying this deadly disease or its devastating complications,” said Tekisha Everette, PhD, Managing Director of Federal Government Affairs at the American Diabetes Association, which is a member of the DAA. “As such, the United States Preventive Services Task Force needs to look at reports such as the one in Health Affairs that offer new insight and a more relevant analytical framework for updating the existing recommendations. The reality is that many groups at very high risk for diabetes are currently overlooked by the existing guidelines.”

The DAA sees screening as the primary tool for identifying individuals who already have diabetes or whose elevated glucose levels place them on the verge of diabetes—a condition known as prediabetes.  Once identified via screening, patients with confirmed cases of diabetes can receive care that helps reduce complications of the disease; while those on the verge of diabetes can reduce their risk of developing type 2 diabetes through lifestyle changes that include weight reduction and increases in physical activity. One such lifestyle intervention program is the YMCA’s Diabetes Prevention Program, currently offered at YMCAs across the US, under the umbrella of the Centers for Disease Control and Prevention’s National Diabetes Prevention Program.

The DAA is a diverse group of 18 patient advocacy organizations, professional societies, trade associations, nonprofit organizations, and corporations, sharing a common goal to defeat diabetes.  Members of the DAA currently include the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) , American Association of Clinical Endocrinologists, American Association of Diabetes Educators, American Clinical Laboratory Association, American Diabetes Association, American Optometric Association, American Podiatric Medical Association, Healthcare Leadership Council, Medicare Diabetes Screening Project, National Association of Chain Drug Stores, National Community Pharmacists Association, National Kidney Foundation, Novo Nordisk Inc., Pediatric Endocrine Society, Results for Life, The Endocrine Society, VSP® Vision Care, and YMCA of the USA.

Visit the DAA website at www.diabetesadvocacyalliance.org