Medicare To Reimburse YMCA For Diabetes Participants

Participants in 17 of the 77 communities where the YMCA of the USA runs a Diabetes Prevention Program will be able to have Medicare pay for the program. It’s part of a project to show that an evidence-based prevention program delivered by a community-based organization can lower incidence of Type 2 diabetes and reduce costs incurred by Medicare.

The program will have no cost to 10,000 qualifying Medicare enrollees during the next three years. The initiative is expected to save Medicare an estimated $4.2 million during the period and $53 million over six years.

The project is funded through a Health Care Innovation Award from the Center for Medicare and Medicaid Innovation (CMMI) in Baltimore, Md.

“Diabetes is a leading driver of health care costs and prevention must be a key strategy for lowering costs,” said Neil Nicoll, president and chief executive officer of Y-USA. “Through this demonstration project we not only want to show positive health outcomes, but also 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.

“Community-based, affordable solutions that have been proven to prevent Type 2 diabetes are vital,” says Ann Albright, Ph.D., R.D., director of CDC’s Division of Diabetes Translation. “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’s initiative for Medicare beneficiaries is a key step to making sure they have access to effective prevention programs.”

This is a fee-based program, with insurance, employers or participants paying a fee, that starts as low as $40 but scales upward based on ability to pay, said Matt Longjohn, M.D., senior director of the Y-USA’s Chronic Disease Prevention Programs. It costs approximately $350 to deliver the program. Approximately 15 percent of the people in the program are Medicare eligible and he expects that to grow by 900 people per month combined in the 17 communities.

Communities participating in the demonstration project are:

• Arizona: Phoenix and Tucson
• Delaware: State of Delaware
• Florida: Clearwater, St. Petersburg, Tampa and Venice
• Indiana: Indianapolis
• Minnesota: Minneapolis/St. Paul
• New York: New York City
• Ohio: Cincinnati, Cleveland, Columbus and Dayton
• Texas: Arlington, Dallas and Fort Worth

The program is already running in these 17 communities, said Longjohn. The only difference is that Medicare participants will use the system just like any other participant whose insurance or employer covers the program.

Visit YMCA.net/diabetes to learn more about the program.