Download Everyone with Diabetes Counts - Lake Superior Quality Innovation

Everyone with
Diabetes Counts
Provider Toolkit
Table of Contents
1: Overview
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2: DSME vs. DSMT
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3: Tips for Integrating DSME into your practice
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4: Resources
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The Everyone with Diabetes Counts Initiative
How to use this toolkit
What is DSME?
DSME is...
DSME is not...
Stanford University Diabetes Self-management Program (DSMP)
Diabetes Empowerment Education Program (DEEP)
DSME Rx pad
Workshop posters
Workshop fliers
Helpful links
Setting up classes in your office
Becoming a DSME trainer
Contact information
Everyone with Diabetes Counts: Provider Toolkit
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Lake Superior Quality Innovation Network | Updated May 28, 2015
Overview
The Everyone with Diabetes Counts initiative
Everyone with Diabetes Counts (EDC) is a national initiative by the Centers for Medicare & Medicaid Services (CMS) to
improve health outcomes and reduce health disparities among people with diabetes. Lake Superior Quality Innovation
Network (QIN) is working with providers, community partners and health care consumers across Michigan, Minnesota and
Wisconsin to empower Medicare beneficiaries to effectively manage their disease through what’s known as diabetes selfmanagement education (DSME).
Our goals are to:
> Increase provider referrals to DSME
> Increase the number of DSME graduates
> Increase the number of DSME workshops and trainers
How to use this toolkit
This guide will help refer your patients with diabetes to DSME. It will teach you how to easily incorporate DSME referrals
into your workflow and provides consumer-friendly resources for you to use in your office.
What is DSME?
DSME is a free program that helps people with diabetes take better care of their health. The classes help patients
understand diabetes and its risks, as well as the importance of diet, exercise, keeping regular physician exams, receiving
annual foot and eye exams, managing medications and more. DSME teaches participants how to live healthier in a fun,
non-threatening community-based environment. DSME does not conflict with other programs or treatment and participants
are referred to their physicians for all medical questions.
There are several types of DSME. Lake Superior QIN will be using Stanford’s Diabetes Self-Management Program (DSMP)
and/or the Diabetes Empowerment Education Program (DEEP). Both incorporate the needs, goals and life experiences of
the person with diabetes and are evidence-based models.
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DSME is...
> An interactive, ongoing process with six facilitated sessions
> Provided according to an evidence-based curriculum, which includes monitoring of progress toward achieving
diabetes self-management goals
> Proactive and provided according to a curriculum that helps participants:
> Understand the complications and impact of diabetes
> Integrate nutrition and physical activity into their lifestyle
> Manage medication(s)
> Develop stronger communication skills with families, caregivers and
health care professionals
> Prevent, detect and treat complications
> Develop personal strategies to manage psychosocial issues and promote behavior change
DSME is not...
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Everyone with Diabetes Counts: Provider Toolkit
Information provided by a health care provider during an appointment
Medical guidance
Educational materials
Telephone-based case management or a 24-hour nurse hotline
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Stanford University’s Diabetes Self-Management Program (DSMP)
Stanford University’s DSMP is a six-week workshop for adults with type 2 diabetes, their family members and caregivers.
Two trained lay leaders guide the workshops. Workshops meet once a week for 2 ½ hours in community settings, such as
senior centers, libraries or churches. Workshops can also be held in a health care provider’s office.
Subjects covered include:
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Techniques to deal with the symptoms of chronic disease, fatigue, pain, depression and stress
Appropriate exercise for maintaining and improving strength and endurance
Healthy eating
Appropriate use of medication
Making action plans
Working effectively with health care providers
Problem solving
Stanford University’s Diabetes Self-Management Program is being used in Michigan, Minnesota and Wisconsin. In
Michigan, it is referred to as Diabetes PATH (Personal Action Toward Health); in Minnesota, it is referred to as Living Well
with Diabetes.
Diabetes Empowerment Education Program (DEEP)
The University of Illinois at Chicago developed the DEEP program to help participants better understand diabetes and its
management. Diabetes can be complicated and confusing; DEEP uses plain language to help participants gain a better
understanding of diabetes self-care. The following topics are covered during the workshop:
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Understanding the Human Body
Risk factors and complications -- the good, the bad and the ugly
Monitoring Your Body
Eating for Health
Medications and Medical Care
Get Up and Move -- Living with Diabetes
Workshop sessions are held once a week for six weeks. Each session lasts approximately 2 hours in community settings
such as senior residences, community centers and churches. DEEP can be taught by lay leaders within the community who
have been trained as certified DEEP peer educators. DEEP is being used in Minnesota and Wisconsin.
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DSME vs. DSMT
Diabetes self-management education | Diabetes self-management training
DSME is designed to complement other types of diabetes education, including diabetes self-management training (DSMT).
The chart below outlines the differences between the two programs.
CMS reimburses for the Medicare diabetes self-management training (DSMT) benefit. The information below highlights
differences between the Everyone with Diabetes Counts (EDC) DSME and the Medicare DSMT benefit.
COST
DSME
Medicare DSMT
• Free of charge to Medicare beneficiary
• Medicare beneficiary pays co-pay
(Medicare covers 80 percent of the allowed adjusted rate,
beneficiary pays 20 percent)
REFERRAL REQUIREMENT
DSME in EDC
Medicare DSMT Benefit
• Does not require a physician order
• Must be ordered by a physician or qualified non-physician
practitioner
TRAINING, TIME & FORMAT
Trainers
DSME in EDC
Trainers
• Licensed health care provider not required
• Many workshops taught and led by community health workers
(CHW), in order to include cultural competency component
• Does not teach what is required to be taught by a licensed
health care provider
Everyone with Diabetes Counts: Provider Toolkit
Medicare DSMT Benefit
• Taught by a licensed health care provider, such as a
certified diabetes educator (CDE) and therefore, can teach
insulin administration and how to use an insulin pump
• If not taught by a CDE, then CMS requires classes be led
by a licensed health care provider, such as a registered
nurse (R.N.), registered dietitian (R.D.) or a licensed
registered pharmacists (R.Ph.)
• A community health worker (CHW) can be part of the overall
team, but cannot lead the team
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Time
Time
Format
Format
• Workshops are 12 -15 hours in total, spread over 6 weeks
(2-2.5 hours per class)
• Workshops are held in consecutive weeks
• Benefit is for up to 10 hours the first year (provided over a
12 month period)
• Follow up in subsequent years is for no more than two hours
per year
• Classes to do not have to be consecutive; can have one- or
two-hour class, then later in the year have an additional class,
or series of classes
• Taught in group sessions only, no more than 15 - 20
people per workshop
• Taught in community-based settings near where people
live, such as senior centers, public housing facilities,
churches, libraries and grocery stores
• Workshops taught for low literacy populations
• Workshops taught in the preferred language of the targeted
population
• Family members are encouraged to attend workshops
with beneficiary
• Usually taught to beneficiary only, typically not inclusive of
other family members or caregivers
• Often taught one-on-one, but can be taught in small group
classes
• Most often, workshops are taught in clinical-based settings
such as hospital outpatient departments and clinics
• Both the first year and subsequent years can be a
combination of individual and/or group training
CURRICULUM
DSME in EDC
Medicare DSMT Benefit
• Specific curriculum not required by CMS
• Focus on clinical measures (i.e., labs)
• Teaches healthy lifestyle changes, behavior changes, basic
anatomy, medication management, the importance of
exercise, proper nutrition, scheduling regular foot and eye
exams, as well as lab tests
• Stresses personal empowerment, self-goal setting and selfinvolvement in care
• Uses the group setting for support and brainstorming to
avoid potential barriers to achieving goals
MEDICARE REIMBURSEMENT
DSME in EDC
Medicare DSMT Benefit
• Not reimbursed by CMS
Everyone with Diabetes Counts: Provider Toolkit
• Must be recognized by CMS as a Certified Diabetes
Center (either American Diabetes Association (ADA)
recognized or American Association of Diabetes Educators
(AADE) accredited) to bill for Medicare DSMT benefit
• Billed by G codes
• G0108: DSMT individual session face-to-face with patient,
each 30 minutes of training 2015 Medicare Fee Schedule
reimbursement: $46.46 - $71.06 (varies by geographic region
& carrier)
• G0109: DSMT group session (two or more patients) Each 30
minutes of training 2015 Fee Schedule $12.57 - $19.20
(varies by geographic region & carrier)
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Tips for integrating DSME
into your practice
Utilize educational materials around your office.
• Put up posters and fliers in exam rooms and waiting rooms
• Promote DSME on your website and social media accounts
• Use DSME Rx pad to refer patients
• Encourage patients to contact local DSME educators and locate workshops
> MICHIGAN: Call 517-335-1236 or visit www.mihealthyprograms.org
> MINNESOTA: Contact Mary Beth Dahl at 952-853-8546 or [email protected]
> WISCONSIN: Contact Mary Funseth at 608-441-8229 or [email protected]
Build DSME into your workflow.
• Add DSME referrals to your after-visit summaries
• Send a secure message about DSME through a patient portal to those with prediabetes and diabetes
• Send letters to patients with prediabetes and diabetes, recommending they attend a workshop
• Use electronic health records (EHR) technology to generate a list of patients with prediabetes and diabetes
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Resources
Educational materials for workshops
Lake Superior QIN has developed a variety of DSME educational materials (e.g., posters, prescription pads, fliers, etc.) for
you to use in your office. Samples are included in this toolkit. All promotional materials are available in English and Spanish.
To request materials, refer to the contact information on page 17.
DSME Rx Pad - English
4.25” x 5.5”
These prescription pads were designed to be used by health care providers, including doctors, nurses and medical
assistants. On the front, is a “prescription” to refer people with pre-diabetes or diabetes to a specific workshop in the area.
The back side has easy-to-understand information about diabetes and how it affects a person’s entire body. It also offers
tips to help manage diabetes and prevent complications.
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DSME Rx Pad - Spanish
Everyone with Diabetes Counts: Provider Toolkit
4.25” x 5.5”
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Fill-in-the-blank workshop flier - English (.pdf)
8.5” x 11”
This flier can be filled in electronically or by hand. Since it’s 8.5” x 11” it can easily be printed from an office computer. These
can be handed out to patients or placed in waiting or exam rooms.
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Fill-in-the-blank workshop flier - Spanish (.pdf)
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8.5” x 11”
Lake Superior Quality Innovation Network | Updated May 28,, 2015
Fill-in-the-blank half page workshop flier - English
4.5” x 5.5”
This flier can be filled in electronically or by hand. The file is set up with two fliers per page, making them easy to print from
an office computer. These can be handed out to patients or placed in waiting or exam rooms. If you would like to include a
map of the workshop location on this flier, please contact us.
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Fill-in-the-blank workshop poster 1 (.pdf)
11” x 17”
This large colorful poster is great to hang up in waiting or exam rooms. It can be filled in electronically or by hand.
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Fill-in-the-blank workshop poster 2 (.pdf)
11” x 17”
This large colorful poster is great to hang up in waiting or exam rooms. It can be filled in electronically or by hand.
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Helpful links & downloadable resources
LOCAL
MICHIGAN
MI Healthy Programs
MINNESOTA
www.mihealthyprograms.org
Michigan’s hub for Diabetes PATH, including
a full list of scheduled workshops and training
materials
WISCONSIN
Enjoy a Healthy Life!
http://www.stratishealth.org/consumers/
healthy-life
Minnesota Department of Health
Diabetes Program
http://mndiabetes.org
Minnesota Diabetes & Heart Health
Collaborative
http://mn-dc.org
REGIONAL
Lake Superior Quality Innovation Network
Everyone with Diabetes Counts Initiative
https://www.lsqin.org/initiatives/diabetes-care
NATIONAL
Living with Diabetes
Self-management guide
Download English version. (.pdf) | Download Spanish version. (.pdf)
Hard copies also available for purchase in English, Spanish and Chinese.
American Diabetes Association (ADA)
http://www.diabetes.org
Living Healthy with Diabetes
A guide for adults 55 and up
Click here to download or request copies. (.pdf)
Quality Improvement Program
http://www.qioprogram.org
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Interested in setting up workshops or becoming a trainer?
Setting up classes in your office
If you’d like Lake Superior QIN to host a DSME workshop in your office, here are some things you’ll need to do:
> Have a meeting space large enough for up to 20 people (e.g., waiting room, lunch room, conference room, etc.)
> Recruit 15-20 Medicare beneficiaries with prediabetes or diabetes (minimum of eight people is required)
> Provide a healthy snack during each session (recommended, not required)
Becoming a DSME trainer
DSME programs are always looking for new trainers! Anyone can become a trainer; you do not need to be a health care
professional. DSME graduates are also encouraged to become trainers once they’ve completed the workshop.
For the Stanford Diabetes Self-Management Program (DSMP), you must:
> Submit an application
> Be affiliated with an organization that holds a current license with Stanford University (Lake Superior QIN can assist
with this)
> Attend a four-day leader training and complete all training activities
> Be available in the six months immediately following training to conduct a workshop
For the Diabetes Empowerment Education Program (DEEP), you must:
> Be affiliated with an organization that has purchased a license to use DEEP (Lake Superior QIN can assist with this)
> Complete a two and a half-day peer educator workshop
> Obtain a minimum of 90 percent in knowledge post-test
> Be rated very good or excellent in teach-back exercise by the Senior Trainer or Lead Trainer who facilitates the
workshop
> Be recommended for certification by the Senior Trainer or Lead Trainer who facilitates the workshop
LakeSuperiorQINcanhelpyoufindatrainingsessionnearyou.
To learn more about diabetes education in your state, request promotional materials, host a DSME
workshop or learn more about becoming a DSME trainer, please contact:
Michigan
Kristie Mimms
[email protected]
248-465-1370
Minnesota
Mary Beth Dahl
[email protected]
952-853-8546
Wisconsin
Mary Funseth
[email protected]
608-441-8229
This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not
necessarily reflect CMS policy 11SOW-MI/MN/WI-B2-15-27 031915
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