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^ DDMUDMPDMGDMDDMUDMTotal Costs 4, ,116381, ,181 DDMUDMPDMGDM 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 (Dec);37: ^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 MWR 2014;63: Strawbridge L, et al: Use of medicare’s diabetes self-management training benefit. Health Education and Behavior. (Ahead of print 1/23/15): 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: mmendationStatementDraft/screening-for-abnormal-glucose-and- type-2-diabetes-mellitus. Public comment now closed. mmendationStatementDraft/screening-for-abnormal-glucose-and- type-2-diabetes-mellitus 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