1. Diabetes Self-Management Education/Training via Telehealth
Sarah P. Smith, MAT, RD, LD, CDE
Palmetto Care Connections
November 16, 2016

2. Atlantic Quality Innovation Network (AQIN)
The federally funded Medicare Quality Innovation Network – Quality Improvement Organization (QIN-QIO) for New York State, the District of Columbia, and South Carolina.
Partners -
The Carolinas Center for Medical Excellence in South Carolina,
IPRO in New York, and
Delmarva Foundation in the District of Columbia.
One of 14 QIN-QIOs operating across the U.S.

3. Atlantic Quality Innovation Network (AQIN)
Works toward better care, healthier people and communities, and smarter spending
Catalyzes change through a data-driven approach to improving healthcare quality.
Collaborates with providers, practitioners and stakeholders at the community level to share knowledge, spread best practices and improve care coordination.
Promotes a patient-centered model of care, in which healthcare services are tailored to meet the needs of patients.

4. What is Diabetes Self-Management Education/Training (DSME/T)?
•Diabetes self-management education and training (DSME/T) is a collaborative process through which people with diabetes gain the knowledge and skills needed to modify their behavior and successfully self-manage the disease and its related conditions.
•This process incorporates the needs, goals, and life experiences of the person with diabetes and is guided by evidence-based standards.

5. Desired Outcomes of DSME/T:
The overall objectives of DSME are to support the following in order to improve clinical outcomes, health status, and quality of life:
- Informed decision-making
- Self-care behaviors
- Problem-solving and active collaboration with the health care team
Facilitating positive self-care behaviors directed at successful diabetes self-management was formally adopted as a desired outcome of DSME/T in 2002.
Facilitating positive self-care behaviors directed at successful diabetes self-management was formally adopted as a desired outcome of DSME/T in 2002.

6. 7 Specific Self-Care Behaviors
Developed by the American Association of Diabetes Educators, known collectively as the AADE7™, have been defined to guide the process of DSME/T and help patients achieve behavior change. Healthy eating Being active Monitoring Taking medication Problem solving Healthy coping Reducing risks

7. National Standards for DSME/T
Five guiding principles
1.Diabetes education is effective for improving clinical outcomes and quality of life, at least in the short-term.
2.DSME/T has evolved from primarily didactic presentations to more theoretically based empowerment models.
3.There is no one "best” education program or approach; however, programs incorporating behavioral and psychosocial strategies demonstrate improved outcomes. Studies show that culturally and age-appropriate programs improve outcomes and that group education is effective.
4.Ongoing support is critical to sustain progress made by participants during the DSME program.
5.Behavioral goal-setting is an effective strategy to support self management behaviors.

8. DSME/T Accreditation and Recognition
In 1997, the federal Balanced Budget Act passed, permitting the U.S. Health Care Finance Administration (HCFA)— now called the Centers for Medicare and Medicaid Services (CMS)— to provide expanded coverage for DSME/T.
Two certifying organizations:
American Diabetes Association - Recognition
American Association of Diabetes Educators – Accreditation
Terminology differs but the programs’ content and concepts are all based on the National Standards for Diabetes Self-management Education and Support

9. Providers of DSME/T
Team Approach: Registered Nurse Registered Dietitian Registered Pharmacist Requires 2 of the 3 to comprise the team. Exceptions are allowed in rural settings. Other health care professionals may be added to the team to enhance the educational experience.

10. Reimbursement of DSME/T
When a program receives recognition or accreditation, they are able to be reimbursed by: Medicare Medicaid in SC (and 45 other states) Many private Insurers Restrictions apply to certain health care organizations for Medicare reimbursement.

11. Barriers/Obstacles to providing DSME/T
Lack of qualified educators in rural areas
Costs incurred vs low reimbursement amount
Reporting requirements
Institutional support
Restrictions on number of hours covered
Transportation
Low referral rate from healthcare providers .

12. What to do???
Bright Idea!

13. Let’s do this via Telehealth!

14. Things we knew: Transportation and staff time costs were increasing
There were limited diabetes educators available
Rural areas had needs for education
We could provide this education
CMS was reimbursing for DSME/T provided by accredited or recognized programs for Telehealth
We were targeting Medicare beneficiaries with diabetes and prediabetes

15. Formed partnerships with:
The Carolinas Center for Medical Excellence (CCME)
Palmetto Care Connections (PCC)
Low Country Area Health Education Center (LCAHEC)
Low Country Health Care Systems, Inc. (LCHCS)

16. First Steps Where education would be provided
Approval from distance site organization
Compatibility of equipment
Responsibilities of all partners
Logistics of plan

17. Proposal to CMS Equipment to be used Who could be the instructor
Curriculum to be used
Ability to communicate during classes
Originating site
Distance site(s)
Evaluation of format and learning outcomes
Impact on contract performance

18. Results of pilot Attendance Graduates
Comparison of pre- and post-tests
1. General diabetes knowledge
2. Comfort living with diabetes
Lifestyle behaviors
1. Fruit and vegetable intake daily
2. Exercising > 30 minutes daily
3. Checking BG daily
4. Medication Adherence
5. Daily foot checks

19. Evaluation and Customer Satisfaction
Evaluation Results on format Customer Satisfaction with format

20. Provided results of pilot to CMS
Report to CMS
Provided results of pilot to CMS

21. Where we are today -
CMS applauded our initiative to pilot telehealth Continue with expanded pilot to provide additional data Contact period is 50% completed CCME to apply for a Special Innovation Project

22. References
AADE Guidelines for the Practice of Diabetes Self-Management Education and Training (DSME/T). American Association of Diabetes Educators, Chicago, Illinois. Revised November 2010.
Haas et al. National Standards for Diabetes Self-Management Education and Support. Diabetes Care Nov;35 (11):
Mensing C. Comparing the processes: accreditation and recognition. Diabetes Educ Mar- Apr;36(2): See also Overview Comparison of National Accreditation.
Powell MP, Glover SH, Probst JC, Laditka SB. Barriers associated with the delivery of Medicare-reimbursed diabetes self-management education. Diabetes Educ Nov-Dec;31(6):890-9.
US Department of Health and Human Services. Expanded coverage for diabetes outpatient self- management (final rule). Program memorandum B

23. Questions?
This material was prepared by the Atlantic Quality Innovation Network (AQIN), the Medicare Quality Innovation Network – Quality Improvement Organization for New York State, South Carolina, and the District of Columbia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy.11SOW-AQINSC-TSK

24. For more information Sarah P. Smith, MAT, RD, LD, CDE
Quality Specialist, CDE
(80) or (803)
IPRO CORPORATE HEADQUARTERS
1979 Marcus Avenue
Lake Success, NY
IPRO REGIONAL OFFICE
20 Corporate Woods Boulevard
Albany, NY
This material was prepared by the Atlantic Quality Innovation Network (AQIN), the Medicare Quality Innovation Network – Quality Improvement Organization for New York State, South Carolina, and the District of Columbia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy.11SOW-AQINSC-TSK