A slew of organizations, including most notably the Robert Wood Johnson Foundation, are talking about creating a “culture of health” as a new way forward in US health policy. The underlying thinking assumes that legislative fixes, including the Affordable Care Act, will continue to be vehemently fought if attitudes towards health do not in some ways fundamentally change. Inherent in the idea of building a culture is incorporating unconventional actors and voices into discussions about how to improve outcomes at a local level. This has led public health strategists to ask new questions about who to involve in community health building efforts with an eye towards employers, small businesses, social service organizations and community institutions.
With this in mind, I recently spoke with Peter Doliber, Executive Director of the Alliance of Massachusetts YMCA about how he sees the Ys fitting into a plan to create health. His background is in public health and hospital administration, having worked in a range of communities to develop programs that increase access to health care, improve health outcomes and create a return on investment. Here’s an abbreviated version of our conversation.
- Can you tell me a little about the YMCA?
The YMCA is one of the oldest and far reaching community service nonprofit organizations in the US. While many people think of a Y as a gym, we are so much more. Every Y in Massachusetts is actively seeking programs, partnerships, and services to improve the health of individuals. Ys take a holistic approach in that we believe health is impacted and influenced by socioeconomic factors including education, employment, behavior, income, housing, and family support.
In each state Ys come together and form an alliance to assist them with policy and presenting a unified voice in service. Through an alliance unique Ys in a state can work collaboratively on common issues and maximizing resources to serve communities.
- What role do YMCAs currently play in creating health at the community level?
YMCAs were leaders in population health long before that term was coined. Over 100 years ago, YMCAs were instrumental in developing community based service locations that believed physical well-being was integral to spiritual health.
Today, YMCAs are intimately involved in creating opportunities for communities to prevent chronic disease, manage chronic and acute illness, and assist individuals in maintaining a good health status. These programs include the YMCA Diabetes Prevention Program in cooperation with the Centers for Disease Control (CDC), Livestrong, falls prevention programs, weight reduction and maintenance programs, employee wellness programs, Healthy Eating and Physical Activity initiatives, as well as center-based programs for recuperation after major surgery or illness.
- You and I have spoken about a considerably expanded role for YMCA’s in the future – what would that look like? What kind of programs and services are Ys well-suited to deliver?
As our health care model moves to one of pay-for-performance and integrates traditional public health with traditional health care through population health programs, most specifically through Accountable Care Organizations (ACOs), YMCAs are uniquely positioned to be a valued partner in this work. YMCAs have the infrastructure, knowledge, and mission commitment to help people gain, retain, and maintain a healthy status. People feel good about going to a Y. More than a location for a workout, it is also a place to connect with neighbors and make new friends. It is a place to meet with others who share the same personal goals and desires for wellness, all in a non-threatening and nurturing environment. These characteristics make Ys the logical partner for community-based, evidence-supported interventions and support.
- What policies or incentive schemes would need to shift in order to support this vision?
As states and the federal government create reimbursement schemes for the ACO model, it is imperative that consideration be given to community service organizations like the Y who are not traditionally structured to be a direct provider. This will require development of a pay-for-performance structure that allows for a non-medical provider to be reimbursed, to be HIPPA compliant, but to not have the overhead and administrative structure associated with traditional medical providers. We need to conceptualize a different type of support provider who works in concert with a medical provider but has the ability to serve in a more cost-effective fashion.
- There’s a huge emphasis at the moment on “accountability” in health care. What changes would need to take place within the Y in order to be sure these organizations to measure up to the accountability standards currently placed on local hospitals, doctors’ offices or clinics?
Ys have been working internally on accountability and data gathering for a long time. Many Ys already have the infrastructure and understanding of the importance of accountability, and those Ys who are engaged in any of our signature programs, such as the YMCA Diabetes Prevention Program, Livestrong, and Healthy Eating and Physical Activity initiatives, are already required to demonstrate their impact on the people they serve. If we have clear measurable results for which we are responsible, and ones which work in harmony with those of the individual’s medical home and provider, we are ready to continue in this direction.
- No one quite knows how to “create health” – why on earth would the Y want to take this all on?
YMCAs are dedicated to Healthy Living, Youth Development, and Social Responsibility. It is our mission to serve our communities through these three focus areas. We recognize that this mission can only be realized in partnership with other organizations whose missions and incentives overlap with our own. Positioning our organization to be seen as the go to partner for population health is a natural fit for our heritage of community service.