1. 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

2. 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

3. 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

4. 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!

5. 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

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

7. ADA and AADE recognized diabetes education programs, Montana, 20164 4 2 1 1 1 1
Updated Jan ,
ADA and AADE data 1 1 1 29
ADA Recognized Programs
AADE Accredited Programs 6

8. 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

9. 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)

10. 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’

11. 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!!!

12. 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

13. 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

14. 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)

15. ADA and AADE recognized diabetes education programs, Montana, 20164 4 2 1 1 1 1
Updated Jan ,
ADA and AADE data 1 1 1 29
ADA Recognized Programs
M-P DEEP Facilitators
AADE Accredited Programs 6

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

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

18. 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)

19. 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?

20. 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

21. 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

23. Stephanie Paugh, PharmD
Marci Butcher, RD, CDE
Montana Diabetes Program – MT DPHHS
Mountain-Pacific Quality Health
(406)
Stephanie Paugh, PharmD
Mountain-Pacific Quality Health
(406)
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-B