Collective Impact & Partner Networks

NACDD and CDC facilitated a competitive application process and selected five state health departments to implement Bright Spot projects in their states:

• Kansas Department of Health and Environment
• Michigan Department of Health and Human Services
• Missouri Department of Health and Senior Services
• Utah Department of Health and Human Services
• Wisconsin Department of Health Services

As instrumental partners throughout the BSI work, during Year 1 state health departments expanded their reach to populations at greatest risk for type 2 diabetes and its complications. The departments leveraged existing chronic disease prevention efforts and their robust partner networks to achieve population and systems-level change. States centered advancing health for all people throughout their work as a core strategy. The innovative approaches resulted in significant program capacity to enroll people with prediabetes. See the BSI One-Pager to learn more.

• State Agency: Kansas Department of Health and Environment (KDHE)
• Backbone Organization: KDHE
• Why backbone organization was selected: KDHE acted as the backbone organization to leverage existing partnerships and connections with organizations that contribute to diabetes prevention across the state.
• Project Overview: KDHE worked with partners to achieve their 500 persons project enrollment goal. They worked with partners to conduct marketing and outreach, host in-person employer events, and coordinate their Arthritis Program with the National DPP lifestyle change program on the HALT platform to increase participation in both programs.
• Populations for Enrollment: Hispanic and Latino, Black or African American, and low-income populations.

• State Agency: Michigan Department of Health and Human Services (MDHHS)
• Backbone Organization: Michigan Public Health Institute (MPHI) Center for Health Equity Practice (CHEP)
• Why Backbone Organization was Selected: MPHI CHEP’s mission is to center equity, promote health, and advance well-being in the Michigan community. MPHI CHEP was selected to serve as Michigan’s backbone organization because they were uniquely positioned to create and facilitate dialogue between clients, communities, government, and policymakers as they are a trusted voice in the community.
• Project Overview: Michigan conducted a project to increase enrollment of Black and African American persons in the National DPP lifestyle change program through the strengthening of equity leadership and accountability, the utilization of community champions to prioritize the voice of the community, and the bolstering of referrals within the largest hospitals in southeast Michigan.
• Populations for Enrollment: Black or African American adults in Wayne, Oakland, and Macomb counties.

To learn more about Michigan’s efforts to support the National DPP lifestyle change program, visit Michigan’s State Story of Medicaid Coverage on the Coverage Toolkit.

• State Agency: Missouri Department of Health and Senior Services (DHSS) Diabetes and Heart Disease Program
• Backbone Organization: Simply Strategy
• Why Backbone Organization was Selected: Missouri selected Simply Strategy as the backbone organization because of their previous knowledge of the National DPP lifestyle change program landscape in Missouri, their existing partnerships with National DPP lifestyle change programs in the St. Louis area, and because they had previously contracted with the Missouri DHSS.
• Project Overview: Missouri conducted a project to increase enrollment in the National DPP lifestyle change program by 1,000 participants. Missouri’s project activities worked toward the expansion of state National DPP lifestyle change program suppliers, creation of referral networks across different organizations, development of a bi-directional health care provider referral pathway, and augmentation of an existing prediabetes awareness campaign to reach more people.
• Populations for Enrollment: Black or African American and Hispanic and Latino adults age 45 and older; high-risk populations located in the St. Louis Region, with a focus on those residing within the St. Louis Promise Zone Region within North St. Louis City and North St. Louis County.

• State Agency: Healthy Environments Active Living (HEAL) program at the Utah Department of Health and Human Services (DHHS)
• Backbone Organization: Steering Committee for the Prevention of Diabetes in Utah (Steering Committee)
• Why Backbone Organization was Selected: Utah selected the Steering Committee as the backbone organization as they are comprised of experts, specialists, and interested parties from various sectors across the state. The Steering Committee meets to work through and discuss policies that encourage the sustainability of the National DPP lifestyle change program, improve infrastructure within the state, and provide guidance and recommendations to partners.
• Project Overview: In 2022, the state of Utah passed a law that provides coverage of the National DPP lifestyle change program for eligible Medicaid members. DHHS capitalized on this by conducting a project to enroll 500 adults enrolled in Medicaid and 500 adults not covered by Medicaid through outreach to patients and health care providers, providing support for CDC-recognized organizations to become Medicaid program suppliers, leveraging the Utah 211 program, and carrying out a social digital marketing campaign.
• Populations for Enrollment: Adults enrolled in Medicaid; women age 45 and older; people living in high health improvement areas.

• State Agency: Wisconsin Department of Health Services (DHS)
• Backbone Organization: The Chronic Disease Prevention Program (CDPP), a program housed in the DHS Division of Public Health.
• Why Backbone Organization was Selected: Wisconsin selected the CDPP as the backbone organization as they work with each National DPP lifestyle change program supplier in the state.
• Project Overview: Wisconsin conducted a project where they partnered with National DPP lifestyle change program and MDPP suppliers across the state and leveraged existing infrastructure to increase enrollment of people at greatest risk for type 2 diabetes in the National DPP lifestyle change program. Wisconsin’s goal was to increase enrollment by 1,809 participants, which was 20 percent more than the baseline enrollment as of July 2022. Wisconsin’s project activities worked toward increasing partnerships across the state with organizations serving populations most impacted by type 2 diabetes and related risk factors, strengthening technical assistance and coordination among suppliers, developing and implementing a data collection process, and boosting communication and outreach.
• Populations for Enrollment: Individuals at disproportional risk of developing type 2 diabetes; supplier-specific populations that included Asian and Hmong, Black or African American, Hispanic and Latino adults, adults with a high school education or lower, adults age 35 and older, men, and adults enrolled in Medicaid and Medicare.

For more information about Wisconsin’s involvement with the National DPP lifestyle change program, see Wisconsin’s State Story of Medicaid Coverage on the Coverage Toolkit.

A backbone organization is critical for the effective implementation of a partner network. The backbone organization as the coordinating body, brings together multisectoral partners and leads a synchronized effort to establish and achieve the goal of increased enrollment in the National DPP lifestyle change program. Backbone organizations create and translate a common agenda into tactical activities that are executed and managed on the ground in states and regions. Examples of organizations that served in a backbone organization capacity include state health departments and public health institutions. However, backbone organizations may also be community-based organizations (CBOs).

To learn more about backbone organizations and explore lessons learned from state case stories, see the What is a Backbone Organization? document.

State health departments pursuing a partner network approach to increase enrollment in the National DPP lifestyle change program decide whether they will serve as the backbone organization or partner with another organization. When deciding, it is important to evaluate whether the organization or department can fulfill the roles and responsibilities outlined below. Successful backbone organizations have proven their capability through prior collaborative projects and initiatives and have existing partnerships with organizations advancing diabetes prevention.

The backbone organization provides project management, data analytics, partnership engagement support, and provide staff (or contractors) to work with CDC-recognized organizations and other key partners in the state or region to assist the partners in meeting local enrollment goals.

The following outlines the key roles and responsibilities of a backbone organization to drive large-scale participant enrollment:

• Serve as an overall project manager.
• Conduct a landscape and data analysis to identify additional opportunities to increase enrollment.
• Facilitate partner commitment.
• Plan and facilitate regular meetings with the partners.
• Work to keep partners engaged, committed, and on task.
• Help partners establish a realistic enrollment goal.
• Track project progress against agreed-upon metrics.
• Develop standard methodology and processes that align with local, regional, and national goals.

To learn more about backbone organizations, see the National DPP NC Backbone Organization Roles and Responsibilities document, and the Bright Spot Initiative Backbone Organization Roles and Responsibilities.

Partner networks are only as effective as the organizations involved. Partnering with organizations with a track record of successful collaboration is essential to drive change toward the shared goal. Organizations committed to preventing type 2 diabetes and other chronic conditions could be potential strong partners. Additionally, members of the partner network should have the capacity, skills, and abilities to carry out activities to meet the needs of populations at greatest risk for type 2 diabetes. Consider evaluating a partner network’s membership based on the following:

• What are the organizations operating within communities of identified populations at greatest risk for type 2 diabetes and its complications, and could those organizations effectively support the shared goal of increased enrollment?
• Are there existing partners that have experience in diabetes prevention? What roles do they currently fill or could fill?
• What resources would a potential partner bring to the partner network? Do those resources align with the strategic needs of the group?
• How could an organization or individual be involved in planning and project activities?
• Are there potential barriers to recruiting certain partners? Are there strategies that could help overcome those barriers?

Partner networks are most effective when the state health department garners collective buy-in from partners early on during partnership development. Gaining buy-in early aids the state health department in finding partners from different sectors that are devoted to specific activities that align with the shared goal of increasing enrollment and advancing diabetes prevention. Some of these activities might center around the following:

• Awareness
• Identification, screening, and testing
• Advancing healthy outcomes for everyone
• Capacity building
• Referrals
• Coverage
• Availability

The Join the Charge Executive Summary and the Join the Charge Full Menu of Commitments documents show the types of organizations that NC DHHS partnered with and what their commitments were. Consider reviewing these documents to get an idea of the types of partnerships that can be part of a partner network.

• Identify connection opportunities between partners and facilitate an introduction. Partners may be able to share resources and support each other as they further their respective diabetes prevention efforts.
• Develop and facilitate partner networks that include various partners (all types of payers, delivery organizations, health care providers, employers, and employer coalitions) with different strengths; strategically engage each partner to maximize promotion and enrollment efforts. State health departments have decades of experience providing leadership and applying the StEM framework to convene and engage multisectoral partners to develop a statewide diabetes action plan to achieve a shared goal toward scaling and sustaining the National DPP lifestyle change program.
• Partner with organizations that influence the communities they operate in and incorporate the community’s voice.
• Align partners and partner networks on National DPP lifestyle change program messaging—marketing materials developed by different partners should be culturally relevant and consistent in language.
• Synergize other chronic disease prevention and management efforts like arthritis management, colorectal cancer screening, and food assistance when promoting the National DPP lifestyle change program – share information when administering programs.
• Work with community champions to build trust within communities.

• Have dedicated staff that can assist organizations through different aspects of the program.
• Objectively identify populations at greatest risk for type 2 diabetes within the state using a data-backed approach:
  • Break down beneficiary data by demographics.
  • Work with partners to leverage their patient data.
  • Use data to understand better how populations in the state consume digital media – tailor marketing using that information.
  • Understand where there are gaps in data and identify opportunities to fill those gaps (e.g., sub-populations that are not effectively captured in existing data sets).
• Work with state policymakers to align on policy language and structure that will effectively provide coverage for the National DPP lifestyle change program for persons enrolled in Medicaid.

• Share a repository of resources partners can leverage for their efforts, such as pre-cleared marketing materials and health care provider toolkits.
• Offer marketing materials; create customized, culturally relevant materials.

• Create open channels for feedback to facilitate accountability across partner networks.

• Convene the partners regularly to thank them for their contributions. Help promote recognition of their efforts through statewide channels.

After identifying populations, state health departments should consider how best to engage those populations to maximize reach and reception. BSI state health departments carried out unique project plans to engage their populations most impacted by type 2 diabetes and related risk factors. Here are some examples:

• One of Wisconsin’s CDC-recognized organizations connected with the Wisconsin Hmong Nurses Association to share health care provider educational materials about the National DPP lifestyle change program and Diabetes Self-Management Education and Support (DSMES) with the goal to promote eligible referrals into the programs.
• In Michigan, MDHHS and MPHI CHEP piloted a community champion workgroup which consisted of one community champion from each health system representing a population at greatest risk for type 2 diabetes in the Southeast Michigan Hospital Collaborative (SEMIHC). The community champions elevated the voices of their communities by collecting feedback and providing it to the health systems. The workgroup evaluated the results and provided recommendations about identifying and solving barriers and future diabetes prevention efforts.
• Utah utilized a staff member to conduct outreach to health care providers with high rates of Medicaid patients eligible for the National DPP lifestyle change program to provide resources on how to help patients enroll and how to receive reimbursement from Medicaid. The staff member contacted 24 primary care physicians who serve Medicaid members with prediabetes.

State health departments must consider how their marketing strategy aligns with their identified populations most affected by type 2 diabetes and related risk factors. Outreach should be created with the specific audience in mind, ensuring that the language will resonate with the population. People that relate to the marketing materials presented to them may be more inclined to inquire about or enroll in the National DPP lifestyle change program. State health departments should ensure that outreach is culturally relevant, relatable, and delivered through media channels that will reach the intended populations most impacted by type 2 diabetes. To learn more about reaching out to potential program participants, visit the Communicating and Promoting the National DPP as a Medicaid Benefit page and the Recruitment and Referral page of the Coverage Toolkit.

Partner networks provide state health departments with more resources and capacity to market the National DPP lifestyle change program effectively. Health care providers, National DPP lifestyle change program suppliers, health plans, community-based organizations, CDC-recognized organizations, marketing vendors, and/or other entities can utilize existing marketing materials in their workflows and awareness campaigns.

To view examples of effective marketing materials and strategies, see the Do You Have Diabetes, and Do You Have Prediabetes – Spanish documents. In addition, please see the BSI Learning Lab 4 Presentation on marketing the National DPP lifestyle change program, and listening to and acting with the community.

When identifying and engaging populations at greatest risk for type 2 diabetes and its complications, it is important to understand the barriers to enrollment they may experience. The costs of the National DPP lifestyle change program may inhibit or prevent people from enrolling. State health departments interested in partner networks to significantly increase enrollment in the National DPP lifestyle change program may consider utilizing existing assets and coverage in their states such as Medicare, Medicaid, commercial health plans, state employee coverage, employer-sponsored insurance, and coverage in correctional facilities (i.e., prisons). A multi-payer approach will ensure that populations with different types of insurance coverage can enroll in the National DPP lifestyle change program, eliminating a potential barrier to enrollment.

States may work with existing partners like employers or commercial health plans to expand their employees’ coverage for the National DPP lifestyle change program. The Case for Coverage for Commercial Health Plans and Employers page of the Coverage Toolkit provides resources for working with employers or commercial health plans. Healm is a free resource designed to support employers considering covering the National DPP lifestyle change program as a benefit for their employees.

If a state does not provide Medicaid coverage for the National DPP lifestyle change program, state health departments may consider partnering with the Medicaid department and state policymakers. Find a map of the states currently covering the Medicaid program here. State health departments can begin having those discussions and work toward establishing Medicaid coverage using the resources found on the Case for Coverage for Medicaid page of the Coverage Toolkit.

Additional information on how NACDD advances diabetes prevention, NACDD partners, success stories, and resources related to diabetes are available on the NACDD Diabetes page.