ATLANTA – Community-based weight loss programs for individuals ages 60 years or older who are at risk for diabetes or heart disease could save Medicare between $7 billion and $15 billion over the lifetimes of one cohort of baby boomers, according to a study in the September Health Affairs.
Obesity, defined as body mass index (BMI) of 30 kg/m2, more than doubled from 18% to 37% of adults ages 65 years and older between 1980 and 2008, according to data from the Centers for Disease Control and Prevention. At the same time, obese adults spent about 40% more on health care than adults whose weight was normal, due to higher rates of diabetes and other chronic illnesses.
"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," study author, Kenneth E. Thorpe, Ph.D., of Emory University, Atlanta, said in a statement.
Dr. Thorpe and his colleague, Zhou Yang, Ph.D., proposed an evidence-based weight loss program for individuals ages 60 to 64 who are not yet eligible for Medicare, but who are overweight (BMI higher than 24) or obese and at risk for diabetes, cardiovascular disease, or both (Health Affairs 2011 [doi:10.1377/hlthaff.2010.0944]).
Specifically, they suggested expanding an existing community-based weight loss program developed by the CDC, the YMCA of the USA, and UnitedHealth Group, in which trained lifestyle coaches help overweight individuals select healthier foods and increase physical activity. The program is provided by 50 YMCAs and is available at more than 116 sites in 24 states. Studies of this and similar programs show that participants ages 60 years and older lose weight and reduce their risk of developing diabetes by up to 71%.
For the current study, the investigators used 2009 census data to estimate net savings to Medicare over a 10-year period over the lifetime of a single cohort of eligible individuals. Their findings were based on the assumption of participation rates of 70% and 55% of eligible individuals using two enrollment scenarios.
The first scenario would limit enrollment to individuals ages 60 to 64 who have prediabetes and whose BMI is higher than 24. The cost to enroll 70% of that target group would be about $590 million ($240 per person for 2.6 million participants) but would result in a net savings of $2.3 billion over 10 years and $9.3 billion in net lifetime savings. If 55% of those eligible participated, estimated savings would exceed $1.8 billion over 10 years and $7.3 billion in net lifetime savings.
The second scenario would broaden eligibility to individuals with the same BMI who were at risk for cardiovascular complications (high blood pressure or elevated cholesterol) regardless of whether they had prediabetes. If 70% of eligible patients participate, Medicare would achieve an estimated net savings of $1.4 billion over 10 years and $5.8 billion in net lifetime savings. If 55% of eligible patients participate, the estimated additional net savings to Medicare would be $1.2 billion over 10 years and $4.6 billion over participants’ lifetimes.
By extending eligibility to both at-risk groups, the authors estimate that Medicare would see net savings of $3 billion to $3.7 billion over the next 10 years and $11.9 to $15.1 billion over participants’ lifetimes, depending on the participation rate.
"Our results show the potential savings to Medicare if a proven community-based approach to reducing obesity and related chronic disease were to be made available, nationwide, to high-risk individuals soon to become Medicare beneficiaries," the researchers said. "In doing so, they also present a potential business case for the federal government to partner with the private sector in order to encourage broad enrollment in effective weight loss programs."
Estimated lifetime Medicare savings of $7 billion to $15 billion depend on several factors, such as how broad eligibility and participation are, the researchers say. They used a 4.2% weight loss impact to avoid overestimation, so the program might have larger effects than expected. The proposed program could result in even greater long-term reductions in federal health care spending by extending the program to additional individuals.
The investigators proposed funding the expanded program through the CDC’s National Diabetes Prevention Program and the Prevention and Public Health Fund. Both were established as part of the Patient Protection and Affordable Care Act of 2010 to identify approaches for improving the quality of health care and reducing costs.
The authors had no financial disclosures. The Peter G. Peterson Foundation provided assistance for the research.