Post on 12-Oct-2020
transcript
QIN-QIO Public Sharing Call:The Basic Business Strategies for Building a Successful DSMT Program
Thursday, October 11, 20183:00-4:30 PM ET
Welcome and Reminders
2
Lindsay KaatzEvent Lead
Susan BrittmanChat Manager
• Please be prepared for sharing and open discussion
• Slides and a recording from today’s session can be found on: https://qioprogram.org/qin-qio-public-sharing-calls-3-part-series
Purpose
• Audience: Patients, community and healthcare providers, local partners, federal partners, and Quality Improvement Organization (QIO) Program partners (*registration required)
• Purpose: The purpose of this session is to teach participants about DSMT program design, business strategies, operations, and financial planning for program success and sustainability
• Expectations: Participants will gain knowledge that is directly applicable to their work in healthcare quality improvement and acquire information that can be easily shared among their own community, organization, or team
• Topics: Topics will be aligned with the CMS Quality Strategy goals
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Learning Objectives
• List the key elements to include in the “Key Preliminary Activities” of a DSMT program business plan.
• List the key elements to include in the “Operations Plan” of a DSMT program business plan.
• List the key elements to include in the “Financial Plan” of a DSMT program business plan.
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Things to Think About
Will you commit to being… • Attentive• Active• Actionable
Show your commitment by clicking the green checkmark!
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Continuing Education Credit
Continuing education credit is available for:• Physicians and Physician Assistants• Registered Nurses and Nurse Practitioners• Dietitians• Pharmacists and Pharmacy Technicians• Certificate of Attendance
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Method of Participation & Instructions for Claiming CE
• Attend the entire event• Complete the post-event assessment that will pop up at
the conclusion of the event• There is a separate evaluation required for CE linked
within the post-event assessment• Once you submit your CE evaluation, you will be
provided with a certificate to retain for your records• For technical assistance, please email Nikki Racelis
(nikki.racelis@qinncc.hcqis.org)• If you have questions about this CME/CE activity, please
contact AKH Inc. at service@akhcme.com.
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CE Information
Physicians:This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providershipof AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc., Advancing Knowledge in Healthcare designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physician Assistants:NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.
Pharmacists:AKH Inc., Advancing Knowledge in Healthcare is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.AKH Inc., Advancing Knowledge in Healthcare approves this knowledge-based activity for 1.5 contact hours (0.15 CEUs). UAN 0077-9999-18-032-L04-P; UAN 0077-9999-18-032-L04-T. Initial Release Date: 10/11/18
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CE Information, Continued
Registered Nurses:AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.This activity is awarded 1.5 contact hours.
Nurse Practitioners:This activity has been planned and implemented in accordance with the accreditation Standards of the American Association of Nurse
Practitioners (AANP) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 030803This activity is accredited for 1.5 contact hour(s) which includes 0 hour(s) of pharmacology. Activity ID #218181
Dietitians:AKH Inc., Advancing Knowledge in Healthcare is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 1.5 continuing professional education units (CPEUs) for completion of this program/material. CDR Accredited Provider #AN008. The focus of this activity is rated Level 2. Learners may submit evaluations of program/materials quality to the CDR at www.cdrnet.org.
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Disclosure of Financial Relationships & Commercial Support
• The planners and faculty do not have any relevant financial relationships to disclose.
• AKH Inc., CRW & Associates, and Telligen do not have any relevant financial relationships to disclose.
• No commercial support was received for this activity.
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Disclosure of Financial Relationships & Commercial Support
Disclosures:It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whoseproducts or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral toNational Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.
Disclosure of Unlabeled Use and Investigational Product:This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Pleaserefer to the official prescribing information for each product for discussion of approved indications, contraindications, andwarnings.
Disclaimer:This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as ageneral guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or otherprofessional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant's misunderstanding of the content.
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Meet Your Speaker
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Mary Ann HodorowiczRDN, MBA, CDE, CEC
Mary Ann Hodorowicz Consulting, LLC
THE BASIC BUSINESS
STRATEGIES FOR BUILDING A
SUCCESSFUL DSMES PROGRAM
Mary Ann Hodorowicz RDN, MBA, CDE, Certified Endocrinology Coder
Mary Ann Hodorowicz Consulting, LLC
Mary Ann Hodorowicz
RDN, MBA, CDE,
CEC
(Certified
Endocrinology
Coder)
Mary Ann Hodorowicz, RDN, MBA, CDE, CEC, is a licensed registered dietitian and certified diabetes educator and earned her MBA with a focus on marketing. She is also a certified endocrinology coder and owns a private practice specializing in corporate clients in Palos Heights, IL. She is a consultant, professional speaker, trainer, and author for the health, food, and pharmaceutical industries in nutrition, wellness, diabetes, and Medicare and private insurance reimbursement. Her clients include healthcare entities, professional membership associations, pharmacies, medical CEU education & training firms, government agencies, food and pharmaceutical companies, academia, and employer groups. She served on the Board of Directors of the American Association of Diabetes Educators from 2013 – 2015, and was the Chair of the Advanced Practice Community of Interest in 2016.
Mary Ann Hodorowicz Consulting, LLC
hodorowicz@comcast.net 708-359-3864
www.maryannhodorowicz.com
Twitter: @mahodorowicz
Learning Objectives
1. List the 6 major plans in the DSMES program business plan.
2. Name the activities to include in the Key Preliminary Activities Plan.
3. Name the key elements to include in the Clinical/Teaching Plan.
4. Name the key elements to include in the Marketing Plan.
5. Name the key elements to include in the Operations Plan.
6. Name the key elements to include in the Financial Plan.
7. Name the key elements to include in the CQI Plan.
There are 6 Major Components of
DSMES Program
Business Plan
Key Preliminary Activities: Define DSMES Team, Stakeholders, Business Concept and Value Proposition
Define DSMES Team, Stakeholders,
Business Concept
and
Value Proposition of Program
Key Preliminary Activities: Define DSMES Team, Stakeholders, Business Concept and Value Proposition
• Define DSMES program team:
o Quality coordinator
o FTE educators:
Type by discipline (e.g., RN, RDN, RPh, etc.)
Credentials
Didactic + experiential preparation in DSMES
Experience in other services (MNT, CGM, etc.)
Defined roles and responsibilities
Key Preliminary Activities: Define DSMES Team, Stakeholders, Business Concept and Value Proposition
o FTE community health workers (CHWs)
o FTE staff support
Key Preliminary Activities: Define DSMES Team, Stakeholders, Business Concept and Value Proposition
• Define program stakeholders:
o Standard 2 of the 2017 NSDSMES: Stakeholder
Input
“The provider(s) of DSMES services will seek
ongoing input from valued stakeholders and
experts to promote quality and enhance
participant utilization.”
Key Preliminary Activities: Define DSMES Team, Stakeholders, Business Concept and Value Proposition
• Define “business concept” to use in marketing materials
o What you are selling in “human fulfillment” terms in <4 words
o Why? Quickly captures customer’s attention!
o Example: what does photographer sell?
Memories
Key Preliminary Activities: Define DSMES Team, Stakeholders, Business Concept and Value Proposition
o What does DSMES program sell?
DSMES sells______________________?
Wellness?
improved health?
Better quality of life?
Increased coping skills?
Longer life?
Key Preliminary Activities: Define DSMES Team, Stakeholders, Business Concept and Value Proposition
Define Value Proposition of Program
Key Preliminary Activities: Define DSMES Team, Stakeholders, Business Concept and Value Proposition
Value proposition (benefits of
program)
to sponsoring organization (SO)
are
outlined in the word
V.I.T.A.L.
VValue of sponsoring organization (SO) is enhanced in the eyes of providers, stakeholders and PWDs via patient outcomes.
I
Increases SO’s relationships with providers via DSMES program and other* related referrals.
Increases revenue for SO via DSMES (plus related services*).
Increases collateral insurer revenue from ancillary services…i.e., lab tests, therapies, etc.
*MNT, CGM, chronic care management, shared medical appointments, obesity therapy, DPP.
IIncreases pay-for-performance, pay-for-value reimbursement when DSMES helps meet insurers’ quality diabetes measures.
Inspires employers to team up with DSMES program on-site as part of employee wellness initiative
T Triggers team-based diabetes care
A
Allows advanced roles/responsibilities to be assumed by diabetes educators which enhance quality diabetes management (e.g., care coordinators, case managers).
Aids achievement of NCQA standards for PCMH recognition and for ACO accreditation; NCQA = National Committee on Quality Assurance.
Aids achievement of ACA healthcare reform goals and standards.
Aids achievement of sponsoring organization’s business-related goals.
Aids state department of health and SO’s own population health strategies to diabetes epidemic.
L
Lessens healthcare costs related to decreased: ER visits; therapies; onset and progression of diabetes complications.
Lessens hospital readmissions within 30 days (can thus prevent health insurance payment penalty)
Lets diabetes educators help sponsoring organization achieve 3 most recognized quality measures* via the program that results in “incentive”… “additional”reimbursement payments.
* What are the quality measures?
Key Preliminary Activities: Define DSMES Team, Stakeholders, Business Concept and Value Proposition
3 most recognized quality measures in healthcare are:
= QUALITY MEASURES
Key Preliminary Activities: Create Project Management Plan
Create Project Management Plan
Key Preliminary Activities: Create Project Management Plan
• Define a formal plan for how DSMES team will achieve
goals in specific time period (ex: goal = achieve AADE
accreditation):
o Have regularly scheduled team meetings
o Define meeting format and rules:
Create agenda for meetings
Decide who will take meeting minutes
Decide time frame for submitting minutes to team
members
Key Preliminary Activities: Create Project Management Plan
o Ensure action steps are assigned to each
team member
o Ensure resources available to complete
action steps
o Define completion dates for each action step
o Confirm next meeting date
Key Preliminary Activities: Create Project Management Plan
Team work works!
Key Preliminary Activities: Create Knowledge & Resource Library
Create Knowledge and Resource Library
Key Preliminary Activities: Create Knowledge & Resource Library
Why
Develop
Your
Library?
Key Preliminary Activities: Create Knowledge & Resource Library
• Format
o Paper or electronic
o Can include audio, video, and web-based and mobile apps
• Tips:
o Keep it current
o Continue to grow it over time
Key Preliminary Activities: Conduct Needs Assessment
Conduct Needs Assessment: 3 “P’s”
Key Preliminary Activities: Conduct Needs Assessment
Needs Assessment: 3 “P’s”
Population Patients
Providers
Key Preliminary Activities: Conduct Needs Assessment
• Population assessment elements:
Key Preliminary Activities: Conduct Needs Assessment
• Population assessment:
o Prevalence and type of diabetes population…e.g., Daley County:
Mostly type 2 diabetes, >50 y/o
11.4% >30 y/o have T2 diabetes compared to 8.2% in state
Reference: NIH Publication No. 11–3892, February 2011
Key Preliminary Activities: Conduct Needs Assessment
• Population assessment:
o Trends
Non-Hispanic white children + adolescents
had highest rate of new cases of type 1
diabetes
Rates of new cases of T2 DM greater among
10 – 19 year age group than in younger
children
Key Preliminary Activities: Conduct Needs Assessment
• Patient assessment elements:
o Age
o Education
o Literacy
o Numeracy
o Race/ethnicity
o Economic status
o Community type
o Transiency
o Work type and
setting
o Leisure habits
o Marital status
Key Preliminary Activities: Conduct Needs Assessment
• Provider assessment elements:
o Define who are allowed to refer to DSMES program, per Medicare
DSMES: MDs, DOs, NPs, PAs, CNS’s
MNT: MDs and DOs only
o Define providers…by name…in area
o Define where providers are located
Key Preliminary Activities: Conduct Needs Assessment
• Determine if providers are referring to other DSMES programs in area
o If not, assess reason(s) why not
Program not meeting providers’ unmet or poorly met needs?
Can you fill this niche?
• If yes, assess how your program can be >10%
better in meeting providers’ needs
Define
PROVIDERS’
NeedsConsider:
--Unmet needs
--Poorly met needs
--What can you do
better?
Consider:
--Unmet needs
--Poorly met needs
--What can you do
better?
Key Preliminary Activities: Define Program Goals
Define DSMES Program Goals
Key Preliminary Activities: Define Program Goals
• First: define sponsoring organization’s goals of DSMES program:
Break even? Physician support?
Research support?
Make profit?
Revenue or cost center?
Absorb some/all of program costs?
Community service regardless
of cost?
Lower health costs of
patient care?
Make entity look good to someone
important?
Meet one or more of entity’s
strategic goals?
Key Preliminary Activities: Define Program Goals
Help SO meet health insurers’ quality measures to receive incentive (extra)
payment under new system of value-based care.
Key Preliminary Activities: Define Program Goals
• Define goals for program
• Create table to show how sponsoring
organization goals are aligned with program
goals
Sponsoring Organization Goals Aligned with Program Goals
Sponsoring Organization Goals DSMES Program Goals
Demonstrate innovative patient education centered in OP chronic care, rather than inpatient acute care (new health care reform).
Implement outpatient DSMES program.
Attract new patients.
Maintain existing patient base.
Obtain positive program outcomes:
• Obtain provider and self-referrals
• Increase referrals each fiscal year
• Maintain high attendance rate in
program
• Increase pt visits each fiscal year
Sponsoring Organization Goals
DSMES Program Goals
Provide highest quality, evidence-based services that improve health and well being of patients.
Adhere to quality, evidence-based standards for DSMES:
• Provide DSMES according to National Standards for DSMES.
• Achieve and maintain accreditation for DSMES Program.
Sponsoring Organization Goals
DSMES Program Goals
Support needs of area and staff physicians.
Support needs of area and staff physicians via outpatient DSMES program.
Provide income-generating services.
Obtain DSMES program revenue via:
• Insurance reimbursement
• Patient payments
• OP receipt of other related services:
o A1c, blood lipid tests
• OP receipt of other services not related to program but as result of positive practice setting experience.
Sponsoring Organization Goals
DSMES Program Goals
Maintain operational process that are:
• Streamlined
• Cost-efficient
• Reliable (consistently produce desired endpoint with conservation of resources)
DSMES operational processes are:
• Streamlined
• Cost-efficient
• Reliable
Ensure patient satisfaction. Patient DSMES satisfaction is high.
Key Preliminary Activities: Write Mission and Vision Statement
Write Mission and Vision Statement
Key Preliminary Activities: Write Mission and Vision Statement
MISSION STATEMENT VISION STATEMENT
FOCUS Present Future
WHY Reason for program’s existence
Long-term goals to grow your program
INFORMS ABOUT
Core values of your organization
Direction of your organization
Key Preliminary Activities: Write Mission and Vision Statement
• Example: DSMES mission statement:
o Present focus of program
Our mission for _____________ (name of
program) is to improve our patients’ knowledge of
and confidence in changing their key self-care
behaviors through active participation in our
DSMES program with the goal of improving key
health/clinical indicators and their quality of life.
Key Preliminary Activities: Write Mission and Vision Statement
• Example of DSMES vision statement:
o Where program wants to go in future:
In addition to providing DSMES to __________ (name of
the target population), our vision is to provide other innovative
diabetes management services shown to improve glycemic
control and other health indicators, such as continuous glucose
monitoring and insulin pump therapy.
Key Preliminary Activities: Define How Program Success Measured
Define How Program Success is Measured
Key Preliminary Activities: Define How Program Success Measured
• Via Patient Outcome Measurement Plan:
oMeasure of success: achieving entire spectrum of
patient outcomes
Key Preliminary Activities: Define How Program Success Measured
Key Preliminary Activities: Define How Program Success Measured
o Via Program Outcome Measurement Plan:
Measure of success: achieving program quality measures
Program Quality Measures Examples
Structure • Use of evidence-based decision support tools
Process • Patient contacted within 48 hrs of referral receipt
Outcome • 100% of DSMES insurance claims are paid
• Provider referrals are increases yearly
• Number of providers who refer increases yearly
SEE APPENDIX FOR FULL LIST
Key Preliminary Activities: Write Executive Summary
What is the “Executive Summary” of a Business Plan?
Key Preliminary Activities: Write Executive Summary
o Brief, but concise summary of each of
6 components of plan
o Positioned first in plan….but last section written
• Usually ends with 1 or 2 clinching, closing sentencesthat answer
“Why is this a winning program?”
Components of
DSMES Business
Plan
Reminder:
SO = Sponsoring Organization
Marketing Plan
• Set of activities designed to satisfy:
o Human and organizational “N.E.W.G.S.”:
Needs … Expectations … Wants … Goals
Market Analysis
Market Analysis defines your
primary and secondary target markets.
9 Possible Target Markets of a
DSMES program =
Your Customers!
Persons with Diabetes & Prediabetes(PWD-Ps)
Organization That Sponsors
Programs
Providers Who Refer
Employers and Their
Employees
State, Public and Community
Health Agencies
Community Persons with
Diabetes But Not Diagnosed
Senior Services and
Senior Housing
Healthcare Insurers
Community Services and Faith-Based
Organizations
Market Analysis
o Examples of primary target markets:
Type 1, type 2 adults only
Women with type 1 diabetes and GDM only
o Examples of secondary target markets:
Providers who refer to DSMES programs
Area employer groups and their employees
Competition Analysis
• Competition Analysis identifies:
o Alternatives to your DSMES program
o If your program has competitive advantage
• To complete:
o Find out everything about other programs
o Call and pretend you are a patient
Competition Analysis
• Competition assessment elements:
Where are competitors’ parent sites and external off-site locations?o
Hospitals
Physician offices
Clinics
Pharmacies
Independent practices
Chains and big box stores
RDN private practices
Physician offices Grocery stores Churches Schools Recreation
departments Fitness centers Assisted living
facilities? Adult day care
facilities?
Competition Analysis
o What are their target diabetes populations?
Type 1, type 2, GDM, adults only, pediatric only?
o How many miles do MOST patients have to travel to get to program?
o Are competitors maximally meeting the needs and expectations of:
Patients?
Providers?
• Include detailed “Competitive Grid” and explanations:
My Program Competitor A Competitor B
Services Offered
Fees
Location
Expertise
Hours of Operation
Referral Required
Length of DSMES Program
Days of DSMES Program
Etc.
Competition Analysis
• Conduct S.W.O.T. analysis of:
o Strengths and Weaknesses of your program’s
internal characteristics
o Opportunities and Threats from external forces:
Competition
Economic environment
Trends
Competition Analysis
Your DSMES ProgramStrengths
Weaknesses
From Competition and External Forces
Opportunities
Threats
7 P’s of Marketing
• Flesh out 7 Ps of “service” marketing in business plan:
Products (services)
Packaging
Promotion
Place (physical evidence of quality)
Processes and Procedures
Price
People (educators, CHWs, staff):
o Interpersonal skills; proficiency; team leadership and dynamics
Marketing Plan for a “Service” = 7 P’s
7 P’s of Marketing
GOAL: be at least 10% BETTER than your
BEST competition in 1 or more of 7 Ps….
7 P’s of Marketing
Product (services)
• Identify your core “service”: DSMES program
• Identify other services
• Use descriptions that fits with target markets NEEDS and
WANTS:
o Provides quality, team-based continuity of care
o Is culturally and linguistically appropriate and evidence-
based
o Helps meet recognition standards of PCMH and ACO
7 P’s of Marketing
Packaging
• ‘Packaging’ a DSMES service is different from packaging a product
• Goal: convey “BIG Four Selling Points” of DSMES
7 P’s of Marketing
“BIG Four Selling Points” of DSMES
1. DSMES is medical service
2. Your brand
3. Perceived value of program
4. Perceived quality of program
7 P’s of Marketing
• Program “brand” is comprised of:o DSMES program nameo Tag lineo Contact infoo Addresso Color schemeo Font styleo Clip arto Graphicso Info-graphico Value perceptiono Quality perception
S.W.E.E.T.S. Are Your Diabetes Lifesavers
D I A B E T E SDo Monitor Your Blood
Glucose (BG) Regularly
InvolveFamily
andFriends
Acquire OngoingSupport
Bring BGValues to
HealthcareVisits
Exercise Regularly
Take Medication as
Prescribed
Ease into Behavior Changes Slowly
See a Diabetes Educator Regularly
L I F E S A V E R S + ?Lose Excess Weight
IdentifyHealthyCoping
Strategies
Fix Your
Problems
EatHealthy
Sleep Well
EveryNight
AcquireSick Day & Travel
Kit
VisitYour
DoctorRegularly
EnjoyRewardsfor All You Do
ReduceRisks
ofComplications
SetSMART
Goals
Topics and Questions of
YOUR Choice
6 Visit Program (Group and Individual, Day and Evening Times) Scheduled Multiple Times Through the Year.
Just Call to Inquire or Register for a Program. You’ll Be Glad You Did!
7 P’s of Marketing
Promotion
• If people don’t know you exist, they won’t knock on your door!
7 P’s of Marketing
FIRST:
Customize… “connect”… your marketing
Promotions to your target markets’
(customers’) specific:
• Characteristics
7 P’s of Marketing
Examples of characteristics of patient target market:
• Age
• Gender
• Abilities (physical, mental)
• Attitudes, beliefs
• Lifestyle
• Religion
• Education
• Patterns of behavior
• Ethnicity, race (higher
prevalence of diabetes?)
• Health status
• Economic status
• Living environment
• Work environment
7 P’s of Marketing
SECOND:
Customize… “connect” … your marketing promotions
to your
target markets’ (customers’) specific NEWGs:
Needs…Expectations…Wants…Goals
EXAMPLES OF
PROMOTIONS FOR YOUR DSMES
Promotions
Ask Businesses and Non-Profits
to Add Information on Your
Program to Their Promotions for
Larger Community-Wide Reach
Partner with Community Health
Agencies for Aligning DSMES
Programs with Agencies’
Population Health Strategies
Promotions
Furnish Your Program in
Key Off-Site Locations:
Accountable Care Organizations,
Patient Centered Medical Homes
and
Other Healthcare Entities
Show How Program Can Help Meet NCQA Standards
withinPCMHs and ACOs
Promotions
Furnish Your Program at
Employee Work Sites
For a Fee
Host Diabetes Patient “Self-Care” Community Events(e.g., Yoga Event)
Host Diabetes Fairs for Community People
Host Diabetes Prevention Parties
Promotions
Host Type 2 Diabetes
Screening Events
Participate in LocalFarmers’ Markets
Participate in
Community Health Fairs
Sponsored By
Other Groups
Develop Info Flyers on
Diabetes Self-Help
Topic(s); Distribute
Where PWDs Gather
Promotions
Conduct Grocery Store
Tours and Give
Attendees Healthy
Shopping List
Create for Providers
“Diabetes Calendars”
for Program Services
Create Branded
DSMES Referral Form
(Pads of 50) and Deliver
to Providers
Create Print Promotions
for DSMES Program:
Slim Jims, Brochures,
Flyers
Promotions
Advertise Programs in
Local Newspapers and
in Sponsoring
Organization’s Newsletter
Promote Programs Online
and on
Social Media Sites
Provide Hot Topic
“Infomercials” on Regular
Basis at SO
Host Regular Online
Diabetes Blogs
Promotions
Be Interviewed on
Local Cable TV
Be Interviewed on
Local Radio Stations
Give Away Free, Fun
Diabetes Goodies at
All Public Events
Promotions
Promote Programs to
Employees at Your
Sponsoring Organization
HOW?
On Employee
Bulletin Boards
With “Diabetes Friendly”
Meals in Cafeteria With
“Ask a Diabetes Educator”
Event in Cafeteria
Promotions
Regularly Communicate Patient
and Program Outcomes to
Providers and Stakeholders
Speak at Community Events in Local Area and Promote Program
Ask Local Restaurants to Put
“Diabetes Friendly” Meal on
Menu 1x/Week
Tap into Available Services
from Your State’s Department
of Health
7 P’s of Marketing Place/Physical Evidence of Quality
• Where program is furnished
• Examples:
o Furnished at SO site…and also off-site, where patients congregate:
Churches
Recreation departments and park districts
Fitness centers/gyms
Libraries
7 P’s of Marketing
• Quality elements:o Adequate seating,
o Space for teaching, supplies, etc.
o Clean
o Furniture in good condition
o Adequate lighting, heat, air conditioning, ventilation
o Bathrooms
o Wheelchair accessible
o Adequate parking and well-lit
o Near public transportation
7 P’s of Marketing
Processes/Procedures (PPs)
• Part of marketing plan as they impact your BIG FOUR SELLING POINTS:
1. DSMES is medical service
2. Your brand
3. Perceived quality of program
4. Perceived value of program
7 P’s of Marketing
You can make or break your success with the type* of PPs you create:
*PATIENT - Centered PPs improve:
• Quality of care
• Patient outcomes
• Physician relationships
*CLINICIAN - Centered PPs decrease:
• Quality of care
• Patient outcomes
• Physician relationships
7 P’s of Marketing
Price
• Determine fee schedule for DSMES program
• Factors used to determine price:
o Insurance reimbursement rates
Medicare, Medicaid, private insurers
o What market will bear (do market research)
o Competitions’ fees
o Patients’ and physicians’ perceived value of programs
7 P’s of Marketing
People
• Refers to perceived quality of all staff working in
DSMES program:
o Quality coordinator, educators, CHWs, support staff
• Must select, recruit, hire quality people with required
skills to do the job!
More important than everything else in business plan!
7 P’s of Marketing
People
• We make >12 assumptions… good or bad…in first
12 seconds of meeting someone, and it’s virtually
unchangeable!
• Does your team convey image of quality …or lack thereof?
o Can make or break your success immediately w/o saying 1 word!
7 P’s of Marketing
• 93% of how we’re judged based on non-verbal data:*
o Demeanor and mannerismso Clothes, shoes, accessorieso Body languageo Grooming: hair, face, makeup, fingernails
• Only 7% on verbal data (person’s actual words):*
o Wordso Voice and toneo Attitude in voice
*THE 7% RULE: FACT, FICTION, OR MISUNDERSTANDING, http://ubiquity.acm.org/article.cfm?id=2043156
7 P’s of Marketing
7 P’s of Marketing
Once a
1st impression
is made,
it’s
virtually
impossible
to change!
NOT
well-groomed?
Others will think:
“Does he pay
attention
to details”?
Components of
DSMES Business
Plan
Operations Plan
• Define structure of program
o Key elements:
Emphasize DSMES program’s alignment with select
standards of:
NCQA standards for PCMH recognition and ACO
accreditation
Joint Commission on Accreditation of Hospitals
Other?
Operations Plan
AADE accreditation or ADA recognition of program
Stakeholders’ purpose and members
Physical space requirements
Polices
Procedures
Organizational chart
Provider referral process
Use of EMR
Use of data tracking system
Operations Plan
• Create design of program:
o Design in initial first year and follow-upsubsequent years:
Number of visits
Type of visits: individual and/or group
Length of each type of visit
Time of each visit
Topics covered in each visit
Operations PlanExample of design to meet initial 10 hours of Medicare DSMT benefit:
Operations Plan
• Create daily schedule for 1 FTE diabetes educator that:
o Is time efficient
o Preserves quality of care
o Assigns time for “non-direct” but key DSMES tasks,
such as:
Marketing
CQI
Operational and financial tasks
Example: 1.0 FTE Educator Schedule in 8 Hour Day + Weekly Totals
Billable DSMES Pt Face
Time
Non-Billable Pre-Visit
Time
Non-Billable Post-Visit
Time
=TOTAL
DSMES TIME
+ Non-DSMESKEY
TASKS
Initial Individual Visit x 1/Day
1 hr + 15 min + 15 min = 1.5 hr
F/Up Individual Visit x 1/Day 0.5 hr + 15 min + 15 min = 1 hr
Group visit x 1/Day 2 hrs + 30 min + 30 min = 3 hrs
Non-DSME Key Tasks 1 hr
DAY TOTALS 3.5 hrs + 1 hr + 1 hr = 5.5 hrs + 1 hr = 6.5 hours
WEEK TOTALS 17.5 hrs + 5 hrs + 5 hrs = 27.5 hrs + 5 hrs = 32.5hours
% of PAID HOURS/WEEK = 54%BillableDSMESTime
= 31%Non-Billable
DSMESTime
= 85%Total
DSMESTime
= 15%Non-DSMES
KeyTasks
Operations Plan
• Create program forms:
o Patient registration
o HIPAA privacy rules notice
o Financial responsibility notice
o Initial intake, referral and appointment form (IRA form)
o Behavior goals monitoring form
o Outcomes monitoring form
o DSMES record
o Provider DSMES referral form (Medicare compliant)
Operations Plan
o Encounter form
o ABN form
o Assessment form
o Progress note
o Program support plan
o Program education plan
o Program attendance sheet (Medicare
requirement)
o Reimbursement tracking form
o Visit tracking form
Operations Plan
• Educator and staff work flow and scheduling
• Patient flow and scheduling
• Space requirements
• Equipment requirements
• Rental contracts for offsite space
• Legal, privacy, safety and health regulatory
mandates
Operations Plan• Define strategies for team work:
o Each educator is assigned roles and responsibilities matching their:
Skills
Training and education
Experience
Credentials and licensure
o Avoid “turf wars”…disastrous!
o Decisions affecting team to be MADE by whole team!
Operations Plan
Can we all
play nice
together,
please?
Components of
DSMES Business
Plan
Financial Plan
• Define:
o Financial quality measures and targets of program
o Timeframe scheduled to meet SO’s goals for
program
o Cash flow projections
o Pro-forma income statement
o Budget
o Breakeven point
Financial Plan
• Breakeven point in 10 hour DSMES program…example:
REVENUE
EXPENSES
Total number of 2 hour group visits = 4 x $40 average reimbursement rate/2 hours/OP = $160 x 4 OPs =
$640 revenue
Total number of 1 hour group visits = 1 x 4 OPs x $20 average reimbursement =
$80 revenue
Total number of 1 hour individual visits = 4 x 4 OPs x $120 average reimbursement rate/hour
$480 revenue
TOTAL AVERAGE REIMBURSEMENT for 10 HOURS $1200
LESS: total estimated expenses* for: 10 hours of DSMES + 5 hours total of pre- and post visit time = 15 hours x $80 per hour =
($1200)
*Expense estimate quick rule of thumb: educator hourly rate of $40 x 2 = $80 per hour
Financial Plan
• Define:
o Fee schedule
o Vendor support
No charge BG meters, strips, software, etc.
o In-network insurance provider status with:
Medicare, Medicaid and private plans
o Malpractice insurance
o State-mandated coverage of DSMES
Financial Plan
• Define financial quality measures
o Monitor quality measures and compared against desired targets
Desired targets are determined by:
Brain-storming with DSMES team
Reviewing with superiors
Benchmarking with other programs
Financial Plan
Example of financial quality measures to define:
• Percent of educator’s hours that is:
o Billable DSMES time
Target = ? (70% ?)
o Non-billable DSMES time
Target = ? (20% ?)
o For non-direct DSMES key tasks (marketing, CQI, etc.)
Target = ? (10% ?)
Financial Plan
• Percent of educator’s DSMES billable hours that are
scheduled vs. billable hours that are completed
o Target: 100% of billable hours that are scheduledare completed
Financial Plan
• Percent of educator’s time scheduled for DSMES vs. percent of time
scheduled for ‘other key tasks’
o Target: 85% is scheduled for DSMES vs. 15% for other key tasks
• Time scheduled for non-billable pre- and post DSMES time for each
1 hour of billable individual visits
o Target: 30 minutes of non-billable time is scheduled for each
1 hour of billable individual visits
Financial Plan
• Billing and reimbursement policies and procedures
• Revenue sources besides insurance reimbursement
• Reimbursement tracking report….see example
Snippet of Mary Ann’s Reimbursement Tracking Report
Financial Plan
• Accounting and bookkeeping system
Components of
DSMES Business
Plan
Clinical/Teaching Plan
• Evidence-based decision support tools to furnish DSMES:
o AND’s Nutrition Practice Guidelines for diabetes, HTN, hyperlipidemia
o ADA Standards of Medical Care in Diabetes
o 2013* Guideline for Overweight and Obesity (most current)
o AADE Accreditation or ADA Recognition of DSMES program
o Evidence-based curriculum for DSMES
*Most current as of Sept. 2018
Clinical/Teaching Plan
• Patient empowerment and motivational
interviewing counseling strategies
• Sample of patient educational handouts
• Type of teaching aids
Clinical/Teaching Plan
• Documentation (paper forms or EMR modules):
o Referring provider communication after each
DSMES visit
o Patient chart
• Point-of-care tests and CLIA waivers to perform
Clinical/Teaching Plan
• Shared medical appointments with provider
o Win-Win for provider, educator and DSMES program
IN ~2 HOURS, ~10 - 12 OUTPATIENTS PARTICIPATE IN
INDIVIDUAL FOLLOW-UP MEDICAL VISITS by PROVIDER
plus
LIFESTYLE/BEHAVIOR CHANGE EDUCATION by EDUCATOR
in INTERACTIVE GROUP SETTING
Shared Medical Appointment: 1 Hour of Diabetes Management+ 30 Minutes of Group DSMES
Traditional Provider Visit:Diabetes Management
Only by ProviderAverage # of OPs 10 10
Total provider time 1 hour (~ 5 - 6 minutes per OP) 3.3 hours (~ 20 minutes per OP)
# of 30 min. units of group DSMES billed by program
1 unit x 10 OPs @ ~$18 per OP None
# of individual E/M visits by provider + reimbursement
10 OPs x code 99214 @ ~ $150 per OP = $1500 for 10 OPs
10 OPs x code 99214 @ ~ $150 per OP = $1500 for 10 OPs
Total average providerreimbursement for E/M
$1000 in 1 hour $1000 in 3.3 hours
Total average DSMESreimbursement per 30 min. $180 for 10 OPs $0
Total average providerreimbursement for E/M
$1000 in 1 hour= $17 per minute
$1000 in 3.3 hours= $5 per minute
Components of
DSMES Business
Plan
Continuous Quality Improvement Plan
Ongoing CQI Plan has 3 distinct activities:
1. Monitor patient behavior change and all other outcomemeasures
2. Complete and report >1 CQI project each year
• Evidence-based CQI process used
• Suggest: Plan – Do – Study – Act (PDSA)
3. Report summary of behavior change and all other outcome
measures to providers, SO and stakeholders regularly
Spectrum of DSMES Outcomes
Continuous Quality Improvement Plan
4 Step CQI Process
Last But Not Least…
Factors Requiring On-Going
Modifications to Your DSMES Business Plan
1. Economic conditions (internal to SO and external)
2. Policies and procedures of your SO
3. Competition forces
4. Provider and patient mix
5. Resources allocated to DSMES program
6. New standards of diabetes care and DSMES
7. New DSMES team members who have different ideas
8. Environmental scanning
o A way to monitor social, political, economic and technological events and trends that may impact DSMES & SO (as new opportunities and threats)
All 6 components of your
DSMES Business Planmust work in synergistic harmony to
maximize Patient, Program and Sponsoring
Organization success.
Time for Questions
DisclaimerThis information is intended for educational and reference purposes only. It does not constitute legal, financial, medical or other professional advice. The information does not necessarily reflect opinions, policies and/or official positions of the Center for Medicare and Medicaid Services, private healthcare insurance companies, commercial entities or professional associations. Information contained herein is subject to change by these and other organizations at any moment, and is subject to interpretation by its legal representatives, end users and recipients. Readers should seek professional counsel for legal, medical, ethical and business concerns. The information is not a replacement for the Academy of Nutrition and Dietetics’ Practice Guidelines and professional resources, American Diabetes Association’s Standards of Medical Care in Diabetes or American Association of Diabetes Educators professional resources. As always, the reader’s clinical judgment and expertise must be applied to any and all information in this document.
Structure, Process and Outcome Quality
Measures
in
DSMES Business Plan
and
2017 National Standards of DSMES
About Structure Quality Measures
• Related to resources (including capabilities, features) of DSMES program’s sponsoring organization (SO)
• DSMES program quality is tied to resources
• When resources available and utilized, results are:
o Maximized efficiency of program’s activities
Maximized efficiency leads to maximized:
Performance of educators and staff Cost control
Examples* of Structure Quality Measures
• IT/software data tracking system to track and monitor:
o Patients’ behavior goal achievement
o Patients’ outcomes (knowledge, confidence, clinical, quality of life, cost-savings, satisfaction)
o Other patient data
o Program data (number of: visits, referrals, etc.)
• Patient appointment reminder systems
Examples* of Structure Quality Measures, Cont.
• Patient registry with filtering ability (e.g., to identify pts due for follow-up DSMES, lab tests, exams,
etc.)
• EHR with essential functions for optimal diabetes care1 and interoperability with other IT systems:
1. Nine Essential Functions of an Information System for Optimal Diabetes Care, National Diabetes Education Program, National Institute of Diabetes and Digestive and Kidney Diseases
Examples* of Structure Quality Measures, Cont.• Evidence-based clinical decision support
tools…examples:
o Diabetes standards of medical care in diabetes
o Diabetes, hyperlipidemia, HTN nutrition practice guidelines
o AADE7™ Self-Care Behaviors
o 2013 Guideline for the Management of Overweight and Obesity in Adults
o Screening for Type 2 Diabetes Mellitus in Adults (U.S. Preventive Services Task Force)
About Process Quality Measures
• Related to the:o Way resources are used to deliver DSMES
programo Way program’s activities and procedures are
executed
• Ask: does the “way” align 100% with established:o DSMES program’s mission, vision and goals?
o DSMES program written policies and procedures?
o National Standards of DSMES?
o Insurers’ DSMES reimbursement rules?o Sponsoring organization’s policies and
protocols?
Examples* of Process Quality Measures• Educators use of:
o Evidence-based decision support tools
o Information technology (IT) systems
o Lab data in EHR
• Regularly scheduled:
o Performance self-appraisals of DSMES team
o In-service education events for DSMES team within sponsoring organization
o DSMES program’s Advisory Committee meetings
Examples* of Process Quality Measures, Cont.
• Pt contacted within 24--48 hours of receipt of referral
• No-show pts contacted within 24--48 hours by educator to inquire about reason and to incent to reschedule
• Educator documentation of adherence to evidenced-based practice guidelines
• Pre-scheduled programs in the year are furnished
• All classes in each program are furnished
• Scheduled classes start and finish on time
About Outcome Quality Measures
• End result of what educators do over period of time
• Indicators of quality of DSMES program and educators
• Desired outcomes measures established by DSMES team
• Type: patient, provider + program outcome measures
• How outcomes established: by DSMES teamo Benchmarking with other DSMES programs
(external data)o Diagnosing internal data related to
measures
Examples* of Outcome Quality Measures
• Patient Outcome Measureso Measurable improvement in outcomes
related to:
Knowledge
Confidence
Behavior change
Clinical—health status
Quality of life
Cost-savings
Examples* of Outcome Quality Measures, Cont.
• Program Outcome Measures:
o A1c measured on all pts improved in the aggregate
o Claims to health insurers with DSMES benefit are reimbursed at maximum rate within 12 months
Examples* of Outcome Quality Measures, Cont.
• Provider Outcome Measures:
o Provider initial referrals increase by 2% in 12 months
o Provider follow-up referrals increase by 3% in 12 months
o New providers refer to program within 3 months of being affiliated with sponsoring organization
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Structure Measures
Realization of sponsoring organization (SO) or sponsoring individual for DSMES program
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Structure Measures:
Realization of written policies and procedures which indicate how each of the 10 National Standards of DSMES will be adhered to by the sponsoring organization or sponsoring individual
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Structure Measures (Standard 1)
Receipt of letter of support from senior administration of sponsoring organization affirming that organization will recognize and support quality DSMES as an integral component of diabetes care
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Structure Measures (Standard 2)
Realization of external stakeholders and experts to promote program quality (aka, Stakeholder Committee)
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Structure Measures (Standard 4)
Realization of program coordinator that is designated to oversee the DSMES program and have oversight responsibility for the planning, implementation, and evaluation of the education services.
• Coordinator is CDE or BC-ADM, or annually accrues 15 hours of CE credits based on program anniversary date
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Structure Measures (Standard 5)
Realization of instructional staff that includes minimum of RN or RDN or RPh with training and experience pertinent to DSMES, or another professional with certification in diabetes care and education, such as a CDE or BC-ADM
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Structure Measures (Standard 6)
Realization of written DSMES curriculum reflecting current evidence and practice guidelines, with criteria for evaluating outcomes, that will serve as the framework for the provision of DSMES
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Structure Measures (Standard 7)
Realization of DSMES program in order to fulfill the AADE accreditation or ADA recognition requirement that:
• >1 participant completes the DSMES program
• A copy of participant’s de-identified chart demonstrating the complete education process be submitted with initial accreditation or recognition application
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Process Measures (Standard 1)
Realization of the documentation of
• An organizational structure
• Mission statement
• Program goals
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Process Measures (Standard 3)
Reliable assessment conducted by provider of the DSMES to identify
• Whom to serve (target population)
• How best to deliver DSMES to that population
• What resources can provide ongoing support for that population
DSMES Business Plan
Quality Measures
Adherence to National Standards
of DSMES Plan
Process Measures (Standard 7)
Realization of DSMES program design that defines the:
• Number of total visits/program
• Number of group and/or individual visits
• Length of time of visits
• Maximum number of pts per visit (if number is limited due to space)
• Locations of the program:
o At sponsoring organization
o At off-site locations
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Process Measures (Standard 7)
Realization of each participant’s:
• Individualized assessment of the DSMES and support needs by one or more of the instructors and signed by the participant
• Individualized education and support plan focused on behavior change that is collaboratively developed by an instructor and the participant
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Process Measures (Standard 7)
Realization of written communication regarding each participant’s individualized education plan, DSMES provided, outcomes achieved and the diabetes self-management support plan with:
• Other health care team members
• Referring provider after each DSMES visit
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Process Measures (Standard 8)
Realization of personalized follow-up plan for Diabetes Self Management Education and Support (DSMES) that is reviewed with participant and communicated with:
• Other health care team members
• Referring provider
DSMES Business Plan
Quality Measures
Adherence to National Standards
of DSMES Plan
Process Measures (Standard 9)
Realization of instructor documentation of:
• Participant’s written behavioral goals and desired outcomes collaboratively developed with the participant and an instructor
• Interventions to achieve behavioral goals and outcomes
• Follow-up assessment of achievement of behavioral goals and outcomes
DSMES Business Plan
Quality Measures
Adherence to National Standards
of DSMES Plan
Process Measures (Standard 10)
Realization of the:
• Measurement of the effectiveness of the education and support
• Continuous quality improvement activities to improve any identified gaps in services or service quality, using a systematic review of process and outcome data
• Process for following-up and evaluating the participant’s desired outcome(s)…e.g. clinical, quality of life, satisfaction
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Process Measures
Reliable assessment conducted by provider of the DSMES to identify
• Referring providers in local area
• People in community who are not patients of referring providers but have diabetes
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Structure Measures and ProcessMeasures (Standards 1 -10)
Realization of each “essential element” of Standards 1 through 10
• For complete listing of essential elements for each of the 10 standards, see separate document titled:
ESSENTIAL ELEMENTS CHECKLIST ANDINTERPRETIVE GUIDANCE FOR AADE DIABETESEDUCATION ACCREDITATION PROGRAM ORADA EDUCATION RECOGNITION PROGRAMCERTIFICATION
DSMES Business Plan
Quality Measures
Adherence to National
Standards of DSMES Plan
Outcome Measures (DSMES Program)
Realization of certification of DSMES program as evidenced by:
• Initial AADE accreditation or ADA recognition of program
• Maintenance of accreditation or recognition at each renewal cycle
DSMES Business Plan
Quality Measures
Clinical/Teaching Plan
Structure Measures (DSMES Team)
Reliable access to:
• EHR for:
o Lab data
o Providers’ notes
o Diagnoses
o Medications
• Patient registry
• Electronic data management system (e.g., AADE7™ System)
DSMES Business Plan
Quality Measures
Clinical/Teaching Plan
Structure Measures (DSMES Team)
• Evidence-based DSMES curriculum
• Decision support tools:
oADA Medical Standards of Care for DM
oAND Online Nutrition Care Manual
oAADE book The Art and Science of DSMES
oChronic Care Model
oOther reference books, journals, online subscriptions, websites, listservs, etc.
DSMES Business Plan Quality Measures
Clinical/Teaching Plan
1. U.S. Institute of Medicine's Quality Chasm Report, seven dimensions of patient-centered care for PWD presented on NDPP information site; at:http://ndep.nih.gov/hcp-businesses-and-schools/practice-transformation/patient-centered-interactions/dimensions-of-patient-care.aspx
Process Measures (Patient and DSMES Team)
Regularly demonstrated patient-centered care by DSMES team, as evidenced by1:
• Respect for pts' values, preferences, and expressed needs
• Coordination and integration of care
• Timely and clear communication with pts
• Physical comfort of pts
• Involvement of pts’ family and friends
• Emotional support of pts: relieving fear and anxiety, and screening for depression
DSMES Business Plan Quality Measures
Clinical/Teaching Plan
Process Measures (Patient and DSMSE Team)
Regularly completed clinical processes by DSMES team within required time frames:
• Completion of patient’s initial assessment
• Rendering DSMES program visits
• Documenting patient visits
• Completing progress notes and forwarding to provider within 48 hours
• Downloading CGM data for provider
DSMES Business Plan
Quality Measures
Operations Plan
Structure Measures:
Right DSMES program design to meet needs, wants and expectations of patients and providers:
• Room/space assigned to program
• Number of total visits/program
• Number of group and individual
visits/program
• Time frame of each visit in program
• Days and times that visits are scheduled
• Number of programs per year and dates of
DSMES Business Plan
Quality Measures
Operations Plan
Structure Measures:
Rendering DSMES program in:
• Other entities (e.g., hospitals w/o
program)
• Branch and/or community sites (off-site)
• Employer work sites
DSMES Business Plan
Quality Measures
Operations Plan
Process Measures (Patient)
Reliable operational processes as evidenced by:
• Patients’ calls/emails returned within 24 hours
• Completion of patient visits attendance sheets
• Maintenance of patient handout inventory
• Classroom fully prepared prior to visits
• DSMES program schedules completed in timely fashion and distributed to pts at 1st visit
DSMES Business Plan Quality Measures
Operations Plan
Process Measures (Patient)
• Patient appointment reminder calls made24--48 hours in advance of each visit
• Educators call no-show patients within 24—48 hours to inquire about reason for not keeping appointment and to reschedule
• Training of DSMES team members for functions performed (including CHWs)
DSMES Business Plan Quality Measures
Operations Plan
Process Measures (DSMES Team)
• Cross-training of team members to substitute for other roles (in cases of absences)
• Ongoing training to keep up-to-date on all aspects of DSMES
• Clear definition of tasks and of assignment of roles among team members
• Routine communication through regular team meetings and paper and e-information flow
DSMES Business Plan Quality Measures
Operations Plan
Outcome Measure (Patient)
Retention of patients in DSMES program
Realization of satisfaction ratings on each survey question as excellent, very good or good by >80% of patients who complete surveys
DSMES Business Plan
Quality Measures
Marketing Plan
Structure Measures:
Reliable support from Marketing Dept. or personnel of sponsoring organization
DSMES Business Plan
Quality Measures
Marketing Plan
Process Measures:
Regular use of various, proven-effective promotion and advertising strategies
• Strategies are summarized in acronym S.U.P.E.R. M.A.R.K.E.T.I.N.G. for obtaining
o Provider referrals
o Patient self-referrals
Quality Marketing Plan Spells:S.U.P.E.R. M.A.R.K.E.T.I.N.G.
Goal:Increase Program Awareness and Value, and
Build Trust In
S Set up screenings markets, malls
at health fairs, farmers’
U Use social program
media + patient blogging to promote
P Pursue free publicity in local newspapers
E Ensure referrals forms are hand-delivered to provider
R Report patient outcomes to providers regularly
M Marketing brochures or slim jimsMailers (single or inside neighborhood ad booklets)
A Ads in local newspapers and church bulletinsArticle writing for local newspapers
R Radio interviewsReferral forms (branded and Medicare compliant)
K Keeping track of ROI for each marketing activity
E Establishing program as employee wellness initiative
T Television interviews on local cable channelsTelephone book yellow pages
I Internet website advertising (sponsoring org, LinkedIn, AADE)
N No charge presentations at community events
G Get program logo, tagline, give-away (Diabetes Calendar)
DSMES Business Plan
Quality Measures
Marketing Plan
Outcome Measures:
Robust Referrals from:
• Providers
• Patient self-referrals
DSMES Business Plan Quality Measures
Financial Plan
Structure Measures:
Reliable access to:
• Personnel in Finance/Accounting Dept. of sponsoring organization (bean counters!)
• Personnel in Billing/Coding Dept.
• Timely financial reports related to DSMES program:
o Budget
o Income statement
o Expense report
DSMES Business Plan Quality Measures
Financial Plan
Structure Measures:
Realization of:
• How DSMES program structured by administration of sponsoring organization:
o Profit center or cost center
• Expectations of same:
o Break-even?
o Make money?
o OK to lose money (as considered goodwill, community service or loss leader)?
DSMES Business Plan Quality Measures
Financial Plan
Structure Measures
• If sponsoring organization or sponsoring individual will bill Medicare for the DSMES, same must:
o Enroll in Medicare Part B as organizational or individual provider
o Be billing Medicare for other services and be reimbursed
DSMES Business Plan Quality Measures
Financial Plan
Process Measures:
If billing insurers:
Reimbursement is maximized by the DSMES team insuring that:
• All insurer-billable visits billed
• All patient co-payments collected
• All out-of-pocket payments from uninsured patients collected
• Insurance claims tracked retrospectively for status
o Action taken on denied/rejected claims to determine corrective action and re-billing
DSMES Business Plan Quality Measures
Financial Plan
Process Measures:
Reliable monitoring by educators of patient financial outcomes…example:
• Reduction in:
o Medications
o ER visits
o Therapies
o Intermediate care facility visits
DSMES Business Plan Quality Measures
Financial Plan
Outcome Measures:
Reimbursement Revenue maximized:
• Claims to health insurers who cover DSMES are reimbursed at maximum rate within 2 months
• 100% of DSMES fees to patients who self pay are collected within 2 months
• 100% of patient co-payments are collected within 2 months
DSMES Business Plan Quality Measures
Financial Plan
Outcome Measures:
Reimbursement Revenue maximized:
• Claims to health insurers with DSMES coverage reimbursed at maximum rate within 2 months
• 100% of DSMES fees to patients who self pay collected within 2 months
• 100% of patient co-payments collected within 2 months
DSMES Business Plan Quality Measures
Financial Plan
Outcome Measures:
Realization of the sponsoring organization’s financial expectations of DSMES program:
• Make a profit (per methodology used by SO)
• OK to lose money (up to specified amount express as a metric, ratio, etc.)
• OK to break even (per methodology used by SO)
DSMES Business Plan Quality Measures
Financial Plan
Outcome Measures:
Rates of diabetes educator productivity meet desired targets
Return on investment in educator hours meets desired targets
DSMES Business Plan Quality Measures
Continuous QualityImprovement Plan
Structure Measures (DSMES Team)
Reliable access to:
• Quality management/CQI director of sponsoring organization
• EHR for:
o Lab data
o Providers’ notes
o Diagnoses
o Medications
• Patient registry
• Electronic data management system (e.g., AADE7™ System)
DSMES Business Plan Quality Measures
Continuous QualityImprovement Plan
Process Measures (DSMES Team)
Regularly scheduled:
• Performance self-appraisals of DSMES team
• In-service education events for DSMES team within sponsoring organization
• DSMES program’s Advisory Committee meetings
Realization of each team member’s explicitly identified goal for professional development
DSMES Business Plan Quality Measures
Continuous QualityImprovement Plan
Process Measures (CQI Plan Specific)
Regularly completed number of pre-identified CQI projects over set period of time
Regular use of evidence-based steps/protocol for conducting CQI projects…example:
• AADE’s Continuous Quality Improvement for Diabetes Education and Support Programs (includes 8 Step CQI Process)
Resolution of identified problems and/or gaps
Realization of improvements in program
DSMES Business Plan Quality Measures
Continuous QualityImprovement Plan
Outcome Measures (Patient)
Realization of patient outcomes:
• Knowledge
• Confidence
• Behavior change
• Clinical—health status
• Quality of life
• Cost-savings
• Satisfaction
Retention of patients in DSMES program
DSMES Business Plan Quality Measures
Continuous QualityImprovement Plan
Outcome Measures (Provider)
Realization of provider outcomes:
• Satisfaction with DSMES program and educators as evidence by survey responses
• Trust and loyalty in DSMES program and in educators as evidence by survey responses and ongoing and increase in provider referrals
Facilitated Discussion
Chat in your questions and comments.
Press *1 on your telephone key pad to enter the teleconference queue.
224
Call to Action
• Share a strategy that you learned today that you intend to put into practice. (Chat it in!)
• Identify at least one partner you can ask to join you in your DSMT efforts.
• Complete the post-event assessment: https://www.surveymonkey.com/r/7LBPPCM
225
CE Credit
• Complete the post-event assessment upon exiting WebEx: https://www.surveymonkey.com/r/7LBPPCM
• It will pop up at the conclusion of the event• There is a separate evaluation required for CE that is
linked within the post-event assessment• Once you submit your CE evaluation, you will be
provided with a certificate to retain for your records• For technical assistance, please email Nikki Racelis
(nikki.racelis@qinncc.hcqis.org)
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Save the Date!
Join us for the remaining two calls in the Three-Part QIN-QIO Public Sharing Call Series: Going Back to Basics of Diabetes Self-Management Training
– The 2nd Thursdays of November (11/8) and December (12/13)– Topics: operations, reimbursement, and CQI for DSME/T
programs– 3:00 - 4:30 PM ET– Registration is required!
• Register separately for each call at https://qioprogram.org/qin-qio-public-sharing-calls-3-part-series
227
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228
Thank you!
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This material was prepared by Telligen, the Quality Innovation Network National Coordinating Center, 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. 11SOW-QINNCC-02338-09/25/18