The Y Receives Innovation Grant to Test Cost Effectiveness of Diabetes Prevention Program Among Medicare Population
Demonstration project is expected to save Medicare program an estimated $4.2 million over 3 years and $53 million over six years.
WASHINGTON, D.C., June 18, 2012 Today, YMCA of the USA (Y-USA),the national office of the Y and a leading nonprofit committed to strengthening community through healthy living, has been named as a preliminary awardee of a Health Care Innovation Award by the Center for Medicare and Medicaid Innovation (CMMI). Y-USA is being funded to demonstrate how an evidence-based prevention program delivered by a community-based organization can lower incidence of type 2 diabetes and reduce the cost burden of the disease on the health care system.
The award, nearly $12 million over three years, will allow the Y to conduct a demonstration project in 17 communities across the nation to deliver the YMCA’s Diabetes Prevention Program to 10,000 Medicare enrollees and assess cost savings to the nation’s largest healthcare payer. The project is estimated to save the Medicare program $4.2 million over three years and $53 million over six years.
“This award from CMMI represents a turning point in the evolution of our nation’s health care system,” said Neil Nicoll, president and chief executive officer of YMCA of the USA. “It helps to shift the focus from a health care system that focuses on treatment to one that values prevention as a way to save health care dollars. It also helps to define a role for community-based organizations, like the Y, as cost-effective providers and partners in our changing health care environment.”
The YMCA’s Diabetes Prevention Program, a part of the Centers for Disease Control and Prevention (CDC) led National Diabetes Prevention Program, is a 12-month evidence-based program that includes 16 weekly core sessions followed by monthly maintenance sessions. The program is delivered in a classroom setting by trained lifestyle coaches and provides a supportive environment where a small group of individuals work together to learn how healthier eating and increased physical activity can help reduce their risk for developing type 2 diabetes. Long-term program goals include reducing participants’ body weight by 7 percent and increasing physical activity to 150 minutes per week.
Because research has shown that programs like the YMCA’s Diabetes Prevention Program can reduce incidence of diabetes among Medicare-age individuals by about 70 percent (compared to 58 percent for younger individuals), the program has been identified as a promising approach in lowering Medicare expenditures.
The demonstration project will take place in 17 communities where the YMCA’s Diabetes Prevention Program is currently available, but will provide best practices and create an infrastructure for serving the Medicare population. The funds will be used to:
- Reimburse Ys, on a pay for performance basis, for delivering the program to at least 10,000 Medicare beneficiaries
- Help 17 Ys recruit and deliver the program to Medicare beneficiaries and track health outcomes for those individuals
- Enhance technology platforms and call center infrastructure to determine and manage Medicare eligibility and process performance-based claims
- Create a national roundtable of partners that will help drive systems changes to increase awareness and enrollment into the program
“CDC estimates that as many as 1 in 3 Americans could develop diabetes in coming years,” says Ann Albright, Ph.D., R.D., director of CDC’s Division of Diabetes Translation. “Community-based, affordable solutions that have been proven to prevent type 2 diabetes are vital. The Y is a key partner in helping the National Diabetes Prevention Program organize those prevention efforts for Americans at high risk. Older Americans face the highest risk for type 2 diabetes, and the Y initiative for Medicare beneficiaries is a key step to making sure they have access to effective prevention programs.”
CMMI is part of the Centers for Medicare & Medicaid Services – the federal agency that administers the Medicare program (http://innovations.cms.gov/). CMMI fosters health care transformation by finding new ways to pay for and deliver care that both improve care and health outcomes while lowering costs. The Center identifies, develops, supports, and evaluates innovative models of payment and care service delivery for Medicare.
In 2010, the Y began a partnership with the Diabetes Prevention and Control Alliance (DPCA) – a subsidiary of Optum – and a collaboration with the CDC’s National Diabetes Prevention Program. Through these shared efforts, the Y has been able to expand the YMCA’s Diabetes Prevention Program from two Ys to 59 Ys in 29 states. DPCA, the program’s third party administrator, will play a significant role in developing and managing the technology infrastructure that will determine eligibility for the program, enroll Medicare beneficiaries into the program, and process claims. The partnership with DPCA has resulted in multiple payers offering the program to its insureds, including UnitedHealthcare, which was the first private payer to offer the program as a benefit and reimburse Ys on a pay for performance basis.
The Y was an inaugural partner with the CDC-led National Diabetes Prevention Program which is working to establish evidence-based lifestyle intervention programs in communities across the nation.
Leading non-profit organizations will partner with the Y in this effort, including the American Academy of Family Physicians, the American Diabetes Association, the American Heart Association, the American Medical Association, the National Association of City and County Health Officials, the National Council on Aging, and the National Council of La Raza.
“The American Diabetes Association is thrilled that the Y has been named as a preliminary awardee of the CMMI Health Care Innovation Award. This award will have a major impact in raising awareness for people who are at risk for type 2 diabetes, and providing them with the tools they need to prevent this disease and lead healthier lives,” said Larry Hausner, CEO, American Diabetes Association. “The Association looks forward to joining together with national organizations across the country to make this demonstration project a success and ultimately to Stop Diabetes®.”
The communities participating in the demonstration project are:
ARIZONA: Phoenix; Tucson
DELAWARE: State of Delaware
FLORIDA: Clearwater; St. Petersburg; Tampa; Venice
MINNESOTA: Minneapolis/St. Paul
NEW YORK: New York City
OHIO: Cincinnati; Cleveland; Columbus; Dayton
TEXAS: Arlington; Dallas; Fort Worth
“Diabetes is a major driver of health care costs in the United States. With CDC estimates predicting that one in three Americans will develop this disease by 2050, these costs will continue to grow. It’s imperative that we take action now to reverse this trend, and the Y is proud to be part of the solution” said Nicoll.
Visit YMCA.net/diabetes-prevention to learn more about the program, find out if it is available at your Y and see if you qualify. To learn more about the Y’s commitment to healthy living visit YMCA.net/healthy-living/.
About the Y
The Y is one of the nation’s leading nonprofits strengthening communities through youth development, healthy living and social responsibility. Across the U.S., 2,700 Ys engage 21 million men, women and children – regardless of age, income or background – to nurture the potential of children and teens, improve the nation’s health and well-being, and provide opportunities to give back and support neighbors. Anchored in more than 10,000 communities, the Y has the long-standing relationships and physical presence not just to promise, but to deliver, lasting personal and social change. ymca.net
YMCA of the USA