The Maryland state agency dedicated to containing the state’s health care costs has awarded Baltimore’s two academic medical centers $43 million over five years to take on the type 2 diabetes epidemic as part of a statewide population health initiative.

The Johns Hopkins Health System and the University of Maryland Medical Center will collaborate to create the Baltimore Metropolitan Diabetes Regional Partnership, which will work with community organizations to increase the number of available city-based programs to prevent or delay type 2 diabetes, and to increase access to community-based diabetes management programs to help people in the Greater Baltimore region who live with diabetes improve their health outcomes.

The Maryland Health Services Cost Review Commission (HSCRC) awarded Baltimore’s two anchor health care organizations $43,299,985 over five years to expand the Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program and American Diabetes Association-recognized Diabetes Self-Management Education and Support programs, evidence-based Centers for Medicare & Medicaid Services-reimbursed diabetes prevention and management services.

“Diabetes ranks among the highest-cost conditions to our health care and public health systems, and is a disease of racial and socioeconomic health inequalities,” says Felicia Hill-Briggs, professor at the Johns Hopkins University School of Medicine and senior director of population health research and development for Johns Hopkins Medicine. “This HSCRC award provides unprecedented opportunity to reduce the burden of diabetes in Maryland by bringing high-quality, proven prevention and self-management training programs right to community venues where they can be accessed by those most at risk, with the infrastructure and capacity-building for these programs to remain sustainable long term.”

“We appreciate the HSCRC’s significant investment in this new partnership which will enable us to expand our community-based programs to provide patients with type 2 diabetes the tools to help them better manage their disease and to develop educational resources for prevention, which is critical to stemming this escalating public health threat,” says Anne D. Williams, DNP, MS, RN, Director of Community Health Improvement at the University of Maryland Medical System.

The awards come with the requirement that the hospitals partner with community-based care delivery sites and offer services in non-health care settings.

The Johns Hopkins Health System will expand the successful diabetes prevention program offered by the Johns Hopkins Brancati Center for the Advancement of Community Care, the first such program in the city to achieve full recognition by the CDC. Since 2015, the Brancati Center, named for the late Johns Hopkins diabetes researcher and physician Frederick Brancati, has consistently exceeded national diabetes prevention benchmarks in program participation, client retention and weight loss. Johns Hopkins’ portion of the grant will be managed by its Office of Population Health.

“When the Brancati Center started working with our community partners in East Baltimore in 2015,” says Nisa Maruthur, a physician, researcher and associate professor of medicine at Johns Hopkins, “we only dreamed that we would one day see diabetes prevention programs across the entire city. With this HSCRC grant, we will get there.”

Diabetes management at the University of Maryland’s Center for Diabetes and Endocrinology (UMCDE) is an American Diabetes Association-accredited program for diabetes self-management education. Both organizations’ program strengths will complement each other and provide comprehensive diabetes prevention and management services throughout the city.

The UMCDE, located on the UMMC midtown campus, is a one-stop shop for patients with diabetes, providing multispecialty care in one location. The staff has successfully lowered patients’ A1C by 2.2% in the past year. The new partnership between Johns Hopkins and the University of Maryland will significantly ramp up these efforts on Baltimore’s west side, as well as in East Baltimore.

The grant will expand the Johns Hopkins Health System’s accredited diabetes management program sites to include community-based clinics and pharmacies, in addition to the hospital-based clinics that currently provide the service.

“We’re excited to get to work to make our city and our state healthier by increasing access to diabetes education for our patients with diabetes,” says Nestoras Mathioudakis, associate professor at the Johns Hopkins University School of Medicine and clinical director of the division of endocrinology, diabetes and metabolism. “We know that diabetes education works to help people lower their blood sugar, blood pressure and cholesterol. Unfortunately, very few eligible patients receive evidence-based diabetes self-management training. Through this important partnership, we will work to ensure that our patients with diabetes receive the training and skills they need to feel empowered to effectively manage this chronic disease.”

“We look forward to partnering with Johns Hopkins on this crucial initiative, which leverages more than 10 years of collaboration between our two institutions on training and striving to improve the health of highest-risk and underserved populations with diabetes,” says Kashif M. Munir, associate professor of medicine at the University of Maryland School of Medicine, director of the UMCDE and head of the Division of Endocrinology at the UMMC Midtown Campus. “This grant will enable us to provide access to diabetes self-management training to 25% more of the population with diabetes in the communities we serve and expand access to programs to prevent type 2 diabetes in 20% more of the population with prediabetes.”

Nearly a quarter of Baltimore residents live in “food deserts,” areas with little access to healthy, nutritious — and affordable — food. And 39% of respondents to a 2018 assessment of the city’s resources said that transportation was a barrier to accessing health care. The HSCRC grant will allow formation of sustainable wraparound services to address such barriers to accessing care and to performing diabetes self-care activities.

The partnership will pay particular attention to racial inequities among Marylanders with diabetes. According to the Baltimore City Health Department’s most recent Community Health Assessment, 14.5% of Black Baltimoreans have diabetes, compared with 10.5% of whites living in the city. The health department’s assessment also shows that the city’s lowest-income earners are nearly 7 times more likely to have diabetes than its wealthiest residents.

Grant dollars will be divided between the Johns Hopkins Health System and the University of Maryland Medical Center. On Baltimore’s eastern side, The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center will be the hubs for comprehensive community-based diabetes prevention and management services. The University of Maryland Medical Center’s downtown and midtown campuses will primarily serve the city’s west side.

“I’ve seen multiple generations of families impacted by type 2 diabetes,” says Kevin Sowers, president of the Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine. “This disease can be physically devastating and can lead to hospitalizations, impact quality of life and result in missed work, which can hurt families financially. We know that there are lifestyle changes and early interventions that can break these cycles and improve lives. This grant will allow us to address structural impediments to living healthy lifestyles, while empowering our community with the evidence-based information needed to address the diabetes epidemic in Baltimore. We’re happy to work alongside University of Maryland to improve the health of our community.”

“Diabetes is a significant public health problem in Baltimore — one that affects many families and contributes to an array of other medical issues,” said Bert W. O’Malley Jr., president and chief executive officer of the University of Maryland Medical Center. “As an anchor institution in West Baltimore, UMMC welcomes this opportunity to work with Johns Hopkins to improve access to diabetes care and prevention services that will improve the health and well-being of city residents — and keep them out of the hospital.”

The reach of the diabetes management part of the grant will extend beyond city limits to include Johns Hopkins Medicine’s Howard County General Hospital in Columbia and Suburban Hospital in Bethesda. The grant will expand diabetes management sites to include community-based clinics and pharmacies, in addition to the hospital-based clinics that currently provide the service.

The grant, which comes in the form of rate and payment adjustments throughout the five-year life of the initiative, includes resources to build technology infrastructure that will allow easier data sharing across the state.