Gina Fleming, MA Project Manager Health Services Advisory Group December 15, 2015 Everyone with Diabetes Counts: Diabetes Self-Management Education

Health Service Advisory Group (HSAG) On a Mission to Make Healthcare Better Medicare Quality Improvement Organization – Arizona, California, Florida, Ohio, and the U.S. Virgin Islands HSAG provides: – Healthcare quality expertise to those who deliver care and those who receive care. – Tools and resources for patients, families and caregivers to be advocates for their own health. Current Initiatives: – Hospital – Nursing Home – Health Information Technology – Care Coordination – Diabetes (Everyone with Diabetes Counts) 2

Everyone with Diabetes Counts (EDC) More than 25 percent of Americans age 65 and older have diabetes – 51 percent are estimated to have pre-diabetes 8.1 million Americans are undiagnosed with diabetes Diabetes was the seventh leading cause of death in the United States in 2010 Diabetes can be treated, managed, and prevented Data Source: CDC National Diabetes Statistics Report, 2014, available at: the-united-states.pdf 3

HSAG’s Role in EDC Increase adoption and implementation of diabetes self-management education (DSME) – Diabetes Self-Management Program, Stanford University – Project Dulce, Scripps Health Whittier Diabetes Institute – Diabetes Empowerment Education Program, University of Illinois at Chicago (UIC) Train organizations statewide to offer DSME Provide assistance to organizations offering DSME Impact over 7,000 Medicare Beneficiaries with diabetes or pre-diabetes 4

Diabetes Empowerment Education Program (DEEP™) Program Description – Evidence-based program – Six weekly workshops – Each class is two hours long – Taught by one certified DEEP™ Peer Educator – Can be delivered in any language – Interactive, hands-on, group learning activities and games including visual aids and demonstrations 5

Interactive Demonstrations 6

DEEP™ Program Description (cont.) – Curriculum based on National Diabetes Care and Diabetes Self-Management Education Guidelines and Recommendations – Meets the highest-level criteria for Title IIID Funding as defined by the Centers for Medicare & Medicaid Services, an operating division of the U.S. Department of Health and Human Services 7

Goals and Target Population Goals: – Reduce diabetes care disparities – Prevent and/or reduce adverse health outcomes related to diabetes – Reduce risk factors associated with diabetes – Increase self-management skills – Facilitate short- and long-term behavioral change Target Audience: – Individuals living with or at risk of diabetes – Includes low-health literacy and low-literacy individuals 8

Medicare Fee-for-Service Diabetics per County in California CountyMedicare FFS Diabetics Los Angeles138,337 San Diego 36,624 Orange 34,669 Santa Clara 24,266 Riverside 22,718 San Bernardino 20,196 Sacramento 19,411 Alameda 18,651 Fresno 18,054 Ventura 14,165 Kern 13,183 San Francisco 12,806 Contra Costa 12,138 San Joaquin 12,000 Tulare 10,722 Monterey 9,933 9

Certified Peer Educator/ Workshop Leader Only one leader required to lead workshop Allows for make-up sessions Program Delivery Method 10

Training Requirements Attend a three-day, train-the- trainer workshop, and receive certification to facilitate DEEP™ workshops as a Peer Educator. Peer Educator training is taught by Lead Trainers. Lead Trainer training is taught by Senior Trainers. 11

Delivery Oversight and Structure Conducting outreach and registering workshop participants Securing community workshop locations Scheduling workshop leaders Collecting workshop participant/completer data – Attendance sign-in sheets – Demographic data – Diagnosis data – Pre and post-activation surveys 12

Program Costs Organizational License: $600 / five-year license Peer Educator Certification: $75 / three-year certification Training Cost (UIC): – Peer Educator Training Fee: $800 per person – Off-site Training Fee: $10,500, plus travel expenses Training Cost (HSAG): None Participant Cost: None 13

Program Costs cont. For a limited time, HSAG will provide: Leader training at no charge to organizations committed to offering this program in their community Materials for conducting workshops Licensing and certification fees may also be provided $40 per DSME completer who meets contract requirements: – Medicare beneficiary (65+) and – Has diabetes or pre-diabetes and – Completes 5 of 6 classes (DEEP™), 4 of 6 classes (Stanford) 14

DEEP Retention Rate in California: 79 Percent 15

Goals are Outcomes-Based and Data-Driven HSAG will help track and analyze data. Track pre- and post-activation measures Track clinical outcomes for 10 percent of participants: – HbA1c – Lipids – Blood pressure – Weight – Foot exams – Eye exams 16

Why DEEP™ Works Incorporates adult education, empowerment principles, and participatory techniques Speeds changes in knowledge and behavioral and clinical indicators Meets the needs of the participants in real time Connects the dots in easy-to- understand language 17

Will You Join Us? Offer DEEP™ internally Outsource DEEP™ to partnering organizations – Include DSME in your Request for Proposal HSAG will provide training and assistance to your organization and your community partners. 18

Thank you! Gina Fleming Office: Cell:

This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for California, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. CA-11SOW-B CMS Disclaimer