…well, not quite “just.” A couple of years ago, the Centers for Disease Control (CDC), the YMCA, and the Centers for Medicare and Medicaid (CMS) worked together to pilot a national diabetes prevention program which is now dubbed aptly the National Diabetes Prevention Program (NDPP). Though the name may not be the most creative, the model certainly is from a wellness perspective.
Now, getting people to lose weight and alter their lifestyle for the long haul pays—literally. CMS has developed a performance based compensation structure. That structure seems as novel as the investment in wellness to being with.
Providers are paid based on program participation level and…wait for it…results. If participants lose 5% or more body weight during the 16 week program, CMS kicks in the bulk of the compensation. If they keep the weight off for 6 months, CMS kicks in even more in the form of bonuses. So, it’s not your standard old “fee for service.” It’s truly “fee for performance.” The current compensation structure pays out more than a gym membership. That being said, the program requires coaching, education, and engagement which your average gym membership doesn’t come with. Those are real costs. The CMS compensation for the program can be up to roughly $65 per month per member.
The A.R.T. Approach
If providers are creative with group formats where they can use a few resources to reach many people and diversify the risk of not everyone losing the desired weight, they can make these program profitable. To make these programs economically viable, they’ve got to take the “A.R.T.” approach. That is they have to:
First, Acquire patients. The best place to do this is through the existing primary care channel where up to 1 out of 2 Medicare patients may suffer from pre-diabetes or full blown diabetes. They need to effectively sell these programs in the office. These programs, however, should not be run by the clinical staff. Many systems are making the mistake by having clinical groups own these programs. More on this issue in a moment.
Second, they have to Retain these patients. Systems have to keep the patients who have signed up for the entire duration of the program. With competing demands on their life, patients can easily wander away from the program. The only way to make money with the bonus structure is to keep them engaged with the program so you have a shot at getting the transformation and weight loss required for the larger payments.
Third, healthcare systems have to Transform these patients as mentioned above. The transformation is, again, where the real money is. You have to keep them engaged and in the program to have a shot at that transformation.
Technology as an Influence Engine
So, what’s all that mean? Healthcare providers have to get into the business of influencing behavior. They need customer relationship management (CRM) capabilities to acquire, retain, and by virtue of retention have a shot at transforming these folks. They need to get good at this work not only to make programs like this one successful, but to keep people healthy in general. Only with this capability will they be successful in an environment with emerging value-based/at-risk compensation models. These programs help providers develop these skills and capabilities.
What if they don’t develop these capabilities? For programs like this one pioneered by the YMCA, folks like the YMCA…or who knows, maybe Crossfit will come in and do the work of keeping the country healthy. And to be honest, why wouldn’t they? They’ve been in the influence game much longer and people already think of these options well before thinking of their healthcare provider when they do make the decision to be healthy.
The clinical setting is not known for engagement nor is it known to be particularly cost effective. When competing with alternative options like the YMCA, healthcare systems need to take a hard look at how to be creative to make the economics work. To do that, they need to look at the resource mix and the tools they need to cultivate, keep, and continually drive engagement.
If healthcare providers don’t get into the influence game, they will cede this important role to others.