By hooking up the 78,000 healthcare providers who use athenahealth’s health IT products with the 1,500 locations participating in the YMCA’s Diabetes Prevention Program, it’s hoped to slow the progression of diabetes in the 86 million Americans diagnosed as pre-diabetic and save lives and billions of dollars in the process.
The idea is that, instead of referring their patients to a specialist, physicians will “refer” their pre-diabetic patients to the YMCA’s one-year program which helps people make small and sustainable lifestyle changes which can lower their risk developing diabetes.
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“If we get clinical integration, with medical providers referring their patients to the Y, we can increase enrollment in the program by 40 percent,” Dr. Matt Longjohn, YMCA national health officer, said in an interview.
Progression to full Type 2 diabetes was prevented in 58 percent of pre-diabetics participating in the program, according to data from the YMCA. Longjohn noted that a majority of the participants are women, the average age is 55 and they averaged a 5.5 percent weight loss. He defined “pre-diabetes” as abnormal blood-glucose levels but not yet to the level of diabetes.
“By preventing new cases and all the costs that go along with them could be significant in bending the cost curve for national care of diabetes,” Longjohn said, noting that, according to an American Diabetes Association study, that cost was around $245 billion in 2012. That total included $176 billion in direct medical costs and $69 billion in lost productivity.
“But, with 86 million Americans with pre-diabetes, it’s just a drop in the bucket,” Longjohn said. “We still have a lot of work to do.”
The YMCA-athenahealth partnership was announced last week during a roundtable program at the Parker Hannifin YMCA in Cleveland featuring Health and Human Services Secretary Sylvia Burwell.
“Care is moving out of the hospital and into more accessible, convenient, and cost effective venues,” athenahealth CEO Jonathan Bush said in a news release. “The YMCA’s DPP is proof that community integrated health, delivered outside of traditional clinical settings, is highly effective in delivering strong health outcomes. We believe the Y is a disruptive force shaking up the way that we treat the most insidious chronic diseases.”
The effort is also being boosted by a new Current Procedural Terminology (CPT) billing code, 0403T, which went into effect Jan. 1. This code means providers can now bill for the participation of a patient in a standardized diabetes prevention program which seeks to have patients make “preventive behavior changes.”
Initially, the CPT code may mostly be for data collection rather than payment, but Longjohn, whose team developed the code, said there are other, more significant aspects attached to it.
“The bigger story is that all of these things indicate that evidence-based prevention programs led by community-based organizations are being recognized as assets,” Longjohn said. “The code accommodates the value community-based organizations are having to the healthcare system.”
Photo: Flickr user Steven Depolo
