April 16, 2012, 11:39 a.m. ET
A new health program being rolled out at YMCAs across the country shows the potential for a community-based organization to deliver a nationwide health-care intervention.
The Y’s target is diabetes. Research has shown that the program, which combines exercise, dieting and individual counseling, can have a big impact in reducing incidences of diabetes. Impressed by the research, insurers and employers are providing direct funding as the YMCA seeks to enroll participants in the program and induce them to reach weight-loss targets.
If it succeeds, the YMCA diabetes-prevention program could help slow the spread of a disease for which about 79 million U.S. adults are currently at risk. What’s more, it could encourage other uses of large community-based groups to attack specific health-care issues in a national coordinated way.
Indeed, there is nothing to stop other large nonprofits with footholds in communities across the country from playing a similar role as “adjunct providers in the health-care system,” says Jonathan Lever, vice president for health strategy and innovation at the Chicago-based YMCA of the USA, the national office for YMCAs in the U.S.
Brandon Sullivan for The Wall Street Journal
LET’S MOVE Sarah Shimchick leads a Phoenix YMCA diabetes-prevention class on a half-hour walk that includes talks on healthier eating.
The Y effort is based on a simple model. The YMCA gets reimbursed by insurance companies and employers for people who enroll in the yearlong diabetes-prevention course. If class enrollment goals are reached, and if participants lose 5% to 7% of their body weight over the year, the Y gets additional payments.
Saving Lives and Money
The reason insurers and employers are willing to ante up: Preventing diabetes can save them and the health-care system enormous amounts of money. According to Tom Beauregard, an executive vice president of UnitedHealth Group Inc., UNH -1.19%the Minneapolis-based insurance company that set up the reimbursement mechanism, it costs about $3,700 a year on average to treat a person with prediabetes, or those with elevated blood sugar that’s not high enough to be considered diabetes. In contrast, treating someone with advanced stages of diabetes tops $20,000.
Type 2 diabetes is a disease characterized by high blood-glucose levels caused by the body’s inability to either make or properly use insulin, according to the Centers for Disease Control and Prevention in Atlanta. At least 26 million Americans already have the disease, which increases the risk of a host of other medical problems such as heart attacks and strokes.
The YMCA classes are designed based on a diabetes-prevention study by the National lnstitutes of Health that compared the effectiveness of the diabetes drug metformin with a program aimed at helping people lose at least 7% of their body weight through diet, exercise and individual behavioral counseling. The results, published in 2002, showed those in the lifestyle-intervention group lowered their risk of developing diabetes by 58% over three years, while those on metformin had a 31% reduced risk.
However, the lifestyle-intervention approach was criticized for being too costly. Researchers at Indiana University later refined the lifestyle course and worked with the YMCA in Indianapolis to see if similar results could be achieved through classes led by less-expensive, non-medical professionals.
The yearlong course that resulted, which starts with 16 weekly classes followed by monthly classes—encourages people to find ways to exercise 150 minutes a week and cut calories by focusing on the amount of fat consumed. The course also provides strategies to help people make permanent behavioral changes.
Based on the results from Indiana and another test site in Kentucky, the Centers for Disease Control provided funding for the YMCA to offer the classes at a handful of facilities.
Then the effort got a major boost in 2010, when UnitedHealth Group approached the YMCA and the Centers for Disease Control about scaling up the program and setting up a reimbursement program.
“It really changed the dynamic,” says Mr. Lever, the YMCA of the USA official. Classes are now offered at 48 YMCAs in 26 states, and the Y plans to add more. The Centers for Disease Control is also continuing to provide some funding for start-up costs such as training additional lifestyle coaches and providing program materials. The YMCA gets reimbursed up to $500 per participant—but less if people fail to achieve weight-loss goals or don’t attend the majority of classes.
UnitedHealth Group has set up a division called the Diabetes Prevention and Control Alliance, which markets the YMCA program to United Healthcare members, other employers and even other insurance companies. General Electric Co. GE +0.11%offers the program to its employees.
Mr. Beauregard says the alliance uses insurance claims data and demographic information to identify who in a company is at risk for developing diabetes, which includes people who are overweight or have another condition like elevated cholesterol levels or high blood pressure.
Coping With Munchies
The program appears to work because it’s simple and focuses on realistic exercise and weight-loss goals. It’s aimed at helping participants give each other strategies for coping with late-night munchies, for example. The program also allows people to use YMCA facilities to exercise free of charge while they are participating in classes.
Sarah Shimchick, a program coordinator at the Valley of the Sun YMCA in Phoenix, explains that initial diet advice focuses on counting fat grams and helping participants aim to lose 5% to 7% of their body weight, which often equates to about 15 pounds for people to see health benefits and prevent the transition to diabetes.
Fred Lopez, 48, who works for a law firm in Phoenix, says he gradually packed on an extra 30 pounds. “I exercised somewhat but I really wasn’t committed on the diet side.” A couple of years ago his doctor put him on Trilipix after a blood test showed he had “extremely high” levels of triglyceride, a type of fat in the blood.
Last year, Mr. Lopez says, his wife saw a flier at their local YMCA offering the diabetes-prevention program, and they both enrolled. Mr. Lopez says he has lost 25 pounds, exercises almost daily and feels terrific. “I have more energy, and I’m no longer exhausted at night.” At his latest doctor’s visit, Mr. Lopez was taken off Trilipix.
Ms. Corbett Dooren is a reporter for The Wall Street Journal and Dow Jones Newswires in Washington, D.C. She can be reached at firstname.lastname@example.org.
A version of this article appeared April 16, 2012, on page R8 in some U.S. editions of The Wall Street Journal, with the headline: The Y Takes On Diabetes.
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