Montana Diabetes Program – MT DPHHS and Programs and Collaborations to Increase Access to Diabetes Education for Older Adults in Montana Montana Diabetes Program – MT DPHHS and Mountain-Pacific Quality Health

Stephanie Paugh, PharmD Marci Butcher, RD, CDE Montana Diabetes Program – MT DPHHS Mountain-Pacific Quality Health AADE 2017 Diabetes Educator of the Year Stephanie Paugh, PharmD Mountain-Pacific Quality Health

Objectives: Identify self-management resources in MT for older adults with diabetes Identify MT DPHHS efforts to increase access to diabetes education for Medicare beneficiaries Identify Mountain-Pacific Quality Health’s efforts to increase peer-led diabetes empowerment workshops in MT communities, targeting Medicare beneficiaries in communities of need

Engaging Partners – At the “High Level” and at the Local Level Everyone with Diabetes Counts – CMS Goal: improve health outcomes and QOL among disparate and underserved Medicare populations Administered by QIN-QIOs CDC/State Health Departments – Diabetes Prevention and Control Programs 1305 – Increase the # of recognized/accredited DSME programs, increase referrals, participation, & reimbursement 1422 – Work on prevention Key to partnerships: It’s all local!

Quality Diabetes Education Initiative: DPHHS support for developing diabetes education programs and diabetes educators… Quality Diabetes Education Initiative: Developing accredited DSME/S programs Developing diabetes educators – ‘peer mentoring program’ - Basics CDE

Diabetes educators make a difference…every day Diabetes educators make a difference…every day. YOU can make a difference every day.

ADA and AADE recognized diabetes education programs, Montana, 2016 4 4 2 1 1 1 1 Updated Jan. 2016 , ADA and AADE data 1 1 1 29 ADA Recognized Programs AADE Accredited Programs 6

Medicare DSME/S benefit 10 hours of INITIAL diabetes self-management and support For new diagnosis or when beneficiary begins Medicare (even if has had prior diabetes education) Group classes preferred, 1 hour individual assessment or education for injection training Provider must document in referral reasons for not doing group Must be provided by accredited or recognized DSME program (meet national standards, apply for accreditation) 3 hours of FOLLOW-UP diabetes self-management education and support annually

Despite huge increases in CDEs and #s of DSME programs in MT… DSME continues to be a vastly underutilized service… Nationally, only 7% of newly diagnosed person with diabetes (PWD) (with insurance) have been seen for DSME/S Medicare beneficiaries with diabetes are NOT utilizing the DSME benefit (poor utilization)

Reasons that PWD do not receive diabetes education… Cost – Medicare requires 20% copay Barriers within the insurance/Medicare benefit Distance to diabetes education Perceived need for education by the PWD Perception of DSME by providers/lack of referrals Perception of providers regarding patient ‘compliance’

Need to work on BOTH ends of the issue… Increasing #s of programs/educators to increase access to DSME/S Working on patient ENGAGEMENT (Mountain-Pacific Quality Health)…to get PWD empowered and engaged in their own healthcare!!!

Mountain-Pacific Quality Health Who are we? The QIN-QIO for: Montana Wyoming Alaska Hawaii, which includes the U.S. Pacific Territories of Guam, American Samoa and Saipan

Engaging People with Diabetes (PWD) or Pre-diabetes and Their Support System Mountain-Pacific Quality Health, DEEPTM (Diabetes Empowerment Education Program) Curriculum: Free, peer-led diabetes empowerment classes Once a week for six weeks

Mountain-Pacific Quality Health, DEEPTM Curriculum: NOT intended to replace DSME done by health professionals, CDEs, recognized or accredited DSME programs Augments and supports professional DSME Gets PWD/pre-diabetes engaged in their own personal health and health care Partner with CDEs/recognized and accredited programs Seeing increases in referrals to professional DSME (Mountain-Pacific structure in our communities supports professional DSME)

ADA and AADE recognized diabetes education programs, Montana, 2016 4 4 2 1 1 1 1 Updated Jan. 2016 , ADA and AADE data 1 1 1 29 ADA Recognized Programs M-P DEEP Facilitators AADE Accredited Programs 6

Building Communities Building relationships… Partnership mentality Get ALL key players to the table Medical community Community organizations Patients and families State/public health

Patient & Family Engagement Health System Patient & Family Engagement Community Sustainability

Building Communities Strategizing together… Get the word out What does the community want/need? Culture change “Sick care” vs. true “health care” Get the word out Local media – What’s the key source of info? Personal stories are very POWERFUL “Get the bus moving” Finding that local “champion” (Doesn’t have to be health professional)

Building Communities Learning about the community… What is already available in the community? Who is the “hub” & where do people meet? Senior centers? - Schools? Clinics? - Churches? Hospitals? - Public health? Libraries? Other?

The “Sweet Spot” for MT’s Mountain-Pacific Work County Extension Agents – Trained 12 agents (Feb 2016) with more trainings to come Community Health Centers (FQHCs) Rural Health Clinics Senior Centers Public Health RNs Recognized/accredited DSME programs MT DPHHS Diabetes Program UM- MTGEC - Geriatric Workforce Enhancement Program Recognizing this work happens at the local level

Montana: Building Sustainable Infrastructure Mountain-Pacific Quality Health – DEEPTM Montana Diabetes Program, MT DPHHS High-level, ongoing support for professional DSME infrastructure Working on telehealth DSME Welcoming partnerships that target “gaps” in services and populations of need Exploring additional opportunities for partnership with Mountain-Pacific – data, support, sharing contacts Finding “gaps” in DSME services, communities and populations  “sweet spot” Meeting identified needs Partner w community organizations and DPHHS – data, support, sharing contacts

Stephanie Paugh, PharmD Marci Butcher, RD, CDE Montana Diabetes Program – MT DPHHS Mountain-Pacific Quality Health mbutcher@midrivers.com (406) 535-4797 Stephanie Paugh, PharmD Mountain-Pacific Quality Health spaugh@mpqhf.org (406) 457-5819 Brought to you by Mountain-Pacific Quality Health, the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Montana, Wyoming, Alaska, Hawaii and the U.S. Pacific Territories of Guam, American Samoa and the Commonwealth of the Northern Mariana Islands, 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-MPQHF-MT-B2-16-36