Diabetes Self- Management Education Florida Medicaid Managed Care Program Presented by: Sarah...

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Diabetes Self-Management Education

Florida Medicaid Managed Care Program

Presented by: Sarah Cawthon Date: May 20, 2014

Today’s Topics

• Medicaid Managed Medical Assistance Program Contract Requirement

• What is Diabetes Self-Management Education (DSME)

• What are the standards for DSME• Benefits of DSME• How to locate resources

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Medicaid MMA Contract Requirement

(20)(c) In the same manner as specified in s. 641.31, F.S., the Managed Care Plan shall provide coverage for … diabetes outpatient self-management training and educational services, if the … services are medically necessary.

Outpatient self-management training and educational services shall be in accordance with American Diabetes Association standards for such services. AHCA Contract, Attachment II, Exhibit II-A, Section V. Covered Services, Page 42 of 106

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Diabetes & Medicaid

There are approximately 272,000 adults with diabetes that have Florida Medicaid coverage.

That is enough people to fill the Superdome more than three and half times!

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Cost of Diabetes – Florida

• $1,390,000,000 ($1.39 billion) - cost of diabetes among Medicaid beneficiaries - 2010CDC Chronic Disease Cost Calculator http://www.cdc.gov/chronicdisease/resources/calculator/index.htm

• Medicaid charges for hospitalizations with diabetes as primary diagnosis - 2012 $295,636,031 - total $38,394 - average AHCA Hospital Inpatient Discharge Data Set

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Diabetes Outpatient Self-management Training and Educational Services

• An ongoing process of facilitating the knowledge, skill, and ability necessary for diabetes self-care.

• Incorporates the needs, goals, and life experiences of the person with diabetes and is guided by evidence-based standards.

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Objectives of DSME

• Support informed decision making• Develop self-care behaviors and problem

solving skills

• Active collaboration with the health care team• Improve clinical outcomes, health status, and

quality of life

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DSME Program Characteristics

• National Standards do not specify a set number of hours for programs or classes

• The average length of a class/ program 7 hours

• The average length of a class session 2 hours

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American Diabetes Association (ADA)

Standards of Medical Care in Diabetes - 2014

Diabetes Care Volume 37, Supplement 1, January 2014http://care.diabetesjournals.org/content/37/Supplement_1/S14.full.pdf

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ADA Standards

People with diabetes should receive DSME and diabetes self-management support (DSMS) according to National Standards for Diabetes Self-Management Education and Support when their diabetes is diagnosed and as needed thereafter.

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National Standards for Diabetes Self-Management Education and Support

• Developed by a Task Force that includes the American Diabetes Association, the American Association of Diabetes Educators, experts in the field, and people with diabetes

• Updated every five years

• Designed to define quality DSME and support

• Assist diabetes educators in providing evidence-based education and self-management support.

• Include 10 Standards http://care.diabetesjournals.org/content/36/Supplement_1/S100.full.pdf+html

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National Standards for Diabetes Self-Management Education and Support

10 Standards 1. Internal Structure 6. Curriculum

2. External Input 7. Individualization

3. Access 8. Ongoing Support

4. Program Coordination 9. Patient Progress

5. Instructional Staff 10. Quality Improvement

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1. Internal Structure

• Document an organizational structure, mission statement, and goals

• Increases efficiency and effectiveness

• Critical factor in clear communication

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2. External Input

• Seek ongoing input from external stakeholders and experts to promote program quality

• Increase knowledge of consumer needs

• Build bridges to key stakeholders

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3. Access

• Clarify the specific population to be served

• Determine how best to deliver diabetes education to that population

• Identify resources that can provide ongoing support for that population

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4. Program Coordination

• Designated to oversee the DSME program

• Has oversight responsibility for the planning, implementation, and evaluation of education services

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5. Instructional Staff

• One or more instructors will provide DSME• At least one of the instructors will be a registered

nurse, registered dietitian, or pharmacist with training and experience pertinent to DSME

or • Another professional with certification in diabetes

care and education, such as a Certified Diabetes Educator (CDE) or Board Certified - Advanced Diabetes Management (BC-ADM)

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6. Curriculum

• Describing the diabetes disease process and treatment options

• Incorporating nutritional management into lifestyle

• Incorporating physical activity into lifestyle

• Using medication(s) safely and for maximum therapeutic effectiveness

• Monitoring blood glucose and other parameters and interpreting and using the results for self-management decision making

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6. Curriculum

• Preventing, detecting, and treating acute complications

• Preventing, detecting, and treating chronic complications

• Developing personal strategies to address psychosocial issues and concerns

• Developing personal strategies to promote health and behavior change

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Curricula Resources

• Diabetes Education Curriculum: Guiding Patients , published by the American Association of Diabetes Educators

• Life with Diabetes, 4th Edition, published by the American Diabetes Association

• NC Self-Management Education Curriculum, published by the NC Diabetes Prevention and Control Program.

• U.S. Diabetes Conversation Map Program, published by Healthy Interactions, Inc.

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7. Individualization

• The diabetes self-management, education, and support needs of each participant will be assessed by one or more instructors.

• The participant and instructor(s) will then together develop an individualized education and support plan focused on behavior change.

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8. Ongoing Support

• The participant and instructor(s) will together develop a personalized follow-up plan for ongoing self-management support.

• The participant’s outcomes and goals and the plan for ongoing self-management support will be communicated to other members of the healthcare team.

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9. Patient Progress

• Monitor whether participants are achieving their personal diabetes self-management goals and other outcome(s)

• Participant success is used to evaluate the effectiveness of the educational intervention(s)

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AADE7™ Self-Care Behaviors

Healthy eating

Being active

Monitoring

Taking medication

Problem-solving

Healthy coping

Reducing risks

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10. Quality Improvement

A systematic process to:• Measure the effectiveness of the education

and support

• Improve any identified gaps in services or service quality

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Certification Organizations

• American Diabetes Association – Diabetes Education Recognition Program

• American Association for Diabetes Educators – Diabetes Education Accreditation Program

Florida Counties with Accredited or Recognized DSME Programs

MADISON

TAYLOR

HAMILTON

SUWANNEE

LAFAYETTE

DIXIE

CO

LU

MB

IA

GILCHRIST

LEVY

UNION

BRADFORD

ALACHUA

PUTNAM

MARION

LAKECITRUS

SUMTER

HERNANDO

BAKER

NASSAU

DUVAL

CLAY ST JOHNS

FLAGLER

VOLUSIA

SEMINOLE

ORANGEBREVARD

OSCEOLA

PASCO

HILLSBOROUGHPOLK

MANATEE

HARDEE

HIGHLANDS

INDIAN RIVER

OKEECHOBEE

ST LUCIE

MARTIN

PALM BEACH

BROWARD

DADEMONROE

COLLIER

HENDRYLEE

CHARLOTTEGLADES

DESOTOSARASOTA

JEFF

ER

SO

N

PIN

EL

LA

S

SANTA ROSAOKALOOSA

WALTON

HOLMES

JACKSON

WASHINGTON

CALHOUN

BAY

GULF

GADSDEN

LIBERTY

FRANKLIN

LEON

WAKULLA

ESCAMBIA

2013

44 counties w/ DSME program

23 counties w/o DSME program

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Why DSME?

9 Comprehensive Diabetes Care – (CDC) • Hemoglobin A1c (HbA1c) testing • HbA1c poor control • HbA1c control (<8%) • Eye exam (retinal) performed • LDL-C screening • LDL-C control (<100 mg/dL) • Medical attention for nephropathy

10 Controlling High Blood Pressure – (CBP)

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• HbA1c and blood pressure reduced

• Fewer hospital admissions, emergency department visits, and outpatient visits.

• Estimated savings in diabetes-related cost over 3 years - $415 per program completer.

• Over 10 years, completers were estimated to experience 12% fewer coronary heart disease events and 15% fewer microvascular disease events

Why DSME?

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• Receiving formal diabetes education is consistently a predictor of engaging in preventive behavior and receiving diabetes-related health services

• Patients who participate in diabetes education are more likely to follow best practice treatment recommendations

Why DSME?

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• DSME at time of diagnosis helps people with diabetes initiate effective self-management and cope with diabetes

• Ongoing DSME and DSMS helps people with diabetes maintain effective self-management throughout a lifetime

Why DSME?

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• Improved diabetes knowledge and improved self-care behavior

• Improved clinical outcomes such as lower HbA1c

• Increased use of primary and preventive services

• Lower use of acute, inpatient hospital services • LOWER COSTS

Why DSME?

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Benefits of DSME

STUDY TYPE OF PROGRAM OUTCOMES

Maine

Ambulatory Diabetes Education and Follow-up

32% ↓ hospitalizations

Los Angeles Diabetes Clinic County Hospital

73% ↓ hospitalizations

Atlanta Outpatient care and Education Clinic

65% ↓ hospitalizations

North Dakota Outpatient Education 72% ↓ hospitalizations

Rhode Island Outpatient Education 51% ↓ hospitalizations

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Cost of DSME

• $352 to $430 – DSME Medicare Reimbursementhttp://medicare.fcso.com/Fee_lookup/fee_schedule.asp

• 7700 – hospitalizations w/ diabetes primary diagnosis – Florida Medicaid beneficiaries – 2012AHCA Hospital Inpatient Discharge Data Set

• $295,636,031 – total Florida Medicaid charges for hospitalizations w/ diabetes primary diagnosis – 2012AHCA Hospital Inpatient Discharge Data Set

• $2,710,400 to $3,311,000 – estimated cost of DSME for 7700

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Ever taken a class or course to learn how to manage diabetes

Florida Adults with Diabetes

Income < $15,000

2012 Behavioral Risk Factor Surveillance System

Yes 40%

No 60%

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Barriers

• Aversion to group classes

• Don’t feel they need information

• Times/dates inconvenient

• Transportation difficulties

• Lack of awareness of benefits

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Healthy People 2020 Priority

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Even Better Outcomes

• DSME – the more the better • Provide follow-up support • Culturally and age appropriate • Tailor to individual needs and preferences• Address psychosocial issues• Incorporate behavioral strategies• Both individual and group approaches have

been found effective

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Resource Information

• AADE Accredited programshttp://www.diabeteseducator.org/ProfessionalResources/accred/Programs.html

• ADA Recognized programs http://professional.diabetes.org/ERP_List.aspx• Certified Diabetes Educator http://www.ncbde.org/find-a-cde/• Find a Diabetes Educator http://www.diabeteseducator.org/find

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Elliot P. Joslin

“The person with diabetes who knows the most lives the longest.”

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Questions?

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Sarah Cawthon

Health Systems Program Manager

Bureau of Chronic Disease Prevention

(850) 245-4391

Sarah.Cawthon@flhealth.gov