Referral Systems for Diabetes Prevention

Submission Date: September 2014

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Michigan

States/Territories Involved: Michigan

Other Funding:

NACDD funding

Domain Addressed:

Community-Clinical Linkages, Health Systems Strategies

Public Health Issue:

• 86 million (more than 1 out of 3) American adults have prediabetes, and 9 out of 10 people with prediabetes do not know they have it. Without lifestyle changes to improve their health, 15 – 30% of people with prediabetes will develop type 2 diabetes within five years.
• The Diabetes Prevention Program research study showed that making modest behavior changes helped participants lose 5 – 7% of their body weight and reduced the risk of developing type 2 diabetes by 58% in people with prediabetes.
• Statewide, regional, or system-wide referral systems can connect people with prediabetes to the National Diabetes Prevention Program’s (National DPP) evidence-based lifestyle change program. Developing and implementing systems for referral of people at risk to sites offering the lifestyle change program is a sustainable strategy to increase use of this program.

Project Objectives:

To pilot a model provider referral system with at least 2 evidence-based lifestyle change program providers and develop a plan to replicate it across the state.

Program Action:

Two evidence-based lifestyle change program providers, YMCA of Marquette County and the National Kidney Foundation of Michigan, strived to establish referral systems in large health systems. Both provider agencies were awarded small subcontracts by the Michigan Diabetes Prevention and Control Program (DPCP) to develop at least one referral process in a healthcare system, linking healthcare providers to the lifestyle change program.

Because they had established relationships with large health systems and credibility in delivering the lifestyle change program, the provider agencies gained access to decision makers at health systems and plans. When possible, the evidence-based lifestyle change program providers used key leaders within the health system or plan to broker meetings with decision makers. During meetings, the providers and decision makers discussed diabetes prevention and worked together to explore opportunities for developing a referral system. Both provider agencies encouraged their partners to add the evidence-based lifestyle change program as a covered health benefit for employees and individuals insured by health plans. While time did not allow this to occur during the grant period, evidence-based lifestyle change program providers and their partners identified tangible next steps for reaching this goal. For example, one provider offered to deliver the evidence-based lifestyle change program to health plan employees in order to get a foot in the door and demonstrate program benefits. The other provider gave its referral prescription pads to a Medicaid health plan and is working toward achieving a 100% referral rate. By project end, provider agencies had met with a total of five health systems and four health plans.

The evidence-based lifestyle change program providers used the six-month contract period to develop and enhance relationships with key decision makers in health systems and health plans. Although the timeframe was too short to fully integrate referral in large systems, the DPCP and both provider agencies are moving forward in discussions with three health systems and three health plans, optimistically looking toward full integration of referral systems in 2014.

In addition to providing funding, the DPCP provided technical assistance through phone calls, including one formal review call two months after contract initiation. Toward the beginning of the contract period, the DPCP arranged for a healthcare referral expert to speak with lifestyle change program providers and provide follow-up support. While the DPCP focused its work in this strategic focus area on health system and plans, they also saw an opportunity to facilitate self-referral. The DPCP provided Michigan Diabetes Prevention Network partners with information on establishing referral systems in 2-1-1 resource centers. Two of the Network’s evidence-based lifestyle change program providers capitalized on this opportunity. As a result, the evidence-based lifestyle change program was included in 2-1-1 resource centers covering twelve Michigan counties.

“Meetings with high level decision makers were made possible through the credibility and trust gained through the experience of delivering other evidence-based programming in the community.” -Richard Wimberley, MI DPCP

State Health Department Roles

• Identified and engaged two evidence-based lifestyle change program providers to establish referral systems with their health system partners
• Linked provider agencies to an expert in healthcare provider referrals for training and follow-up technical support
• Provided additional resources and technical assistance, which enabled provider agencies to focus staff time on building relationships with their health system partners

Partners

• Health systems and plans
• Michigan Diabetes Prevention Network
• National Kidney Foundation of Michigan
• YMCA of Marquette County

Impact/Accomplishments:

• 6 Healthcare system partners
• 163,695 Adults with prediabetes living in the geographic area covered by the referral system

Challenges/Lessons Learned:

Factors Supporting Success

• Dedicated Funding: $12,500
• Established network of partners that included evidence-based lifestyle change program providers, Michigan Department of Community Health programs, and state and national partners interested in working on diabetes prevention efforts
• Provider agencies had experience establishing relationships with health systems and credibility in their communities
• Michigan Quality Improvement Consortium had existing guidelines for diabetes prevention under Adult Preventive Services which reinforced referrals
• Lifestyle change program provider agencies used their relationships and experience to gain entry to decision makers
• Both provider agencies utilized key leaders within health systems when conducting outreach
• Worked to build long-lasting relationships with health systems and health plans Provided regular follow-up with health systems

Challenges and Solutions

Challenge: Due to short time frame, establishing a complete, integrated referral system was not possible
Solution: Both provider agencies worked smartly and diligently to build long-lasting relationships with health system partners, allowing them to continue work on this project

Challenge: Health system partners were at different stages of readiness to adopt a referral system
Solution: The two evidence-based lifestyle change program providers tailored information to each partner and continued to focus on relationship building

Next Steps:

The DPCP will work with the lifestyle change programs and disseiminate provider referral system to the Michigan Diabetes Prevention Network.

Program Areas:

Diabetes

State Contact Information:

MI
Jennifer Edsall
Michigan Diabetes Prevention and Control Program
(517) 335-8378
edsallj@michigan.gov

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