Diabetes Self- Management Education Florida Medicaid Managed Care Program Presented by: Sarah Cawthon Date: May 20,

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 2

Medicaid MMA Contract Requirement (20)(c) In the same manner as specified in s , 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 3

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! 4

Cost of Diabetes – Florida $1,390,000,000 ($1.39 billion) - cost of diabetes among Medicaid beneficiaries CDC Chronic Disease Cost Calculator Medicaid charges for hospitalizations with diabetes as primary diagnosis  $295,636,031 - total  $38,394 - average AHCA Hospital Inpatient Discharge Data Set 5

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. 6

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 7

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 8

American Diabetes Association (ADA) Standards of Medical Care in Diabetes Diabetes Care Volume 37, Supplement 1, January

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. 10

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 11

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 12

1. Internal Structure Document an organizational structure, mission statement, and goals Increases efficiency and effectiveness Critical factor in clear communication 13

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 14

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 15

4. Program Coordination Designated to oversee the DSME program Has oversight responsibility for the planning, implementation, and evaluation of education services 16

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) 17

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 18

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 19

Curricula Resources Diabetes Education Curriculum: Guiding Patients, published by the American Association of Diabetes Educators Diabetes Education Curriculum: Guiding Patients Life with Diabetes, 4th Edition, published by the American Diabetes Association Life with Diabetes NC Self-Management Education Curriculum, published by the NC Diabetes Prevention and Control Program. NC Self-Management Education Curriculum U.S. Diabetes Conversation Map Program, published by Healthy Interactions, Inc. U.S. Diabetes Conversation Map Program 20

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. 21

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. 22

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) 23

AADE7™ Self-Care Behaviors Healthy eating Being active Monitoring Taking medication Problem- solving Healthy coping Reducing risks 24

10. Quality Improvement A systematic process to: Measure the effectiveness of the education and support Improve any identified gaps in services or service quality 25

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Certification Organizations American Diabetes Association –Diabetes Education Recognition Program American Association for Diabetes Educators –Diabetes Education Accreditation Program 27

Florida Counties with Accredited or Recognized DSME Programs MADISON TAYLOR HAMILTON SUWANNE E LAFAYETTE DIXIE COLUMBIA GILCHRIST LEVY UNION BRADFORD ALACHUA PUTNAM MARION LAKE CITRUS SUMTER HERNANDO BAKER NASSAU DUVAL CLAY ST JOHNS FLAGLER VOLUSIA SEMINOLE ORANGE BREVARD OSCEOLA PASCO HILLSBOROUGH POLK MANATEE HARDEE HIGHLANDS INDIAN RIVER OKEECHOBEE ST LUCIE MARTIN PALM BEACH BROWARD DADE MONROE COLLIER HENDRY LEE CHARLOTTE GLADES DESOTO SARASOTA JEFFERSON PINELLAS SANTA ROSA OKALOOSA WALTON HOLMES JACKSON WASHINGTON CALHOUN BAY GULF GADSDEN LIBERTY FRANKLIN LEON WAKULLA ESCAMBIA counties w/ DSME program 23 counties w/o DSME program

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) 29

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? 30

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? 31

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? 32

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? 33

Benefits of DSME STUDYTYPE OF PROGRAMOUTCOMES 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 DakotaOutpatient Education72% ↓ hospitalizations Rhode IslandOutpatient Education51% ↓ hospitalizations 34

Cost of DSME $352 to $430 – DSME Medicare Reimbursement – hospitalizations w/ diabetes primary diagnosis – Florida Medicaid beneficiaries – 2012 AHCA Hospital Inpatient Discharge Data Set $295,636,031 – total Florida Medicaid charges for hospitalizations w/ diabetes primary diagnosis – 2012 AHCA Hospital Inpatient Discharge Data Set $2,710,400 to $3,311,000 – estimated cost of DSME for

Ever taken a class or course to learn how to manage diabetes Florida Adults with Diabetes Income < $15, Behavioral Risk Factor Surveillance System 36

Barriers Aversion to group classes Don’t feel they need information Times/dates inconvenient Transportation difficulties Lack of awareness of benefits 37

Healthy People 2020 Priority 38

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 39

Resource Information AADE Accredited programs urces/accred/Programs.html ADA Recognized programs Certified Diabetes Educator Find a Diabetes Educator 40

Elliot P. Joslin “The person with diabetes who knows the most lives the longest.” 41

Questions? 42

Sarah Cawthon Health Systems Program Manager Bureau of Chronic Disease Prevention (850)