welcome to the 2016 diabetes summit! summit day ... rdn, lrd, mba 11:45 – 12:00 evaluation ......

Welcome back to the 2016 Diabetes Summit Day 2!

Before we get started again… CME Forms Pre-test Post Test Day 2 Evaluation Interested in becoming a Diabetes Coalition member? Of course you are! Please fill out the Diabetes Membership Form Reimbursement Forms -Submit to Janet Lucas: [email protected]

Wi-Fi Password:

mailto:[email protected]

7:00 - 8:00 Breakfast

8:00 - 9:00 Increasing Provider Referrals for DSME & NDPP Sacha Uelman RD, CDE

9:00 - 10:00 Quality: The Case for DSME Jo Ellen Condon, RD, CDE

10:00 - 10:45 Vendor Break

10:45 - 11:45 National Diabetes Prevention Program Update Tera Miller, RDN, LRD, MBA

11:45 – 12:00 Evaluation and Wrap Up

Agenda Day 2

Increasing Provider Referrals for

your DSME and NDPP

Objectives

• Learn simple steps to increase referrals to your diabetes

education and prevention program

• Identify key people who can help get the word out about

diabetes education and prevention programs

• Prepare a simple presentation to use when meeting with

key people and groups to solicit your program

• Avoid making assumptions about your audience and

referral base

The Facts as we know them

• 9.3% of the US population has diabetes-that’s 29.1 million

people!

– Another 8 million of those people don’t even know they have it.

– 11.8 million of them are seniors

• 1.4 million more people diagnosed each year

• 86 million more people in the US have pre-diabetes

Sacha logic

• If every one of those 86 million

people attended our Diabetes

Prevention Program, 50

million of them would NOT get

diabetes (or at least delay the

diagnosis for a few years)!

• If every one of those 29 million

people with diabetes attended

our Diabetes Education

programs: another 18 million

are likely to avoid

complications.

So, why aren’t they beating down

our doors?

• Doctors are busy and

overwhelmed.

• Information overload.

• Everyone “thinks”

they have the best

answer.

• We’ve been around

forever, we’re not

flashy and new, but

we are tried and true!

What can we do?

• It’s not rocket science: they need to know about you in order to send a referral your way.

• Ensure that the right people know about our programs: – Primary Care physician’s offices

– Endocrine Clinics

– Cardiovascular Medicine clinics

– Inpatient discharge planners

– Social workers

– Quality Committees

– Emergency Departments

– Other Dietitians and Nurses

– The people we are trying to reach

Grassroots approach to market

your program

• Start with people you know

– Are there 1 or 2 physicians that already send you a lot of

referrals?

– Do you have contact with clinic managers that might have

interest in your cause?

– Are there like minded programs that can share information?

• Find some “champions”: Physician champions are key,

but other professionals can help your cause as well!

Our physician champions

• Family Medicine Resident approached us about the DPP and used her contacts to get us on the agenda for some meetings.

• Those meetings led to other doctors finding out about us and then we had even more contacts

• Our Medical Director helped get us on the agenda for other meetings.

• Several physicians in our health system with other contacts were advocates.

Keep your docs in the loop

• Send regular updates about your

program progress to your physician

champions.

• Send patient success stories and

statistics as well as feedback from

patients attending your program.

• Keep in contact at least monthly:

find something to share, you gather

these tidbits every day, take some

time to BRAG!

Other champions

• Clinic managers were excited and

shared with their medical directors.

• Nurses attended our program

themselves and were advocates.

• Nurse managers heard about our

program and wanted to refer patients.

• Know that you will find help in places

you never would expect

• Diabetes touches almost everyone and

most people can relate and want to help

your cause.

10 minute presentation

• Use your contacts to get on the meeting

agendas

• Doctors, nurses and administrators often

have monthly or weekly meetings

• Keep it short: what is the take home

message?

• Do your homework:

– Who is your audience?

– Who or what programs are you competing with?

– Remember: appeal both to professional and

personal interests

Don’t make assumptions

• First presentation to local insurance provider

– We assumed everyone knows:

• Diabetes prevention is a top priority

• Common Sense = prevent disease because that’s much cheaper than treating disease.

• What the DPP is

• Behavior change can prevent or delay diabetes

Don’t make assumptions

• First presentation to local physician group

– Assumptions we made

• Doctors know the stats and value of diabetes

prevention by behavior change

• All primary care doctors are familiar with the NDPP

• Nobody wants to pay for our programs

• They aren’t referring to us because they don’t think

we provide value

• They know what prediabetes is and know when to

diagnose

Our presentations

• Our first presentation

contained 44 slides, was

very informative and put

people to sleep.

• Next version had 25

slides, a bit better but still

too long.

• We were adding to

information overload!

10 slides in 10 minutes

• What is Pre-Diabetes and how is it diagnosed?

• What is the prevalence of pre-diabetes and what is the success of the NDPP?

• Who is eligible for the DPP and who to refer?

• What does our program entail?

• Testimonials from former or current participants.

• How to refer to our program.

Getting the word out

• Have a catchy but brief flyer, CDC has a template for you

• Can the local DME (Durable Medical Companies) insert a

flyer in their supply order shipments?

• Are there websites that list local events where you can

advertise info sessions?

• The best advertising is word of mouth.

Don’t forget your peeps!

• Word of mouth is the best

referral you can get, but your

patients might need a

reminder to spread the word.

• Written testimonials from your

participants.

• Marketing directly to your

patients: flyers in waiting

rooms and clinic rooms or

anywhere likely patients might

be hanging out!

Final notes

• Use your connections, they are out

there!

• Get some physician champions and

get them excited about your

programs!

• Grassroots marketing works really

well!

• Don’t make assumptions.

• Keep people in the loop and utilize

your success stories.

Questions?

Thank you!

Sacha Uelmen, RD, CDE

734.998.2475

[email protected]

Copyright © 2016 by American Diabetes Association All rights reserved. This document or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the American Diabetes Association.

Maximizing

Quality

in Your

DSME Program

Presented by Jo Ellen Condon RD, CDE

Alexandria, VA

Managing Director Education Recognition Program

American Diabetes Association


Learning Objectives

• List 3 quality measures that can promote DSME referrals and utilization

• Describe the Federal Government Hospital Readmission Reduction Program

• Deliver a “DSME Elevator Speech” ready to deliver

• Identify what CQI projects would meet ADA’s criteria for standard 10 of the National Standards of DSME/S


uality

Why is it so important to

measure Quality?


Quality Measure and Positive Outcomes

Measures that reflect

– Improved Health Outcomes

– Improved Quality of Life

– Improved Medical Guideline Adherence

– Cost Savings

Advertised they lead to increase referrals


uality

What Are You Measuring?

How Did You Determine

What to Measure?


Do Your

Quality Measures

Match the

Needs and Concerns

of Your

Current and Potential Referral Sources?


DSME Quality Check

Provides the foundation to help people with diabetes to navigate the required daily self care decisions and activities and has been

shown to improve health outcomes

• Reduces Healthcare Costs • Reduced A1C • Reduced Hospitalizations • Reduced ER Visits

Diabetes Care Volume 38, July 2015: Diabetes Self-Management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association


2014 Harvard Law White Paper


Harvard Law 2014 White Paper

• White paper

• Examines the role of DSME in diabetes treatment

• Evaluates if the reduction or elimination of cost-sharing would be a cost-effective strategy for increasing DSME utilization

• Evaluated recent DSME cost-benefit analyses

• Authors conclude that little or no cost-sharing could improve patient health and reduce costs.

Supported by Harvard Law School 2014 White Paper

http://www.diabetespolicy.org/wp-content/uploads/2014/06/6.11.15-Reconsidering-Cost-Sharing-for-DSME.pdf















The Urban Diabetes Study

Evaluated

Nutritionist Visits,

Diabetes Classes, and

Hospitalization Rates

and Charges Jessica M. Robbins et al., Nutritionist Visits, Diabetes Classes, and Hospitalization Rates and Charges: The Urban Diabetes Study, 31

DIABETES CARE, no. 4, 655, 657 (Apr. 2008).

Link: http://care.diabetesjournals.org/content/31/4/655.full

http://care.diabetesjournals.org/content/31/4/655.full


Diabetes Education Reduces Hospitalizations and Hospital Costs

• 4.7 year observational study

• 18,404 PWD

• 15,939 no education

• 2,465 one or > education visits

Jessica M. Robbins et al., Nutritionist Visits, Diabetes Classes, and Hospitalization Rates and Charges: The Urban Diabetes Study, 31 DIABETES CARE, no. 4, 655, 657 (Apr. 2008).

Link: http://care.diabetesjournals.org/content/31/4/655.full

http://care.diabetesjournals.org/content/31/4/655.full



• One or more diabetes education or nutrition visits

• Reduced hospitalization and hospital charges

Reduction Per Year

Per Patient

• With Education Hospital Charges $6,244

• No Education Hospital Charges $10,258

• Cost Savings with Education $4,014 Jessica M. Robbins et al., Nutritionist Visits, Diabetes Classes, and Hospitalization Rates and Charges: The Urban Diabetes Study, 31 DIABETES CARE, no. 4, 655, 657 (Apr. 2008).



Each Educational Visit was Associated with

$1,684 reduction in total hospital charges

per patient over the course of the

4.7 years Jessica M. Robbins et al., Nutritionist Visits, Diabetes Classes, and Hospitalization Rates and Charges: The Urban Diabetes Study, 31 DIABETES CARE, no. 4, 655, 657 (Apr. 2008).


Assessing the Value of Diabetes Education

Evaluated

The Impact of DSME on

Financial Outcomes

(Cost of Patient Care)

Ian Duncan et al., Assessing the Value of Diabetes Education, 35 THE DIABETES EDUCATOR, no. 5, 752, 757 (Sept./Oct. 2009)


Diabetes Education Decreases Cost

• 3 year (2005 to 2007) study of administrative claims data assessing process measures and costs

• Participant had claim for DSME or MNT • (G0108-Go109 and 97802 to 97804, G0270, G0271)

Commercial Medicare Advantage No Education With Ed. No Education With Ed.

2005 142,829 10,994 42,000 1,664 2006 149,860 11,957 49,756 2,309 2007 154,654 12,277 53,902 2,443 Average Participants per Year 11,741 2,138

Ian Duncan et al., Assessing the Value of Diabetes Education, 35 THE DIABETES EDUCATOR, no. 5, 752, 757 (Sept./Oct. 2009)



Commercial Insurance Average Monthly Annual Per Pt. / Month No Education Education Difference Difference Costs $95965 $905.39 -$54.26 -$651.12 Inpatient $311.61 $223.09 -$88.52 Outpatient $198.83 $212.28 +$13.45 Professional $315.92 $310.69 -$5.23 Pharmacy $133.29 $159.33 +$26.04

Average Pts/year X Annual Savings = A LOT of $$$$$ 11,741 X $651.12 = $7,644,799.92

PMPM-Per Patient Per Month Ian Duncan et al., Assessing the Value of Diabetes Education, 35 THE DIABETES EDUCATOR, no. 5, 752, 757 (Sept./Oct. 2009).



Medicare Advantage Insurance Average Monthly Annual Per Pt. / Month No Education Education Difference Difference Costs $1,196.22 $1,029.39 -$166.83 -$2,001.96 Inpatient $468.87 $308.08 -$160.79 Outpatient $184.76 $192.72 +$7.96 Professional $308.48 $285.84 -$22.64 Pharmacy $234.11 $242.75 +$8.64

Average Pts/year X Annual Savings = A LOT of $$$$$ 2,138 X $2,001.96 = $4,278,052.48

PMPM-Per Patient Per Month Ian Duncan et al., Assessing the Value of Diabetes Education, 35 THE DIABETES EDUCATOR, no. 5, 752, 757 (Sept./Oct. 2009).


Diabetes Education Decreased Costs & Increased HEDIS Compliance

Other Study Outcomes

• DSME participants were more compliant to HEDIS measurements except Medicare Advantage Population for eye exams • HEDIS Measures – A1C, Lipid, Microalbuminuria, Eye Exam

• Overtime DSME participants healthcare costs continued to be

lower than those who did not receive education

HEDIS – Healthcare Effectiveness Data and Information Ian Duncan et al., Assessing the Value of Diabetes Education, 35 THE DIABETES EDUCATOR, no. 5, 752, 757 (Sept./Oct. 2009).


DMSE Lowers A1C

Self Management Education For

Adults With Type 2 Diabetes

Self-Management Education for Adults with Type 2 Diabetes: A Meta-Analysis of the Effect on Glycemic Control, 25 DIABETES CARE 1159, 1164 (2002) Link: http://care.diabetesjournals.org/content/25/7/1159.full.pdf


DMSE Lowers A1C

• Meta Analysis of 31 Studies • DSME lowers A1C

• 0.76% immediately after DSME • 0.26% at 1 – 3 months follow up • 0.26% 4 months or later follow up • 1% was noted for every 23.6 hrs of additional

contact Pearl: DSME needs to be ongoing

Self-Management Education for Adults with Type 2 Diabetes: A Meta-Analysis of the Effect on Glycemic Control, 25 DIABETES CARE 1159, 1164 (2002) Link: http://care.diabetesjournals.org/content/25/7/1159.full.pdf


2015 Chronicle Diabetes

2015 ADA ERP Chronicle Diabetes Benchmark

Report

9,374 patients 477 Sites

A1C reduction 1.26% (0.1 - -4.9%) 2015 added

Diabetes related Hospital and ER Visits


A1C

What is it and why do we care?

What is the goal A1C?

Why do we care about A1C?

eAG: estimated average glucose

28.7 x A1c – 46.7 = eAG


1% A1C Reduction

1% reduction in A1C levels has been found to be associated with risk reductions

• 21% Diabetes Related Deaths

• 14% Heart Attacks

• 37% Microvascular Complications

Eyes ~ Kidney ~ Nerves

Irene M. Stratton et al., Association of Glycaemia with Macrovascular and Microvascular Complications of Type 2 Diabetes (UKPDS 35): Prospective Observational Study, 321 THE BMJ 405, 405, 409 (Aug. 2000).

Link: http://www.ncbi.nlm.nih.gov/pubmed/10938048

http://www.ncbi.nlm.nih.gov/pubmed/10938048




A1C and Wounds

The Affects of Glycemic Control On Foot Ulcer Would Healing

411 PWD

Every 1% increase in A1C there was a

=15% decreased odds of wound healing.

Source: Abstract 0189-OR. Cook EA, Cook JJ, Henao M, et al. The importance of sustained glycaemic control during wound healing. Link: http://www.diabetesjournal.co.za/downloads/SADVD_ADA_Watch.pdf

http://www.diabetesjournal.co.za/downloads/SADVD_ADA_Watch.pdf

http://www.diabetesjournal.co.za/downloads/SADVD_ADA_Watch.pdf


Surgical Site Infections

• Surgical Site Infections (SSI) are at an increased risk for PWD for majority of surgeries

• Meta-analysis and systematic review • The review included 94 published studies from 1985 to 2015.

• None of the studies differentiated between T1DM and T2DM.

• SSI risk appears to be highest for cardiovascular surgery patients with diabetes

Emily T. Martin, Keith S. Kaye, Caitlin Knott, Huong Nguyen, Maressa Santarossa, Richard Evans, Elizabeth Bertran and Linda Jaber Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infection Control & Hospital Epidemiology, Available on CJO 2015 doi:10.1017/ice.2015.249 Link: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10079557&fileId=S0899823X15002494

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10079557&fileId=S0899823X15002494

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10079557&fileId=S0899823X15002494


Surgical Site Infections

• SSI are the most frequent cause of hospital-acquired infection

• Frequently lead to re-hospitalization

• Annual healthcare cost of SSI’s is more than $3 billion

• Previous studies have identified that hyperglycemia and diabetes are risk factors for SSI

• Precautions for prevention of SSI

• Establishing and maintaining euglycemia before and after surgery

• Appropriate prophylaxis treatment


Current Healthcare Environment

Diabete Self-Management

Education and Support

29.1M with Diabetes

86 Million Pre-Diabetes

Glycemic Control

A1C

11 to 15 minute PCP visits

Inpatient and ER Cost

Hospital Readmission

Reduction Program

Microvascular Health & Wellness

Payment for Performance

1.4 Million New DM

Diagnosis per year

HEDIS Measures

NCQA


Current Healthcare Environment

DSME

29.1M with Diabetes

86 Million Pre-Diabetes

Glycemic Control

A1C

11 to 15 minute PCP visits

Inpatient and ER Cost

Hospital Readmission

Reduction Program

Microvascular Health & Wellness

Payment for Performance

1.4 Million New DM Diagnosis

per year

HEDIS Measures

NCQA

DSME

DSME DSME

DSME

DSME

DSME

DSME

DSME

DSME


2016 Diabetes HEDIS Measures

• Eye Exams

• A1C Control

• <7%

• 7%-9%

• >9%

• Blood Pressure

• Diastolic 80 – 89

• Diastolic ≥ 90

• Systolic ≥ 140

• Systolic <140

• Nephropathy Screening Link: https://www.excellusbcbs.com/wps/wcm/connect/d0d72c45-4bbf-4bdb-8956-abcc1a1cee7a/HEDIS+Measures+2016.pdf?MOD=AJPERES&CACHEID=d0d72c45-4bbf-4bdb-8956-abcc1a1cee7a

Link:

https://www.excellusbcbs.com/wps/wcm/connect/d0d72c45-4bbf-4bdb-8956-

abcc1a1cee7a/HEDIS+Measures+2016.pdf?MOD=AJPERES&CACHEID=d0d72c45-4bbf-4bdb-8956-abcc1a1cee7a


Primary Care Provider

90% of people with diabetes can be successfully managed by

Primary Care Providers

Reference: U.S. Department of Health and Human Services: National Ambulatory Medical Care Survey, 2004 [report online]. Available from http://www.cdc.gov/nchs/data/ad/ad346.pdf

http://www.cdc.gov/nchs/data/ad/ad346.pdf


2014 Kaiser Health News

• Not unusual for PCP appointments to be scheduled for 15-minutes

• Some physicians who work for hospitals report seeing patients every 11 minutes

• Medicare moving from fee for service to Payment for Performance

How Can Your DSME Program Assist?

Robin PC, 15-Minute Visits Take A Toll On The Doctor-Patient Relationship. Kaiser Health News 2014; April 21


Hospital Readmission Reduction

Federal Hospital Readmissions Reduction Program (HRRP)

Part of the Affordable Care Act (ACA) - Affective since October 1, 2012

CMS Financial Penalty – 1% Excessive Hospital Readmissions

Within 30 Days of Discharge

Heart Failure (HF) Heart Attack (AMI)

Pneumonia (PN)

2013 = 2/3 received 1% reduction


2015 HRRP Additions

Federal Hospital Readmissions Reduction Program

2015 Additions

Penalty Increased to 3%

3 additional diagnosis

Chronic Obstructive Pulmonary Disease (COPD)

Total Knee Arthroplasty (replacement) (TKA)

Total Hip Arthroplasty (replacement) (THA)


2017 Addition


2015 ruling added one additional diagnose

that will take affect in 2017

1 additional diagnosis added for a total of 7 diagnosis

Coronary Artery Bypass Graph (CABG) ~350K to 400K performed annually

https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html




















HRRP


(HRRP)

/

https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/OMH_Readmissions_Guide.pdf









Questions


Quality Question of the Day

Are there any

different measures

you think may benefit

your DSME Program?


Standard 10 Quality Improvement

The provider(s) of DSME will measure

the effectiveness of the education and

support and look for ways to improve

any identified gaps in services or

service quality using a systematic

review of process and outcome data.


Standard 10 Criteria

• DSME Program Must Measure and Aggregate a minimum of 2

Outcomes

• Aggregate one or more patient selected behavioral goal outcomes

• Aggregate one or more other participant outcomes

• DSME Program Must have a CQI Project based on one of the

What are the parts of a CQI Project?


Standard 10 Criteria

Standard 10 Criteria requires evidence of:

• CQI project must have • Opportunity for improvement

• Baseline measurement

• Target outcome

• Steps for improvement

• Planned outcome measurement


Standard 10 Cycle and Worksheet

CQI Cycle and

Worksheet

Activity


Questions


Acronyms

AADE – American Association of Diabetes Educators ABN – Advance Beneficiary Notice of Non-Coverage ADA – American Diabetes Association ASR – Annual Status Report BC-ADM – Board Certified in Advanced Diabetes Management CCM – Chronic Care Management CDC – Centers for Disease Control and Prevention CDE – Certified Diabetes Educator CHW – Community Health Worker CMS – Centers for Medicaid and Medicare Services DEAP – Diabetes Education Accreditation Program DPP – Diabetes Prevention Program DSME – Diabetes Self-Management Education DSMT – Diabetes Self-Management Training (term Medicare uses) DSME/S – Diabetes Self-Management Education and Support EDC – Everyone with Diabetes Counts (CMS)

Note: DSME/S, DSME and DSMT are used interchangeably


Acronyms

ERP – Education Recognition Program

FQHC – Federally Qualified Health Center

MAC – Medicare Administrative Contractor

MNT – Medical Nutrition Therapy

MUE- Medically Unlikely Edits

NAO – National Accrediting Organization

NCBDE – National Credentialing Board for Diabetes Educators

NSDSMES – National Standards for Diabetes Self-Management and Support PC – Program Coordinator PDM – Pre Diabetes RD – Registered Dietitian RHC – Rural Health Clinic UOS – Units of Service

Vendor Break!

10:00 – 10:45 AM

Thank you!

Before you leave please complete :

Post-Test for Day 2 (Pink sheet)

Evaluation Form (Yellow sheet)

Diabetes Coalition Membership Form

Please submit reimbursement forms to Janet Lucas once complete.

[email protected]

mailto:[email protected]

welcome to the 2016 diabetes summit! summit day ... rdn, lrd, mba 11:45 – 12:00 evaluation ......

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