DEBORAH F. CHRISTIAN, PA-CDiabetes Self-Management Education Program Manager

Health Services Advisory Group (HSAG)

Everyone with Diabetes Counts:Diabetes Self-Management Education

HSAG: Your Partner in Healthcare Quality

• HSAG is the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for California, Arizona, Florida, Ohio, and the U.S. Virgin Islands.

• QIN-QIOs in every state and territory are united in a network administered by the Centers for Medicare & Medicaid Services (CMS).

• The QIN-QIO program is the largest federal program dedicated to improving health quality at the community level.

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HSAG’s QIN-QIO Responsibility

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HSAG is the Medicare QIN-QIO for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands.

Nearly 25 percent of the nation’s Medicare beneficiaries

QIO Task Areas

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Improve Coordination

of CareImprove

Medication Safety

Improve Nursing Home

Quality

Reduce Hospital

Infections

Improve Health Through Health

Information Technology

Improve Cardiac Health

Prevent and Manage Diabetes

Patient is at the center of care.

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Everyone with Diabetes Counts (EDC)

• Diabetes was the seventh leading cause of death in the US• Nearly 30 million Americans have diabetes.• 8.1 million Americans are undiagnosed• Upwards of 86 million Americans prediabetes• Among the Older Adults

– More than 25 percent of Americans age 65 and older have diabetes.– 51 percent are estimated to have pre-diabetes.

• 11th Scope of Work– Reduce health disparities – Initiative: Everyone with Diabetes Counts or EDC– Economic burden $245 billion annually (2012)

Data Source: CDC National Diabetes Statistics Report, 2014, available at: http://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf

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The Burden of Diabetes in California

• Over 4 million Californians have diabetes (13.4% of adult population)

• Over 11 million Californians have pre-diabetes (38% of adult population)

• Diabetes costs an estimated $37.1 billion / year– Direct medical expenses $27.6 billion in 2012– Indirect cost $9.5 billion in 2012

Data Source: Centers for Disease Control & Prevention (CDC)

• African Americans• Hispanics/Latinos• American Indians/Native

Americans/Alaska Natives• Asians/Pacific Islanders• People living in rural

areas

• California Incidence– AA & Hispanics: 14%– Asian population

• Filipino: 15%• South Asian: 16%• Pacific Islanders: 18%

Disparities Exist in Diabetes Care

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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™ (DEEP),

University of Illinois at Chicago (UIC)• Train organizations & individuals statewide to offer

DSME• Provide assistance to organizations offering DSME• Impact more than 7,000 Medicare beneficiaries with

diabetes or pre-diabetes

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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

Special consideration for:– Includes low-health literacy and low-literacy individuals

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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– FUN

• Interactive, hands-on, group learning activities, and games, including visual aids and demonstrations

DEEP Modules

• Diabetes risk factors and complications• Nutrition• Physical activity• Use of the glucose meter • Medications• Building partnerships with diabetes healthcare team• Psychosocial effects of illness• Problem-solving strategies• How to access community diabetes resources

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“Tell me and I forget,teach me and I may remember,

involve me and I learn.”-Benjamin Franklin

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Why DEEP Works

• Incorporates adult education, empowerment principles, and participatory techniques

• Speeds changes in knowledge and behavioral and clinical indicators

• Meets the needs of participants in real time

• Connects the dots in easy-to-understand language

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Interactive Demonstrations

Understanding a Food Label

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Visualizing Fats and Carbohydrates

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Cheeseburger Cola Soda FriesTotal Fat 24 g = 6 teaspoons 0 g 29 g = 7 teaspoons

Total Sodium 897 mg = .16 teaspoons 15 mg = negligible 328 mg = .06 teaspoonsTotal Carbs 39 g = 8 teaspoons 35 g = 7 teaspoons 63 g = 13 teaspoons

Total Fat, Salt, and Carbs13 teaspoons of lard

½ teaspoon of sodium28 teaspoons of sugar

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• Certified peer educator/ workshop leader• Only one leader required to lead workshop• Allows for make-up sessions

Program Delivery Method

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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.

• No-cost training offered.

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Goals are Outcomes-Based and Data-Driven

• HSAG will help track and analyze data.• HSAG tracks pre- and post-activation measures.• HSAG tracks clinical outcomes for 10 percent of participants: – HbA1c– Lipids– Blood pressure– Weight– Foot exams– Eye exams

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• 1,124 Medicare beneficiaries with diabetes or pre-diabetes graduated from a DSME workshop.

• 470 Medicare beneficiaries completed both the Pre- and Post-Patient Activation Surveys.

• Gender– Male: 27 percent– Female: 73 percent

• Average age: 72

• Reported Health Conditions– High Blood Pressure: 61 percent– High Cholesterol: 52 percent– Arthritis: 35 percent– Eye Disease: 18 percent– Heart Disease: 14 percent– Lung Disease: 5 percent

California Demographics (January 2015 to April 2016)

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California Demographics (cont’d)

Ethnicity

52% Not Hispanic

or Latino

48% His-panic or

Latino

Race• White: 29 percent• African American: 15 percent• Asian: 13 percent• American Indian: 6 percent• Native Hawaiian: 2 percent• Other: 35 percent

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Pre- and Post-Patient Activation Survey

• 14 total questions– 4 questions: Diabetes knowledge– 5 questions: Coping with diabetes– 5 questions: Self-care methods

• Administered during first week and then again at sixth week

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Diabetes Knowledge

0%20%40%60%80%

100%78%

64%80% 71%

97% 94% 92% 90%

Pre-PAS Post-PAS

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Coping with Diabetes

Feeling over-

whelmed

Handling stress Asking for support

Asking doctor questions about treatment plan

Ability to make a plan to control

diabetes

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

40% 43%

70%

81%

68%

40%

84%

92% 95%90%

Pre-PAS Post-PAS

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Self-Care Measures

0

1

2

3

4

5

6

7

5

4.1

5

6.7

5.65.7

4.8

5.9

6.7 6.4

Pre-PAS Post-PAS

In the last week, average number of days doing self-care

Num

ber o

f Day

s

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DEEP Retention Rate in California: 79 Percent

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Program Costs

• Organizational License: $600/five-year license • Peer Educator Certification: $100/three-year certification • Training Cost (for UIC): – Peer educator training fee: $800 per person– Off-site training fee: $10,500, plus travel expenses

• Training Cost (for HSAG): None • Participant Cost: None

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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 five of six classes

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Will You Join Us?

• Offer DEEP internally• Outsource DEEP to partnering organizations• HSAG will provide training and assistance to your organization and your community partners.

Thank you!

818.395.3988 - celldchristian@hsag.com

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.2-08162016-01

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