April 25, 2016
In March of 2016, Centers for Medicare and Medicaid Services Innovation released certification around a Medicare Diabetes Program. The program was built based on evidence from a collaboration of the YMCA and the Centers for Disease Control and Prevention (CDC). Over a multiple year time frame, the YMCA offered the diabetes prevention program (DPP) to participants and allowed this opportunity to evaluate the effectiveness of the program. CMS Innovations offered $11,885,134 to Y-USA to fund its DPP that eventually resulted in Medicare signaling reimbursement due to the cost effectiveness of the intervention.
The program started to enroll participants at YMCA locations in February of 2013. In March of 2015 there were already 6,874 beneficiaries who were recruited and of those 5,696 enrolled. After looking at over two years of clinical and economic data, the DPP was able to show significant cost savings even when accounting for the cost of the intervention. In addition to evaluating the clinical data from the three year pilot, CMS Innovations also evaluated a clinical trial done on the DPP through coordination with the CDC. A model was created to project future savings. The focus of the program was on diabetes aspect of behavioral health. This case study signals that policy leaders are eagerly searching for cost-effective solutions in behavioral health.