Lessons from Launching the Diabetes Prevention Program in a Large Integrated Health Care Delivery System: A Case Study

Abstract

There is urgent need for health systems to prevent diabetes. To date, few health systems have implemented the evidence-based Diabetes Prevention Program (DPP), and the few that have mostly partnered with community-based organizations to implement the program. Given the recent decision by the Centers for Medicare & Medicaid Services to reimburse for diabetes prevention, there is likely much interest in how such programs can be implemented within large health systems or how community partnerships can be expanded to support DPP implementation. Beginning in 2010, Montefiore Health System (MHS), a large health care system in the Bronx, NY, partnered with the Young Men's Christian Association (YMCA) of Greater New York to deliver the YMCA's DPP. Over 4 years, 1390 referrals to YMCA's DPP were made; 287 participants attended ≥3 classes, and average weight loss was 3.4%. Because of increased patient demand and internal capacity, MHS assumed responsibility for DPP implementation in May 2015. Fully integrating the program within the health system took 5-6 months, including configuring electronic health record templates/reports, hiring a coordinator, and creating clinical referral workflows/training guides. Billing workflows were designed for risk-based contracts. In the first 11 months of implementation, 1277 referrals were made, and referrals increased over time. Twenty-four class cycles were initiated, and 282 patients began attending classes. Average weight loss among 61 graduates from the Summer/Fall 2015 wave of MDPP classes was 3.8%. Additional opportunities for expansion include training allied health staff, providing patient incentives, increasing master trainer capacity, offering DPP to employees, and securing reimbursement.

Keywords: chronic disease; diabetes; diabetes prevention.

FIG. 1.

Time line of DPP implementation, including collaboration with YMCA and integration within Montefiore Health System. EHR, electronic health record; YMCA, Young Men's Christian Association.

FIG. 2.

Example of Epic screenshot tracking patient attendance.

FIG. 3.

Referral rate by quarter during the implementation of the YMCA's DPP compared to baseline implementation of the MDPP. DPP, Diabetes Prevention Program; MDPP, Montefiore Diabetes Prevention Program; Q, quarter.

FIG. 4.

Percent of Diabetes Prevention Program (DPP) participants still participating in the program by week. (A) Limited to patients attending the 4th session and (B) among all participants.