- The YMCA may not be a traditional healthcare provider, but its widely acclaimed diabetes management program sets a good example for organizations seeking innovative ways to boost patients’ chronic care skills while cutting costs.
The program, which heavily influenced the new National Diabetes Prevention Program (DPP) for Medicare patients, has significantly lowered the rate of emergency department visits and reduced inpatient hospital stays while saving the healthcare system an average of $278 per patient per quarter, according to a new study published in Health Affairs.
The community-based initiative aims to improve patient education about diabetes management, encourage more physical activity, and guide patients towards the behavior changes that can keep them healthy, active, and out of the hospital, according to a team of researchers from RTI International.
Using small group discussion sessions, personal coaching, and activity tracking, the program resulted in nine fewer inpatient stays and nine fewer ED visits per 1000 patients each quarter for three years.
“The YMCA of the USA (the Y), a nondenominational, nonprofit community-based organization, received a Health Care Innovation Award of $11,885,134 from CMS to test a lifestyle intervention prevention model for Medicare beneficiaries with prediabetes in seventeen regional YMCA networks nationwide,” the authors explained.
“The goal of the Y model is to get participants to lose 5 percent or more of their body weight and gradually increase their physical activity to 150 minutes per week.”
Previous studies have found that even small decreases in weight for diabetic patients can result in significant health improvements and better blood glucose control, the article continues, while changes in diet and physical activity level can help individuals maintain wellness for longer.
The YMCA program’s core curriculum teaches patients about the impact of diet and exercise on their conditions, presents strategies for making good lifestyle decisions, and encourages participants to engage in stress management and positive thinking to maintain motivation and prevent behavioral missteps.
“The core sessions are followed by eight monthly maintenance sessions that are focused on maintaining lifestyle changes and receiving continued support,” says the study. “The maintenance sessions are less structured than the core sessions and allow participants to continue meeting and discussing strategies to maintain or continue their weight loss. A participant can attend a maximum of twenty-four one-hour sessions over twelve months.”
After analyzing claims and other data for 3319 Medicare fee-for-service participants and a corresponding comparison group, the researchers found that YMCA program patients lost an average of 9.5 pounds between January 2013 and June 2015.
Throughout the course of the study, the 3319 participants produced more than $5 million in savings for Medicare, with cost reductions dropping sharply in the first year before leveling out somewhat in subsequent quarters.
Patients who entered the program with fewer health problems tended to produce even higher rates of savings, with $303 per member per quarter across the entire intervention period.
Hospital and ED utilization also dipped significantly among adherents to the diabetes management program, although in this case, the healthier and sicker subpopulations did not differ much in admissions or ED rates.
Source: Health Affairs
Interestingly, ED visit rates among the control group actually rose while the intervention group declined, despite similar rates of utilization during the baseline study period.
Overall, the program produced such positive results for diabetes patients that Medicare decided to make the YMCA’s model into the first reimbursement-eligible diabetes management program in the country.
The model’s ability to measurably reduce costs indicates that community-based coaching and educational strategies could help the tens of millions of patients with prediabetes and diabetes better manage their health while trimming unnecessary spending from the healthcare system.
“Based on the proposed reimbursement rates and our estimates of reduced spending, the return on investment of this program would be $2.2 per $1 for the first year and $3 per $1 for the three years for which we have data, assuming a 3 percent discount rate,” the study projects, adding that the estimate does not include pharmaceutical expenditure savings or Part D Medicare claims, which may offset each other to some degree.
Nevertheless, the study concludes, the relatively simple model could be expanded easily to communities across the country and may bring speedy improvements to diabetes and pre-diabetes patients.
“Based on the literature regarding the clinical trial of the CDC’s Diabetes Prevention Program and follow-up studies showing that the lifestyle intervention has a long-term effect on diabetes incidence, beneficiaries may experience greater longevity and quality of life as a result of the Y model—further increasing the return on investment in it.”