REDEFINE YOUR HEALTH

TRANSFORM YOUR LIFE

IMPROVING HEALTH
THROUGH THE YS
NATIONAL NETWORK OF
COMMUNITY-BASED
PROGRAMS

JULY 18, 2017

THE (WH)Y
3
 Anthony Bowen
founded the first
African American
YMCA in 1853.

4
 THE Y: ASSOCIATIONS & BRANCHES

OUR REACH
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HEALTHY LIVING
IMPROVING THE NATIONS HEALTH AND WELL-BEING

Critical Social Issues Affecting Our Communities:

High rates of chronic disease and obesity (child and adult)
Needs associated with an aging population
Health inequities among people of different backgrounds

Our Shared Intent:

To improve lifestyle health and health outcomes in the U.S., the Y will help lead the
transformation of health and health care from a system largely focused on treatment
of illnesses to a collaborative community approach that elevates well-being, prevention
and health maintenance.

Our Desired Outcomes:

People People reduce The healthy choice Ys emphasize Ys partner

achieve their the common is the easy, prevention for with the key
personal risk factors accessible and all people, stakeholders
health and associated affordable choice, whether they who influence
well-being with chronic especially in are healthy, health and
goals disease communities with at-risk or well-being
the greatest health reclaiming
disparities their health

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COMMUNITY INTEGRATED HEALTH

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 THE YS PIPELINE OF EVIDENCE-BASED
HEALTH INTERVENTIONS
DISCOVERY DEVELOPMENT DISSEMINATION
Efficacy Validation Translation Scaling Dissemination

Diabetes Prevention YMCAs Diabetes Prevention Program

Falls Prevention EnhanceFitness, Moving For Better Balance

Arthritis Self-Management EnhanceFitness

Cancer Survivorship - LIVESTRONG at the YMCA

Hypertension control Blood Pressure Self-

Monitoring
Childhood Obesity Intervention
Healthy Weight and Your Child

Brain Health

Parkinsons

Tobacco
Cessation
AN EXAMPLE

9
THE STATISTICS

DIABETES
29.1 million
Americans

People who know they

have prediabetes ~10%

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PREDIABETES
86 million Americans (37%
of all adults) with
progression to diabetes at
rate of 10% per year
50% of adults 65+ have
prediabetes; age alone
qualifies participants with
risk quiz
 A JOURNEY 20 YEARS IN THE MAKING

Chapter 6
Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Community
1997-2002 2005-2008 2008-2010 2010-2013 2014-2016 Integrated
Health

EFFICACY TRANSLATION VALIDATION SCALING DISSEMINATION

NIH IU Sch. of Medicine CDC Partnership with 250 Ys worked

YMCA of Greater YMCA of Greater TPA allowed first to serve more
Indianapolis Louisville 100 Ys to track participants and
participants and understand how
facilitate the health care
contracting with landscape has
third party evolved allowing
payors for new
opportunities for
11 | YMCA's CIH | 2017 YMCA of the USA sustainability
SIMILAR RESULTS HAVE BEEN SHOWN
ELSEWHERE

28 TIMES.

Analysis of 28 studies applying the findings of the DPP

research study in real-world settings
Average weight change was 4%
Weight change was similar whether program was delivered
by clinically trained professionals or lay educators
Every additional lifestyle session attended, weight loss
increased by 0.26 percentage point

Ali et al. Health Affairs, 2012

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YMCAS DIABETES PREVENTION PROGRAM
THE PROGRAM IS:
Led by a trained Lifestyle Coach
A year-long program: 25
sessions
Open to all community
members; YMCA membership is
not required
A Centers for Disease Control
and Prevention (CDC) - approved
curriculum

PROGRAM GOALS:
Reduce body weight by 5-7%
Increase physical activity to 150
minutes per week
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DELIVERING OUTCOMES AT SCALE:
YMCAS DPP By The Numbers
( as of 6/30/17)

Diabetes (29M) Participants attending 54,768

at least one session

Completers average 5.5%

year-end weight loss

Average physical 162.5

activity minutes per
week
Y associations 249
delivering program

States where the 47

program is available

Total program sites 1,699

Trained Lifestyle 4,334
Coaches
Low income 21.9%
Prediabetes
14 (86M) participants*
*Participants at or below Federal Poverty Guidelines
ACHIEVING SCALE: YMCAS DPP

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GAME CHANGER:
MEDICARE COVERAGE 1/1/18!

When compared with similar beneficiaries not in the program, Medicare

estimated savings of $2,650 for each enrollee in the Diabetes
Prevention Program over a 15-month period, more than enough to cover
the cost of the program.
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A NEW WAY OF WORK
From the 2017 Physician Fee Schedule:

We disagree with commenters who stated that some organizations

that meet the MDPP supplier requirements would be unable to
obtain an NPI. Under 45 CFR part 162, subpart D, health care
providers, as defined in 45 CFR 160.103, may obtain NPIs. The
definition of health care provider at 45 CFR 160.103 specifies,
in part, that any person or organization who furnishes health
care in the normal course of business is a health care provider.
Section 45 CFR 160.103 defines health care to include,
among other things, preventive services. Because MDPP
services are considered additional preventive services, we
believe MDPP suppliers and coaches who furnish MDPP in
the normal course of business are furnishing health care
and therefore qualify as health care providers that are eligible
for NPIs under 45 CFR part 162, subpart D.

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THE YS APPROACH
MEETING PARTICIPANT NEEDS

Program materials in
Spanish, Chinese,
Portuguese, and
audio files

Multiple spoken
language delivery
options:
Spanish
Somali
Hmong
Chinese
Portuguese
OUTREACH AND ENGAGEMENT
Enrollment in the program is dependent on successful outreach
and engagement strategies.

Marketing campaigns most RAISING

individuals with prediabetes do not know AWARENESS IS
it. KEY!

Physician referrals health care

providers need to be screening for
prediabetes and work to engage them
for identification and referral to the
program.

Screening events screening

members and enrolling them
immediately in the program through
health fairs or special lunch and learns.

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RECRUITMENT PARTNERS

It takes a village:
Employers and health plans
Health care systems and physicians
Senior centers
Community organizations
Faith-based organizations
Media 17%
yield
from
health
care
referrals
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 THE NEED TO INCREASE THE LIKELIHOOD
OF SUSTAINABILITY

Programs must exist

beyond grant funding
Real costs exist for
providers and must be
taken into account
Billing codes and
necessary
infrastructure must
allow for non-licensed
providers

GOAL: remove cost as

a barrier to
participation

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YMCA's CIH
CIH || 2017
2017 YMCA
YMCA of
of the
the USA
USA
 Y-USAS MSO

Y-USA assumed the functions of a Management Services

Organization (MSO) -- providing administrative, business,
and technology services to local Ys to enable them to receive third
party payment for the delivery of the YMCAs DPP and other chronic
disease prevention programs.

MSO Team MSO Vendor(s)

Existing Structure
Local Ys
Program delivery
Track participant
outcomes in
technology system
Raise funds to assist
with sustainability in
absence of 3rd party
payors.
New Additional Structure
Chronic Disease
Prevention Program Healthy Living Department MSO
Team
Train Ys to deliver DPP Employs staffs for: Contracts with
and other programs Payor engagement vendors for:
Management and Contracting Technology platform
administration support Account Billing / revenue
Coordinate for Management cycle management
technology support
Technology support
Provide reporting
Compliance
technical assistance to
Ys for reporting to Reporting
partners, CDC, etc. Finance

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PAYOR ENGAGEMENT AND ENROLLMENT

Medicare Claims-based Direct Pay Self-pay

Medicare Y-USA contracts Local Ys contract Local Y works
suppliers with payors on directly with with individual
participating in behalf of entire Y payor consumers
CDCs recognition program network
program file for claims
claims

Performance Performance Flat fee Sliding scale

based based based on need
reimbursement reimbursement
model model
reimbursement reimbursement

Begins 1/1/18 Available now Available now Available now

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NOT JUST THE
DPP
 THE YS PIPELINE OF EVIDENCE-BASED
HEALTH INTERVENTIONS
DISCOVERY DEVELOPMENT DISSEMINATION
Efficacy Validation Translation Scaling Dissemination

Diabetes Prevention YMCAs Diabetes Prevention Program

Falls Prevention EnhanceFitness, Moving For Better Balance

Arthritis Self-Management EnhanceFitness

Cancer Survivorship - LIVESTRONG at the YMCA

Hypertension control Blood Pressure Self-

Monitoring
Childhood Obesity
Intervention

Brain Health

Parkinsons

Tobacco
Cessation
EVIDENCE-BASED HEALTH INTERVENTIONS

Examples of data collected

Program:
Impact and improved health
Demographics and qualification
Self-report and observed

Process:
Uptake and Reach
Self-report and observed

Learning agendas all of the above and more

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ENHANCEFITNESS

THE PROGRAM IS:

For older adults at all fitness levels and is especially
beneficial for older adults living with arthritis
Land-based group exercise program for older adults
Delivered in 16 week intervals: 48 sessions per cycle
Open to all community members; YMCA membership
is not required
Nationally recognized by the Centers for Disease
Control and Prevention, US Department of Health
and Human Services, Administration for Community
Living, and the National Council on Aging
Involves fitness checks, data collection, and data
entry

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DELIVERING OUTCOMES AT SCALE:
FALLS PREVENTION/ARTHRITIS SELF-MANAGEMENT

PROGRAM REACH MAY 2017

Number of Y associations offering the program 177
Number of states delivering the program 42
Number of EnhanceFitness sites
85% Y sites | 15% non-Y sites
365
Number of certified instructors 1,778
Number of participants served 20,933

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MOVING FOR BETTER BALANCE

THE PROGRAM IS:

For individuals 65 years or older, physically mobile, with impaired
stability and/or mobility and individuals 45 years or older with a
condition that may impact stability and/or mobility
Small group program based on 8 forms of Tai Chi-based movements,
modified specifically for falls prevention
Delivered in 12 week intervals: 24 sessions per cycle Open to all
community members; YMCA membership is not required
Involves fitness checks, data collection, and data entry

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DELIVERING OUTCOMES AT SCALE:
FALLS PREVENTION

PROGRAM REACH MAY 2017

Number of Y associations
43
offering the program
Number of states
17
delivering the program
Number of program sites
73% Y sites | 27% non-Y 43
sites
Number of participants
624
served
Average number of
17.2
sessions attended

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LIVESTRONG AT THE YMCA

THE PROGRAM IS:

For for adults 18 years old or older who are
living with or beyond cancer treatment
Small group program inclusive of
individualized cardiovascular conditioning,
strength training, balance and flexibility
exercises
Delivered in 12 week intervals: 24
sessions per cycle
Open to all community members; YMCA
membership is not required
Involves pre and post Functional and
Quality of Life assessments facilitated by a
YMCA-certified instructor

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ONGOING DATA COLLECTION:
CANCER SURVIVORSHIP

PROGRAM REACH MARCH 2017

Number of Y Associations
offering the program 226
Number of communities 600
delivering the program
Number of states
delivering the program 40
Number of Certified
Instructors 3,642
Number of participants
served 47,007

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YMCAS BLOOD PRESSURE SELF-
MONITORING PROGRAM
THE PROGRAM IS:
Delivered in four-month cycles
Participants receive support from trained
Healthy Heart Ambassadors for the
duration of the program
Monthly nutrition education seminars
Participants self-monitor, or measure
and track their own blood pressure at
home
Open to all community members; Y
membership not required

PROGRAM GOALS:
Reduction in blood pressure
Better blood pressure management
Increased awareness of triggers that
elevate blood pressure
Enhanced knowledge to develop healthier
34 | YMCA's CIH | 2017 YMCA of the USA eating habits
ONGOING DATA COLLECTION:
BLOOD PRESSURE SELF-MONITORING PROGRAM
PROGRAM REACH MAY 2017
Number of Y Associations
offering the program
Number of states delivering the
program
Number of program sites
61% Y sites | 39% non-Y sites
Number of participants enrolled
Percentage of participants who
begin the program uncontrolled^
Percentage of participants who
begin the program uncontrolled
and became controlled
Average change (mm/Hg) in
systolic blood pressure (in
uncontrolled)
Average change (mm/Hg) in
diastolic blood pressure (in
uncontrolled)
RESULTS
Participants were asked to provide
64 feedback at the conclusion of the
program about their plans to
continue self-monitoring their blood
28 pressure. Almost all program
participants plan to continue to self-
monitor their blood pressure and feel
135
they made progress on their health
3,474 and well-being goals.
48%
I have made progress towards my
43% health and well-being goals as a 87%
result of participating in this blood
pressure self-monitoring program
-11.3*
I plan to continue to self- 94%
-6.3* monitor my blood pressure
IN SUMMARY
Community based
organizations must
play a vital role in
improving the
health of our nation
by:

Delivering
evidence-based
programs

Partnering with
health care

Working with
payors - remove
cost as a barrier

Collecting and
using the data to
improve delivery
THANK YOU
Heather Hodge, M.Ed.
Senior Director, Evidence-based Health Interventions
YMCA of the USA
101 N. Wacker Drive
Chicago, IL 60606
heather.hodge@ymca.net