The news that Medicare has agreed to pay the cost of the YMCA of the USA’s Diabetes Prevention Program (DPP) for up to 10,000 qualifying Medicare enrollees over the next three years, as reported on The NonProfit Times’ website, is not just good news for Y. It could benefit the American taxpayer as well, since the initiative is predicted to save Medicare an estimated $4.2 million over the next three years, and potentially $53 million over six years.
Heart disease, stroke, diabetes, asthma, and other chronic diseases account for about 70 percent of all deaths in the United States and gobble up an estimated 75 percent of the money Americans spend on health care, according to the Centers for Disease Control and Prevention. Unless we can reach people at risk of chronic disease with the right interventions, these largely preventable diseases threaten to halt or even roll back gains in Americans’ health and life expectancy.
The good news is that for some chronic diseases we have a pretty good idea of what it takes to change individual behavior. Consider diabetes: 26 million Americans already have the disease and the National Diabetes Information Clearinghouse estimates that 79 million more are at risk with pre-diabetes, a condition where blood glucose levels are elevated but not yet high enough to be diagnosed as diabetes. A research effort led by the National Institutes of Health (NIH) found that a structured lifestyle intervention could reduce the risk of developing Type 2 diabetes by almost 60 percent among people with pre-diabetes.
The challenge for this and other evidence-based interventions targeting chronic diseases is to move beyond small-scale demonstrations to reach the people who need it. Indeed, by 2006, four years after NIH had unveiled results of its DPP study in the New England Journal of Medicine, few people were receiving the intervention and an estimated 5 to 6 million more had developed the disease.
Enter national nonprofit networks. The YMCA of Greater Indianapolis crafted an adaptation of the DPP, working with researchers to ensure that this lower-cost group version produced similar health benefits. The program is now being rolled out across the network. With approximately 900 local Ys with more than 2,600 branches around the country serving millions of people each year, there is plenty of room for growth.
The Y and other such networks don’t employ doctors and nurses, provide clinical services, or treat patients. What they offer are features that are both hard to replicate and uniquely suited to the task of changing thinking and behavior on a national scale:
- A presence in communities across the nation;
- Large numbers of people already coming through their doors; and,
- Staff and volunteers with deep knowledge and expertise about the communities they serve.
The Y isn’t the only network that sees the potential for using its expertise and reach to address chronic disease. OASIS, a 30-year-old organization that serves adults age 50 and older, got interested in a school-based curriculum called Coordinated Approach to Child Health (CATCH), shown by the NIH to produce significant reductions in childhood obesity.
OASIS uses its older adult volunteers, rather than teachers, and has adapted the curriculum for after-school settings. The CATCH Healthy Habits program, as the OASIS adaptation is known, is now offered by approximately 500 older volunteers at 95 locations across 14 states. It reaches more than 3,900 children in grades K – 5.
Many nonprofits attempt to scale up their programs. What sets the scaling efforts of networks like the Y and OASIS apart is that they are using a pre-existing distribution infrastructure for something other than its original purpose. And the Y and OASIS are not the only nonprofits with large distribution networks that can be mobilized.
The Boys & Girls Clubs of America has 50,000 trained staff and reaches almost 4 million young people annually through its 4,000 clubs. Organizations like Girls Inc. and Big Brothers Big Sisters of America engage many hundreds of thousands of children and youth each year. These nonprofit networks have a reach and impact into day-to-day life in communities that few organizations can rival.
The experience of OASIS and the Y suggest that such networks must undertake four key tasks to successfully scale public health interventions:
(1) Find an intervention that fits their mission and capacities;
(2) Adapt the intervention so it can be delivered in the community;
(3) Maintain fidelity to the intervention, as the Y did by creating a small team devoted to supporting implementation of its DPP program across the network; and, (4) Secure funding to scale up the intervention.
Money is, of course, a big challenge when it comes to turning promising pilot programs into large-scale efforts that can reach tens of thousands of people across the nation.
Both the Y and OASIS got initial help from philanthropy. But the YMCA’s DPP got its biggest boost when the giant insurer UnitedHealth Group began reimbursing the Y for its eligible insured customers that participated in the program. Now, the news that Medicare has agreed to pay for the program for some enrollees, at least on a trial basis, opens up a whole new horizon for the Y or other networks that can demonstrate real cost-savings from their chronic disease prevention programs.
While much remains to be done to prevent and manage major chronic diseases, national nonprofit networks can make a significant contribution to the effort. If government, philanthropy, public health researchers, and insurers support the move, the consequences for the nation’s health could be far-reaching and long lasting. NPT
Taz Hussein is a partner at The Bridgespan Group and a co-leader of the firm’s public health practice area. Michaela Kerrissey is a consultant at The Bridgespan Group.