National Perspective on NDPP, DSMES, Diabetes Educators

from AADE

Hope Warshaw, MMSc, RD, CDE, Owner, Hope Warshaw Associates, LLC and President-elect AADE

Economic Burden of Diabetes, Prediabetes, GDM in VA*

Medical Costs^ Indirect Costs^

DDM UDM PDM GDM DDM UDM Total Costs

4,425 601 1,116 38 1,768 239 8,181

DDM UDM PDM GDM

564 (6.8%) 207 (3.2%) 2,213 (36%) 6.8 (6.7%)

*Dall, et al. The Economic Burden of Elevated Blood Glucose Levels in 2012: Diagnosed and Undiagnosed Diabetes, Gestational Diabetes Mellitus, and Prediabetes. Diabetes Care. 2014 (Dec);37:3172-3179.

^Dollars are reported in millions

State Level Prevalence#

#Data are reported in thousands (prevalence rate).

Topics to cover

• New stats/research on utilization of DSMES• Essential Health Benefits and ACA• USPSTF decision/timeline for screening at risk adults for diabetes • NCQA and DSMES as HEDIS indicator• AADE DPP model • AADE education programs calendar

Topics: New stats/research on utilization of DSMES

1. Li R, et al.: Diabetes self-management education/training among privately insured persons with newly diagnosed diabetes US 2011-2012. MWR 2014;63:1045-1049 . 2. Strawbridge L, et al: Use of medicare’s diabetes self-management training benefit. Health Education and Behavior. (Ahead of print 1/23/15):

http://heb.sagepub.com/content/early/2015/01/20/1090198114566271.abstract

Only 6.8% of persons with newly diagnosed T2DM with private health

insurance participated in DSME within 12 months of diagnosis(1) diagnosis

Only 5% of Medicare participants receive DSME and/or MNT(2)

Topic: Essential Health Benefits and ACA

• 1/28 update (Ruth Lipman, PhD, AADE CSPO at time): • DSMES/T (DSMES) was not graded by Federal Gov – Office of Management

and Budget(OMB), MNT was. States get to decide for themselves whether they will cover DSMT for Medicaid recipients in their states.

• 5/20 update (Leslie Kolb, MBA, RN, Director of Accreditation and Quality Initiatives): • More states are working on reimbursement for DSMES and Prevention [DPP

programs] due to CDC funding for these programs. States are looking at barriers to DSMES b/c they’re charged with increased access. One huge barrier is reimbursement.

Topic: USPSTF decision/timeline for screening at risk adults for diabetes

• USPSTF decisions often result in Medicare and thus other payers covering a preventive service.• Announcing public comment: http://

www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/screening-for-abnormal-glucose-and-type-2-diabetes-mellitus. Public comment now closed.• Decision on this preventive service has not be made.

Topic: NCQA and DSMES as HEDIS indicator

• Goal: Get DSMES added as a HEDIS indicator to the Adult Diabetes Measurement Set

• Final step: AADE needs a physician-based organization to champions these measures within AMA• 5/22/15: AADE is at the early stages of pulling together a couple of diabetes-

related associations willing to be part of a workgroup to accomplish this goal. • Additional detail:

• Diabetes Advocacy Alliance (DAA) (national advocacy group AADE is a member of) is working to condense the number of measures for diabetes (currently ~98).

• Big problem for DSMES is that it’s a “process” measure not an “outcome” measure.

Topic: AADE DPP Model

Why CDC selected AADE for the 4 year DPP Cooperative Agreement (granted 2012)?

• Work with AADE’s diverse membership (14,000+) of multidisciplinary diabetes educators• According to AADE’s Nat’l Practice Survey 80.5% of members

reported including people with prediabetes in classes and/or doing programming specifically for people with prediabetes • Working with the network of DSMES with AADE DEAP or ADA ERP

accreditation/recognition

AADE DPP’s Programmatic Data DPRP Feedback from CDC*

Requirements for DPRP recognition from CDC

AADE DPP programs

Proportion of participants program eligibility determined by a blood based test

> 50% 72%

Attendance at core sessions

> 80% 92%

Mean body weight loss > 5 - 7% 5.90%

*Based on 12 month data feedback sheets from Original AADE DPP sites

AADE DPP Model – AADE’s Network:

• AADE has a network of 45 AADE DPP Sites in 16 states• Diabetes Educators at sites are trained lifestyle coaches• All AADE DPP sites are• DSMES accredited/recognized programs • Recognized through CDC’s DPRP program• Deliver the National DPP with trained Lifestyle Coaches and oversight from a

Diabetes Educator

11

Topics: AADE Education/CE Programs Calendar

• Building your DSME Program workshop: 11/6 Phoenix - 1 ½ day training with original workshop plus Building your Prevention Program. • AADE Annual Meeting, Aug 5-8, New Orleans: 2 pre-conferences• Building your DSME Program• Pharmacology Boot Camp

• Webinar: Reimbursement for Diabetes Education - Tips and essentials for conquering reimbursement for DSME, 6/17 • CORE Concepts® Course Online, 7/6 thru 9/6• Learn more: diabeteseducator.org/ProfessionalResources/products/

Q & A