A Collaborative Provider-Insurer Approach to Implementing a Diabetes Prevention Program in a Community Setting

Objective: Implement a community-focused approach to providing healthy lifestyle interventions for persons at-risk for developing diabetes through collaboration of a health system, regional health insurer and community physicians’ practices.

Methods: Heritage Valley Health System (HVHS), an integrated healthcare delivery system, collaborated with UPMC Health Plan to implement LifeSmart, a set of prevention programs for people diagnosed with pre-diabetes and/or metabolic syndrome. LifeSmart includes nutrition counseling, Group Lifestyle Balance™ (GLB), fitness and smoking cessation opportunities. University of Pittsburgh Diabetes Prevention Support Center trained HVHS healthcare professionals to deliver GLB, a core LifeSmart component. HVHS physicians participated in program planning and implementation. UPMC Health Plan targeted participants by using claims data and marketing resources. HVHS and UPMC Health Plan subsequently engaged specific physician groups through targeted mailings, e-mail blasts, and periodic physician meetings to expand the program.

Results: The collaboration between HVHS, UPMC Health Plan and participating physicians resulted in 876 referrals (Year1: 353, Year2: 523) and 437 participants enrolled (Year1: 148, Year2: 289) in LifeSmart. Referrals increased by 48% and enrollment by 95%, from Year1 to Year2. Year 2 data reflects January through September 2009. The number of referring physicians increased by 24% (Year1: 54, Year2: 67).

Conclusion: The HVHS/UPMC Health Plan collaboration is an example of a provider/insurer partnership that can successfully translate clinical research into a community health initiative.