As we announced before, the Centers for Medicare and Medicaid Services is evaluating including intensive behavioral counseling for adults with obesity as a Medicare benefit. Below are comments we just filed with Medicare. (The comment period closes September 30, 2011) Readers still have time to submit their own comments.
Sarah McClain, MHS
Coverage and Analysis Group
Centers for Medicare and Medicaid Services
Mail Stop C1-09-06
7500 Security Boulevard
Baltimore, Maryland 21244-1850
Dear Ms. McClain,
The proposed coverage of intensive behavioral counseling of adults for obesity is both indicated by its endorsement by the United States Preventive Services Task Force , subsequent literature, and two studies published in the last month.
The Look AHEAD study has focused on the benefits of lifestyle changes to achieve weight loss in overweight/obese participants with type 2 diabetes. The study population which received intensive lifestyle intervention (such as that contained in the proposed decision memorandum) obtained superior results to those receiving usual care (diabetes support and education.) At year 4, there was a 4.7% reduction from initial weight in the intensive lifestyle group compared to 1.1% in the usual care group. 46% of the intensive lifestyle group lost more than 5% of initial weight and 23% lost more than 10%. (The usual care group saw 25% lose more than 5% and 10% lose more than 10%.)
As these results would predict, the intensive lifestyle group had significantly greater improvements in glycemic control and several markers of cardiovascular disease risk.
As with the Diabetes Prevention Program, the study’s oldest participants, 65-74 years of age, lost significantly more weight than younger counterparts at all 4 years, and reported lower daily caloric intake, higher physical activity and overall greater adherence to the behavioral program. (Wadden TA, Neiberg RH, Wing RR, et al, Four-Year Weight Losses in the Look AHEAD Study: Factors Associated with Long-Term Success, Obesity (2011) 19;10: 1987-1996.)
Thus, it appears that Medicare could ‘look ahead’ with some confidence that the proposed benefit can result in immediate health improvements to Medicare beneficiaries.
These health improvements can be economically quantified, although that is not necessary for the purposes of National Coverage Determinations. Recently, Dr. Kenneth Thorpe reported that a 10% reduction in weight in persons with obesity age 60-64 could provide Medicare with savings of $1.8 to $2.3 billion over ten years and even more if overweight pre-diabetic adults were included. (Thorpe KE, Yang Z, Enrolling people with prediabetes ages 60-64 in proven weight loss program could save Medicare $7 billion or more. Health Affairs 2011 Sep; 30(9):1673-9) While the study participants did not achieve the 10% criteria, their remarkable results indicate a significant cost saving to the Medicare program could be achieved.
For these reasons, the Centers for Medicare and Medicaid Services should not only implement the proposed decision memorandum for Medicare beneficiaries but to explore ways in which such intensive behavioral counseling for obesity may be utilized by as many obese beneficiaries as possible. This would include a two-prong educational campaign. The first prong would be directed to the appropriate health care professionals to make them aware of the benefit and how to achieve competency in intensive behavioral counseling. The other prong would be directed at Medicare beneficiaries to make them aware of the new benefit and possibilities of successful weight management.
Editor & Publisher, Downey Obesity Report