This is the story of how the Muskegon YMCA, long a pillar of the community of Muskegon County, MI, wove itself into a broader supporting fabric, reaching out beyond a physical building to serve community members in the community. The story centers on the Y’s Diabetes Prevention Program, which reflects a deeper shift in approach where the Y collaborated with the hospital system in the “institutional” direction, and also reached out to a variety of other community players, from schools and churches to gyms and Federally Qualified Health Centers (FQHCs). Instead of drawing people into its own building, it started operating with welcoming partners in their facilities. Spoiler alert: This kind of collaboration reflects a wonderful, positive culture, but it also needs money to sustain itself.
Founded in 1917, the Muskegon Y moved into its flagship waterfront building, with space for both indoor and outdoor exercise, in 1979. Its pool was the county’s only indoor, 6-lane, 25-meter swimming pool. As in so many communities, this “old” Muskegon YMCA brought people together to be or to become their best selves, with more than 3,000 members at its peak around 2014 and a board drawn from the community’s most respected leaders.
However, the Y faced challenges in the mid-2010s. Its building – and especially its pool – needed repairs, but the Y’s endowment had gradually shrunk as Muskegon County itself hit a rough patch. In 2014, Bruce Spoelman, who had run the Y’s Camp Pendalouan 20 miles north since 2004, took on the job of CEO to turn things around.
But that is just the story of the YMCA’s brick-and-mortar body. Its real value lies in its soul – and its commitment to the community it lives in. The question at the end of our story is: How can this model scale?
A New Era
That soul moved to the Y’s new headquarters in a corner storefront on Third Street, closer to the community and to public transit. The Y started focusing on all community members rather than just gym/YMCA members. People would drop in for healthy cooking classes or one-on-one heart-health counseling rather than for exercise machines. (The Y now partners with local organizations such as Muskegon Family Care (an FQHC), Viking Athletic Complex and Tanglewood for the exercise classes it continues to offer.) In a sense, health took priority over fitness. This reflected a nationwide YMCA (re)focus, accelerated by COVID, on so-called “outreach Ys,” but only a few delivered as fully as Muskegon.
Meanwhile, hospital system Trinity Health, based in Livonia, MI, was also looking more closely at health from the other direction – health care. It submitted a grant application in response to a call from the
Centers for Disease Control and Prevention for partners to deliver its National Diabetes Prevention Program (DPP), combining individual submissions from seven of its local hospital systems, including Trinity Health Muskegon’s (called Mercy Health at the time; we’ll call it Trinity Muskegon from here on for simplicity). Trinity Muskegon’s submission, however, was different. Instead of offering its own capacity, Trinity’s Muskegon system reached out to the Y to operate the program on its behalf.
That happened through the Health Project, Trinity Muskegon’s community health worker outreach program. Health Project hub manager Judy Kell and YMCA executive director Melissa Wikman worked together on their part of the Trinity Health CDC grant request, expanding on an earlier, much smaller grant ($25,000) from the Health Project to the YMCA for a similar but less formal program.
And so, in 2017, shortly after Spoelman took over the Y and a couple of years before COVID, Trinity Muskegon and the Y jointly became one of seven Trinity Health sites to receive a share of the $8.5-million CDC grant. In 2023, Trinity Health won another 5-year, $12.5-million grant from the CDC to advance health equity among adults at risk for developing type 2 diabetes. The new grant also includes a bonus: Social-needs screening and interventions delivered by community health workers (CHWs), though the payment pathways are still in the works. Muskegon YMCA, with its $300,000 share of the total grant, now has the ability to bill Medicare and Medicaid for the DPP program and to offer referrals to low/no-cost resources that remove barriers – such as lack of transportation, healthy food or housing – to successful participation in the DPP and to other paths to health as well.
Over to You, YMCA!
All this stemmed from that very first grant of $25,000 from Trinity Muskegon to the Y… The very first Certified Lifestyle Coach trained using that grant was YMCA member services manager Shauna Hunter, now executive director of Pathfinders in Muskegon Heights, the county’s highest-need community. She added diabetes prevention to her coaching portfolio and started the Y’s first DPP class, strengthening the Y’s case for delivering on the larger grant in 2017.
Hunter recalls: “I was very excited about it. The Grand Rapids Y already had a Diabetes Prevention Program, and I knew I had a ready audience. Diabetes affects so many people of color… including me: My A1C wasn’t high – but having obesity increased my chances. Teaching the class helped me be careful about what I eat and watching my A1C. My daughter had diabetes and together we actually reversed it.”
As an outsider from Wellville, I was enthusiastic and encouraging, but also slightly skeptical. The DPP’s curriculum was still a bit old-fashioned at the time – focused on reducing fats more than carbs (until its latest, 2021 iteration, with less focus on calorie-counting and more emphasis on forming healthy habits, eating with family and setting personally meaningful goals).
The whole idea is not a rigid protocol as much as a lifestyle identity change – from “Whatever!” to “I’m a healthy person and treat my body as the amazing asset it is.” That “relational” message is reinforced because the YMCA, like all the CDC grantees, must deliver the program in group settings, with ample peer-to-peer support along with scheduled sessions led by a trained coach.
The “API”
So I followed the program with interest. At one point, I was discussing it with a YMCA staffer. “We’ve got a good relationship with the local Trinity system,” she said, “but we’re not getting the referrals from the doctors and other staff. It’s very slow.”
I suggested that they should invest in an API, to improve the ease of referrals. “Where could we hire one?” she asked.
I laughed and explained politely: “An API is an Application Programming Interface. It would help your computer talk to theirs, and to their patient records in Epic, so you could be recommended directly to the doctor when a patient’s data indicate the need.” Aha! she said. They got an API and set things up, and the technical challenges got easier.
But in the end, the joke was on me. What the Y really needed was an Amazing, Personable Intermediary. And ultimately, they did indeed hire one. Judy Kell, who had worked on the original grants, suggested that the Y hire Kelli DeLong , who at the time was Community Health Innovation Region (CHIR) Coordinator for the Health Project. As DPP coordinator at the Y, Kelli swung into action, connecting with all her former colleagues at Muskegon Trinity, and also with local FQHCs Muskegon Family Care and Hackley Community Care.
“The first order of business,” DeLong says, “was to address the gap between clinical and community providers. Understanding the healthcare system and language, as well as barriers clinicians faced when addressing prediabetes, I got to work to be the first Trinity Regional Health Ministry [RHM] to create a successful bidirectional referral process for seamless referrals and prompt progress reporting.”
The Muskegon Y is now offering the program not just in Muskegon but also online across the state of Michigan through 13 other Ys. The program has served more than 1,300 individuals, and is still growing. Collectively, those individuals have lost over 11,000 pounds. Perhaps that’s not the best measure, but it’s the simplest and most trackable. We’d love to see a measure of how much Muskegon benefits from a healthier population and a second-hand impact on the families and friends of the participants. Kelli notes that the Y is now Principal Investigator on a CDC grant working with the University of Michigan to determine the long-term effectiveness of the DPP locally in Michigan, so please stand by!
Meanwhile, the national DPP as assessed by the US Department of Health & Human Services has not only been successful in reducing transitions from pre- to actual diabetes, but has also demonstrated cost savings. Over 15 months, Medicare enrollees in the program cost $2,650 less per participant than controls, which is far more than the cost of the program itself. (This is one of many studies; the numbers differ, but they all agree that the program is well worth it.) Indeed, because of its effectiveness and cost-saving benefits, the program is the first preventive health service to gain national Medicare coverage under the Affordable Care Act.
More deeply, the program depends on and enriches the local community spirit, keeping people healthy not just physically but also mentally. It’s an investment in social fabric rather than physical infrastructure.
As Shauna Hunter says: “Everything that I learned at the Y kind of just traveled with me, to Pathfinders and beyond.
“People change only when their mind is changed. It’s about celebrating the wins! ‘Yeah, I might have messed up. I could have done better… but this part I did well.’ You’re still accountable for bad behaviors, but praise works better than shame.”
In short, Muskegon Y’s DPP is an amazing success that deserves to spread nationally. Yes, YMCA of Greater New York – and many others – I’m looking at you!
Going Forward
But unfortunately, the current full reimbursement rate (for each participant reaching all their goals) applies only to those individuals on Medicaid or Medicare who meet the CDC’s criteria.
Assuming a participant attends every class and achieves every weightloss milestone, the maximum possible reimbursement from both Medicare and Michigan Medicaid is $768 per participant. This is well below Medicare and Medicaid’s cost savings and at the same time above the YMCA’s (or Trinity’s) costs to deliver the program.
On the flip side, people with diabetes incur average medical expenses of approximately $16,750 per year – about three times higher than those who don’t have diabetes. Statewide, preventing all eligible 580,000 Michigan Medicaid members from developing type 2 diabetes has a potential future savings of a whopping $9.7 billion per year.
This is the wrong-pocket reality faced by so many such cost-saving programs. Medicare and Medicaid will save money, but the YMCA, Trinity and other DPP operators lose money.
My hope is that the program expands and starts working with local food retailers in a nonprofit, sustainable, Blue Zones-style initiative to foster healthy eating (along with healthy food!). Even as Ozempic lures people with the funds (or diagnoses) to pay for the drug, the lifestyle aspect of the DPP will remain important as most people cannot afford such drugs. With luck, the National YMCA along with Medicaid/Medicare will be a vector for the expansion of this program across the country; other YMCAs may follow Muskegon’s transformation into an outreach Y – not just with DPP, but also with other programs pioneered by Muskegon Y in child care, veggie vans and school lunch programs, all launched during COVID in collaboration with local partners and now needed more than ever. Just like the people in Shauna Hunter’s pioneering DPP cohort, let’s praise funders into doing more, rather than shame them for any imperfections!
BONUS: The people of the DPP
Shauna Hunter, the Y’s first diabetes coach.
When she first started teaching the DPP classes, Shauna says, “The first thing I did was to get the curriculum…and a scale. Every time they entered the training room they had to weigh themselves …. It’s a journey for everyone. There’s lifestyle changes that need to take place. Some people use food for comfort; sometimes the food you eat is what you have… or what you can afford.
“So when I went through the lessons, I needed to speak to each individual. Everyone has the same goal, but how to reach it is different. What do you choose? Or, how do you make what you choose healthy?
“It was a healing space as well. The whole class celebrated when one member told us one week: ‘How I chose something better.’ And the group could see the A1Cs come down. I do see some of those people today, and they tell me, ‘I’m still doing good.’ Or, ‘I’m struggling a bit but I still remember what you told me.’ Our mission at the Y lists ‘the spirit, the mind and the body.’ The body comes last for a reason. Fitness cannot happen without the mind.
“Everything that I learned at the Y kind of just traveled with me. I created a new culture at Pathfinders after I took over as [executive] director.
“I had learned that people change only when their mind is changed. It’s about celebrating the wins! ‘Yeah, I might have messed up. I could have done better… but this part I did well.’ That is very much a part of Pathfinders. You’re still accountable for bad behaviors, but praise works better than shame.”
Mimi Bartelson, a graduate
Mimi Bartleson of Grand Rapids, 54 years old, joined a Muskegon Y online DPP group in November 2022. She was an active member for a year, and now still stays in touch with a number of her classmates in Muskegon and elsewhere. Two years later, she’s following the habits she picked up during the program, including regular exercise and healthier eating. Mimi is a former grade-school teacher; now she works as a paid care-giver for a one-year-old. She has a personal and family history of breast and other cancers, and knows that being healthy (and watchful) is the best defense; Here’s her take on the program:
“You find other people who are naturally encouraging,” she says. “We’re not competing; we’re holding one another accountable! Ashleigh [our coach] would talk about setting a goal. You set a goal, and then a week later you may realize… oops! Sometimes people were laughing because they blew it off… but then you set a new goal, and the next time you keep it. Because in the end, that is what you really want to do. That’s what you’re there for.
“In fact, I already knew a lot of the information they gave us. It wasn’t so much educational, more motivational. It just moved you to action. I got rid of all the white rice in the house. I added anti-inflammatory things like flax seeds to my smoothies. Those became habits. My blender is sitting on the counter, waiting for me to use it right. You do something like a three-mile walk three days in one week, and then you realize you can do that every day.”
And her numbers are good too, from pre-diabetic to totally normal, with fasting glucose under 100. Way to go, Mimi!