OR WAIT 15 SECS
Leader of the YMCA’s Diabetes Prevention Program explains how it is improving diabetes care.
Chronic diseases, such as diabetes, have reached epidemic levels in the U.S. One in three of the 86 million Americans with prediabetes currently has no idea that they have this condition, and that they are at high risk of developing full-blown diabetes. Without intervention, 30% of those adults are likely to develop type 2 diabetes within five years.
“Unfortunately, gaps in opportunities for healthy living exist in cities and towns across the country,” according to Matt Longjohn, MD, MPH, national health officer for YMCA of the USA, and the YMCA’s Diabetes Prevention Program (YMCA’s DPP).
To help close these gaps, or reduce barriers, the YMCA is expanding its mission work to include becoming a catalyst for community integrated health.
To help combat the spike in prediabetes, the YMCA’s DPP helps adults with prediabetes reduce their risk for developing type 2 diabetes. More than 47,700 people have participated in the DPP to date across 47 states and in more than 1,600 program locations.
How the program works
Facilitated in a group setting, the DPP helps participants lose 5% to 7% of their body weight and increase their physical activity to 150 minutes per week through moderate physical activity equivalent to brisk walking. Trained lifestyle coaches lead small groups of participants in discussing healthy behavior changes. The program consists of 25 one-hour sessions delivered over the course of a year.
The DPP uses a CDC-approved curriculum and is part of the CDC-led National Diabetes Prevention Program. The YMCA program has been shown to prevent or delay new cases of type 2 diabetes by 58% and as much as 71% in adults older than age 60 years.
Last spring the YMCA’s DPP was certified by the HHS to reduce costs and lower incidence of type 2 diabetes Medicare participants.
Medicare estimated a savings of $2,650 for each person enrolled in the Diabetes Prevention Program over a 15-month period, more than enough to cover the cost of the program ($150 for the year, you don’t have to be a YMCA member to participate, and the YMCA will never turn anyone away due to their inability to pay).
This marks the first time that a preventive service pilot program, which was funded by a $12 million Health Care Innovation Award from The Center for Medicare and Medicaid Innovation (CMMI)-has proven to reduce cost and lower incidence of type 2 Diabetes.
Longjohn talked with Managed Healthcare Executive about the DPP and the benefits of bridging the gap between clinician and community.
Q: Why would managed care execs be interested in the DPP program?
Longjohn: The YMCA’s DPP is one of the world’s largest and most well-researched behavior-change programs. Over the past 15 years it has become recognized as the standard of care in preventing type 2 diabetes and certified as a cost-saving intervention. Managed care executives who are looking to achieve improvements in patient health, care quality and their bottom line should all be considering how to integrate this proven program into their clinical pathways as a preventive service.
Knowing managed care executives are responsible for delivering medical services in ways that improve quality and reduce costs, these professionals can look to the YMCA’s DPP as a resource to integrate within their healthcare systems (hospitals, clinics and PCP practices, etc.), as a community-integrated intervention to which they can refer patients for services that address problems that are often too time-intensive or expensive to manage in their health care setting.
As a covered entity, the Y can accept electronic referrals, code for the service as a claim, and be reimbursed using a value-based payment model; all while producing clinically significant outcomes at 20% of the cost seen when the same services are delivered within healthcare systems.
Q: What led to the YMCA’s DPP program? What was happening at the YMCA that warranted it?
Longjohn: The YMCA’s DPP uses a curriculum approved by the Centers for Disease Control and Prevention (CDC) and is part of the CDC’s National Diabetes Prevention Program. The YMCA’s DPP offers access to trained lifestyle coaches who empower small groups of participants to develop healthy eating habits, increase physical activity and make other lifestyle changes to improve their health profile and overall well-being.
Because the YMCA’s DPP is delivered at local facilities that people trust, respect and frequent regularly, the Y has been able to leverage its presence in more than 10,000 communities across the country to begin scaling and disseminating deliver this life-saving and cost-effective intervention.
In 2016, the Y completed a four-year $12 million Health Care Innovation Award demonstration project in cooperation with the Center for Medicare and Medicaid Innovation (CMMI). In this project the Y was able to serve nearly 8,000 Medicare beneficiaries in 17 cities.
In March 2016, the U.S. Department of HHS announced that the demonstration was the first in history to be a cost-saving community-based preventive service. A claims-based evaluation showed cost savings for Medicare participants of $2,650 per person over a 15-month period; a five-to-one return on investment from the approximate $500 yearly cost of the program.
This finding has enabled HHS draft regulations that will allow Medicare to cover CDC-approved Diabetes Prevention Programs, like the YMCA’s DPP, as a covered benefit beginning in 2018.
Q: Based on your experience, what have you learned from the program, implementation, etc., that you could pass on to managed care executives?
Longjohn: Regardless of the political fate of the Affordable Care Act, it’s clear that healthcare purchasing trends and other forces behind healthcare transformation (e.g., the need to increase accessibility and use of preventive services and behavioral health interventions) are creating the need for Community-Integrated Health solutions like the YMCA’S DPP. The value proposition behind low cost, well-researched, community-based and cost-saving interventions is too big to ignore.
Q:What does the future hold for the program?
Longjohn: With 2,700 locations and a presence in more than 10,000 communities in the U.S., the Y is one of the few community-based organizations with the ability to scale a program that takes preventive services out of the clinic and directly to the people who need it most. The Y is continuing efforts to scale evidence-based interventions and integrating with clinical systems to play our part in helping to transform our healthcare system into one that values prevention over treatment.
The HHS announcement and certification of cost-savings started a process that is expected to allow CDC-recognized Diabetes Prevention Programs to become a covered benefit for Medicare beneficiaries with prediabetes. While the government supports expansion of the Diabetes Prevention Program it must go through a lengthy period of rulemaking and public comment. A first set of rules was finalized in November of 2016, and more rules are expected to be finalized in 2017 to make this program a covered benefit in 2018 at the earliest.
In 2016, with the support of the Robert Wood Johnson Foundation, the Y has become even more integrated into health care. Local Ys are obtaining National Provider IDs becoming recognized covered entities, using athenahealth as the Y’s electronic health record and claims processing platform, and using recently approved CPT codes to issue claims to insurers.
Beyond diabetes, we are also working with partners to help develop ways to bridge the “community to clinic gap” in other areas of concern, like hypertension. Together with the American Heart Association, we are working to develop delivery model that aims to enhance clinical care by creating a direct link to the community, more people with high blood pressure will be connected to resources that help them achieve better health. The enhancements will include innovations to connect clinics with local Ys in 10 cities. As part of this effort, the Y will engage the communities at large, to help at-risk individuals and groups better manage their blood pressure using the most current science-based programs shown to produce better blood pressure control.