Physicians must adopt a population health approach to the practice of medicine in order to manage risk in this unstable health care market. And with the rising costs associated with diabetes, this patient population remains at a greater risk for increased expenses. By creating a community-based population health strategy, physicians can address those at-risk or currently diagnosed with diabetes.
Mission Health Partners, a member of a large accountable care organization (ACO), partnered with the YMCA of Western North Carolina (WNC) to expand access to diabetes prevention, self-management and lifestyle-modification coaching with the aim of successfully improving patient outcomes and cutting the total cost of care for the target population.
“It’s no surprise that healthy people cost less money,” said Calvin Tomkins, MD, assistant medical director at Mission Health Partners. “For health care to be viable moving forward, we need to look at interventions that generate health.”
“We’re really good at illness in the health care field, but we need to rely on our partnerships in the community to help us out with promoting health,” Dr. Tomkins added during an AMA webinar.
Their targeted population was McDowell County, North Carolina, which is about 30 minutes east of Asheville. In the predominantly rural, mountain community, 70 percent of adults are obese or overweight. More than 14 percent have been diagnosed with type 2 diabetes and about 35 percent have prediabetes.
Creating a diabetes prevention program
The YMCA of WNC collaborates with Mission Health on diabetes prevention and management, food insecurity, employee wellness and the two organizations have multiple co-located facilities. Together they created the Taking Control of Type 2 Diabetes (TCT2) program, a year-long diabetes intervention consisting of 28 group sessions of up to 15 participants.
“What we want to make sure folks understand is that we provide a balanced approach,” said Tim Blenco, chief operating officer at the YMCA of WNC. “You’re never going to take control of diabetes if you are relying solely on medication. You must incorporate diet and exercise and you need to do all three at the same time.”
The YMCA of WNC offers free child care to TCT2 participants during class, overcoming that barrier to attendance. Program participants also receive a family membership to the Y, encouraging the whole family to engage in a more active lifestyle so long as they remain active and engaged participants.
More time spent with patients
According to Blenco, many referring providers and other colleagues said, “You are doing exactly what we want to do because you have the gift of time with these patients.”
“That is one of the most important things we can point out here,” he added. “We spend more than an hour with these patients getting to know them and their families before starting them in program. We need everyone involved to understand that this is a very intensive intervention.”
This program allows health professionals to focus on the necessary clinical interventions and moves part of the behavior change work to a more fun, engaging and supportive environment. The program’s “gift of time” offers up to four contact hours each month with patients. The social connectedness patients feel while participating in this program, and at the Y outside of class, can affect their entire outlook.
“Being able to provide support, you’re going to impact their depression, anxiety and sense of isolation,” said Dr. Tomkins. “In turn, they are going to have less of a need for those unhealthy behaviors and everything will start to improve. This is crucial to tackling the chronic diseases that incur high costs.”
“This program underscores the sense of connectedness, engagement and motivation that is necessary to treat behaviorally caused chronic conditions. I see the Y playing an even bigger role moving into the future,” he added.
In October 2017, the AMA announced a multistate effort aimed at reducing the incidence of type 2 diabetes nationwide. The AMA offers online CME to expand your knowledge in diabetes management. Explore educational content such as “Prevent Diabetes STAT.”
