Medicare

At least 10 percent of Medicare beneficiaries are diagnosed with diabetes. Although experts agree that close medical and patient monitoring is important to slow or prevent complications of the disease, Medicare beneficiaries are not receiving recommended levels of physicals, eye exams, blood tests, and other screening services. Several factors may contribute to low use of monitoring services, including doctors' lack of awareness of the latest recommendations and patients' lack of motivation to maintain adequate self-management care. Efforts by Medicare health maintenance organizations (HMO) to improve diabetes care have been varied but generally limited. The Health Care Financing Administration (HCFA) also has begun to test preventive care initiatives for diabetes and has targeted this area for special emphasis. But like the efforts of Medicare HMOs, HCFA's initiatives are quite recent, and the agency does not yet have results that would allow it to evaluate their effectiveness.

GAO noted that: (1) while experts agree that regular use of preventive and monitoring services can help minimize the complications of diabetes, most Medicare beneficiaries with diabetes do not receive these services at recommended intervals; (2) this is true both in traditional fee-for-service Medicare, which serves about 90 percent of all beneficiaries, and in managed care delivery; (3) the efforts of Medicare HMOs to improve diabetes care have been varied but generally limited, with most plans reporting that they have focused on educating their enrollees with diabetes about self-management and their physicians about the need for preventive and monitoring services; (4) very few plans have developed comprehensive diabetes management programs; and (5) at the federal level, HCFA has targeted diabetes for special emphasis and has begun to test preventive care initiatives, but like the HMOs, HCFA's efforts are quite recent and the agency does not yet have results that would allow it to evaluate effectiveness.