Diabetes SelfManagement Education
Florida Medicaid Managed Care Program
Presented by: Sarah Cawthon
Date: May 20, 2014
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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
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Medicaid MMA Contract
Requirement
(20)(c) In the same manner as specified in s.
641.31, F.S., the Managed Care Plan shall
provide coverage for … diabetes outpatient selfmanagement 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
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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!
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Cost of Diabetes – Florida
• $1,390,000,000 ($1.39 billion) - cost of
diabetes among Medicaid beneficiaries - 2010
CDC Chronic Disease Cost Calculator http://www.cdc.gov/chronicdisease/resources/calculator/index.htm
• Medicaid charges for hospitalizations with
diabetes as primary diagnosis - 2012
 $295,636,031 - total
 $38,394 - average
AHCA Hospital Inpatient Discharge Data Set
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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.
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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
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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
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American Diabetes Association (ADA)
Standards of Medical Care in Diabetes 2014
Diabetes Care Volume 37, Supplement 1, January 2014
http://care.diabetesjournals.org/content/37/Supplement_1/S14.full.pdf
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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.
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National Standards for Diabetes SelfManagement 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
http://care.diabetesjournals.org/content/36/Supplement_1/S100.full.pdf+html
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National Standards for Diabetes SelfManagement Education and Support
1. Internal Structure
10 Standards
6. Curriculum
2. External Input
7. Individualization
3. Access
8. Ongoing Support
4. Program Coordination
9. Patient Progress
5. Instructional Staff
10. Quality Improvement
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1. Internal Structure
• Document an organizational structure, mission
statement, and goals
• Increases efficiency and effectiveness
• Critical factor in clear communication
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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
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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
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4. Program Coordination
• Designated to oversee the DSME program
• Has oversight responsibility for the planning,
implementation, and evaluation of education
services
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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)
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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 selfmanagement decision making
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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
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Curricula Resources
• Diabetes Education Curriculum: Guiding Patients,
published by the American Association of
Diabetes Educators
• Life with Diabetes, 4th Edition, published by the
American Diabetes Association
• NC Self-Management Education Curriculum,
published by the NC Diabetes Prevention and
Control Program.
• U.S. Diabetes Conversation Map Program,
published by Healthy Interactions, Inc.
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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.
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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.
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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)
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AADE7™ Self-Care Behaviors
Healthy
eating
Being
active
Monitoring
Taking
medication
Problemsolving
Healthy
coping
Reducing
risks
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10. Quality Improvement
A systematic process to:
• Measure the effectiveness of the education
and support
• Improve any identified gaps in services or
service quality
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Certification Organizations
• American Diabetes Association
– Diabetes Education Recognition Program
• American Association for Diabetes
Educators
– Diabetes Education Accreditation Program
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Florida Counties with Accredited or Recognized DSME Programs
ESCAMBIA
HOLMES
OKALOOSA
SANTA ROSA
JACKSON
WALTON
NASSAU
WASHINGTON
GADSDEN
CALHOUN
HAMILTON
LEON
MADISON
LIBERTY
COLUMBIA
BAY
SUWANNE
E
WAKULLA
TAYLOR
GULF
FRANKLIN
DUVAL
BAKER
UNION
CLAY
LAFAYETTE
ST JOHNS
BRADFORD
GILCHRIST
ALACHUA
DIXIE
PUTNAM
FLAGLER
LEVY
MARION
VOLUSIA
LAKE
CITRUS
SEMINOLE
SUMTER
HERNANDO
ORANGE
BREVARD
PASCO
2013
44 counties w/ DSME program
POLK
OSCEOLA
HILLSBOROUGH
INDIAN RIVER
MANATEE
OKEECHOBEE
HARDEE
ST LUCIE
23 counties w/o DSME program
HIGHLANDS
DESOTO
SARASOTA
MARTIN
CHARLOTTE
GLADES
HENDRY
LEE
PALM BEACH
BROWARD
COLLIER
MONROE
DADE
Why DSME?
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Comprehensive Diabetes Care – (CDC)
•
•
•
•
•
•
•
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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
Controlling High Blood Pressure – (CBP)
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Why DSME?
• 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
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Why DSME?
• Receiving formal diabetes education is
consistently a predictor of engaging in
preventive behavior and receiving diabetesrelated health services
• Patients who participate in diabetes education
are more likely to follow best practice
treatment recommendations
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Why DSME?
• 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
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Why DSME?
• 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
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Benefits of DSME
STUDY
TYPE OF PROGRAM
OUTCOMES
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 Dakota
Outpatient Education
72% ↓ hospitalizations
Rhode Island
Outpatient Education
51% ↓ hospitalizations
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Cost of DSME
• $352 to $430 – DSME Medicare Reimbursement
http://medicare.fcso.com/Fee_lookup/fee_schedule.asp
• 7700 – 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 7700
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Ever taken a class or course to
learn how to manage diabetes
Yes
40%
No
60%
Florida Adults with Diabetes
Income < $15,000
2012 Behavioral Risk Factor Surveillance System
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Barriers
• Aversion to group classes
• Don’t feel they need information
• Times/dates inconvenient
• Transportation difficulties
• Lack of awareness of benefits
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Healthy People 2020 Priority
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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
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Resource Information
• AADE Accredited programs
http://www.diabeteseducator.org/ProfessionalReso
urces/accred/Programs.html
• ADA Recognized programs
http://professional.diabetes.org/ERP_List.aspx
• Certified Diabetes Educator
http://www.ncbde.org/find-a-cde/
• Find a Diabetes Educator
http://www.diabeteseducator.org/find
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Elliot P. Joslin
“The person with diabetes who knows the most
lives the longest.”
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Questions?
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Sarah Cawthon
Health Systems Program Manager
Bureau of Chronic Disease Prevention
(850) 245-4391
Sarah.Cawthon@flhealth.gov
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