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Spotlight on Innovation: YMCA’s Efforts to Fight Chronic Disease

Better Medicare Alliance
Thursday, December 3, 2015

A Growing Crisis: YMCA Identifies Chronic Disease As A Top Priority

Chronic disease has been described as a growing crisis in the United States by health and economic experts as statistics show  devastating impact on quality of life and significant loss of life.  The YMCA, a worldwide community-based organization known for its health and wellness programs, decided to act to understand how chronic conditions – such as diabetes, congestive heart failure, chronic obstructive pulmonary disease, obesity – have an impact on their members and the communities they serve. The organization began a concerted effort to involve its staff and facilities  to combat the impact of chronic disease. 

An important part of this effort was the decision to hire Dr. Matt Longjohn, a noted physician and expert in chronic disease prevention and management, as YMCA’s National Health Officer. Dr. Longjohn is the first physician executive at the YMCA in 130 years. Dr. Longjohn has led the organization’s effort to identify opportunities to engage with government, health plans, providers, and a diverse array of community-based organizations across the country to address this problem.

Partners in the Fight Against Chronic Disease: YMCA and Medicare Advantage

The fastest growing segment of YMCA’s membership is the older adult population who rely on YMCA’s fitness and wellness programs for seniors. Many of YMCA’s senior members are enrollees in Medicare Advantage (MA), private managed care plans under Medicare, as result of  YMCA’s membership benefits being offered by specific MA plans in many markets. 

With the establishment of evidence-based chronic disease management programs where payment for services provided to MA beneficiaries is risk-based, YMCA has become a helpful partner. Using nationally recognized evidence-based programs, YMCA has taken on the responsibility to offer wellness, nutrition, and exercise programs to MA beneficiaries at risk for chronic disease,  with particular focus on outreach to underserved, minority beneficiaries.

Diabetes, in particular, is a critical problem among underserved Medicare beneficiaries. The YMCA has taken on this challenge by implementing a robust diabetes prevention program that combines exercise, nutrition assistance and individual counseling to reduce risk of the disease. The organization is reimbursed by MA plans for people who enroll and meet program goals. YMCA’s Diabetes Prevention Program (DPP) is a prime example of evidence-based, results-oriented work the organization has spearheaded and highlights how YMCA works with MA plans to improve care for seniors. 

YMCA’s DPP is based on a model developed by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). The NIH/CDC model, implemented over a ten year period, found that structured lifestyle interventions could reduce new cases of diabetes by 70% in people who were identified as pre-diabetic and older than 60. YMCA adapted this model, implementing it first at two sites, before scaling nationwide to 1,300 sites in 43 states and 186 cities. 

The program has been so successful that the Center for Medicare and Medicaid Innovation (CMMI) has been studying it to determine its applicability to the Medicare Fee-For-Service population. In 2012, YMCA received a $12 million Health Care Innovation Award to conduct a demonstration project estimated to save the Medicare program $4.2 million over three years and $53 million over six years. These savings are projected for a small subset of the Medicare population – based on participation of just 10,000 enrollees.

In an effort to address health inequity, the NIH initial DDP study oversampled underserved populations, including African-Americans, Hispanics, and low income participants in the development of the model that YMCA uses today with MA plans, according to Dr. Longjohn. Under the model, the YMCA hires health coaches from within communities at greatest risk, making the program more accessible to typically hard-to-reach enrollees. Programs are delivered in many foreign languages and accessible to those who are visually impaired.

The DPP is just one example of YMCA’s efforts. YMCA also provides programs for cancer survivors, arthritis self-management, blood pressure self-monitoring, and many others. Through the promotion of these programs, MA plans are able to leverage the important role that community-based organizations like YMCA play in underserved communities to create community integrated health models that yield results. 

Dr. Longjohn sees the role of YMCA as essential to promoting quality and improving outcomes for MA beneficiaries. Prevention programs targeted to risk reduction, slowing disease progression, and promoting healthy behaviors that the YMCA offers under MA are proving to help large numbers of enrollees who do not consistently engage with health care providers. Through the partnership with MA plans, YMCA is rewarded only when it actually changes the behavior of enrollees. This has led to  YMCA health and community staff interacting as a part of the expanded care team assigned to MA enrollees who have the potential to face or are managing chronic conditions. 

The YMCA’s effort to fight chronic disease is an innovative approach that involves community-based organizations in strategic partnerships with health care providers to successfully deliver health care interventions. The YMCA is proud of its innovative model and is looking forward to taking on more partnerships with Medicare Advantage plans.  YMCA will continue to seek ways to leverage its considerable capacity and its focus on healthy living for seniors to improve the lives of beneficiaries at risk of serious chronic disease.

About the YMCA

Since the establishment of the YMCA in the USA in 1851, the YMCA (the Y) has been innovating to meet the changing needs of the communities it serves. The Y is the leading nonprofit organization for youth development, healthy living and social responsibility. The Y’s mission is to implement programs that build healthy spirit, mind, and body for all. The Y has more than 2,700 facilities ,with approximately 19,000 full time staff and 600,000 volunteers, serving 10,000 communities across the United States. The Y engages 9 million youth and 13 million adults each year.

About Better Medicare Alliance

The Better Medicare Alliance (BMA) is a non-profit, 501(c)(4) advocacy coalition that brings together Medicare beneficiaries, health plans, hospital systems, providers, businesses, retiree organizations, senior service agencies, and advocacy organizations that support Medicare Advantage. BMA’s mission is to promote and sustain the federal policy that enables the option of Medicare Advantage within Medicare. BMA articulates the value of MA through research, policy, and engagement of organizations and beneficiaries as advocates for MA.

Diabetes Prevention Program Research Group, “Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin¸” NEJM Vol. 346, No. 6 (2002): 393-403.
 News Release, “The Y Receives Innovation Grant to Test Cost Effectiveness of Diabetes Prevention Program Among Medicare Population.” (June 18, 2012). Link: http://bit.ly/1LGxgFb