Don Gettinger

CMS QIN-QIO Cardiac Health & Everyone With Diabetes Counts Overview

Sharon Barclay

Objective

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Provide an overview of the goals of the Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network-Quality Improvement Organization (QIN-QIO) 11th Scope of Work (SoW) and Everyone With Diabetes Counts (EDC) initiative including what diabetes educators need to know to become involved in improving outcomes for those with or at risk for diabetes.

Restructuring

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Began exciting new, multi-state 5-year contract:

• August 1, 2014 - July 31, 2019

Beneficiary and Family Centered Care (BFCC)-QIOs

• #2 nationwide - Case Review and Monitoring

• www.keproqio.com

Quality Innovation Network (QIN)-QIOs

• #14 nationwide - Quality Improvement (QI) Activities

• www.atomAlliance.org

atom Alliance

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Multi-state alliance for powerful change composed of three nonprofit, healthcare QI consulting companies.

CMS 11th SoW Task Overview

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Goals

• Improve Cardiac Health

• Reduce Disparities in Diabetic Care

• Improve Prevention Coordination through Meaningful Use (MU) of Health Information Technology (HIT)

• Collaborate with Regional Extension Centers (RECs)

• Reduce Healthcare Associated Infections (HAIs)

• Improve Mobility and Decrease Healthcare Acquired Conditions in Nursing Homes

• Continue and Create Coordination of Care Community Coalitions

• Provide assistance in Value-Based Payment, Quality Reporting and the Physician Feedback Reporting Program

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Cardiac Health

Cardiac Health: atom Alliance

Spread Million Hearts initiative

Churches, providers, hospitals, communities, civic groups

Physician Practices - Certified Electronic Health Record Technology (CEHRT)Report and track:

Aspirin/Antithrombotic with IVDControlled blood pressure Cholesterol LDL-C Tobacco cessation

Home Health Agencies

Your Church can participate!

100 Congregations for Million Hearts  If you know of any congregation from any faith-

organization that would also be interested in participating, please share this information with them.

Feel free to contact us with questions at

millionhearts@cms.hhs.gov.

Join www.millionhearts.org

Patient Education

Key tools and resources

Health literature

Spanish translation version Many tools or patient resources

Patient & Family Engagement

Have patient representatives involved

Empower patients with Medicare to understand their care and be an active participant in their care

Give patients with Medicare the knowledge and confidence to ask important health-related questions and get answers

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Diabetes

Medicare Diabetes Prevalence & Expenditures

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Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14*Source: CMS Chronic Conditions Among Medicare Beneficiaries, Chartbook, 2012 Edition**Source: 2013 testimony by the Congressional Diabetes Caucus in the US House of Representatives and the American Diabetes Association)

60% of Medicare beneficiaries have multiple chronic conditions*

14% of Medicare beneficiaries have 6 or more chronic conditions. Top 5 are: Hypertension, High Cholesterol, Ischemic Heart Disease, Arthritis and Diabetes*

Dual Eligible beneficiaries (those with both Medicare and Medicaid coverage) are 1.4 times more likely to have diabetes*

26.9% of Medicare beneficiaries age 65+ (10.9 million Americans) have diabetes and account for about 32% of Medicare spending**

Everyone With Diabetes Counts (EDC) Initiative

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Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

Pilot launched in Florida seven years ago

Expanded to nine states/territories (NY, GA, LA, WV, TX, MS, MD, DC, US VI)

Expanded nationally to all QIN-QIOs with 11th SoW

EDC Goals

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Improve health equity by improving health literacy

EDC is a disparity reduction program.

Engage both beneficiaries and health care providers

Improve actual clinical outcomes in the six measures

Facilitate sustainable diabetes education

Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

EDC Components

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EDC’s five components:

• Recruitment and education of beneficiaries

• Recruitment and education of physician practices and staff

• Recruitment of partners/stakeholders

• Data collection and analysis

• Sustainability planning/implementation

EDC is a continuous plan/do/study/act (PDSA) cycle; “keep or tweak”

Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

Accomplishing EDC

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Recruit, enroll, and teach beneficiaries utilizing a CMS-approved evidence-based DSME program

• Provide free DSME classes

• 6 consecutive weeks

• 1 class a week

• 1 ½ to 2 hours each class

• Family members or care-givers encouraged to attend

Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

Accomplishing EDC (Continued)

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Increase the number of diabetes educators, certified diabetes educators, community health workers (CHWs), and certified diabetes education sites in Indiana

Recruit physicians

• Improve adherence to standards of care for people with diabetes

• Improve provider data collection and data analysis skills

• Improve use of electronic health records (EHRs)

• Educate provider staff

• Provide technical assistance to interested practitioners

Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

Accomplishing EDC (Continued)

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Recruit local and state partners and stakeholders

• Mutual disseminate of aligned tools, resources and program information

• Collaborate on the train-the-trainer and sustainability plans

Utilize Data

• QIN‐QIO will obtain clinical results of diabetes measures for 10% of Medicare beneficiaries who complete DSME

• CMS will match the data to Medicare claims data

• Allows for following beneficiaries’ data longitudinally over time

Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

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DSME Program

Diabetes Education and Empowerment Program (DEEP)

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University of Illinois at Chicago Midwest Latino Health Research Training and Policy Center

Developed to provide community residents with the tools to better manage their diabetes in order to reduce complications and lead healthier, longer lives. Based on principles of empowerment and adult education

Two Components

• Train-the-Trainer

• Three day-workshop

• Training stresses development of skills and knowledge related to diabetes by using interactive group activities

• Diabetes Patient Education

• DSME content divided into eight modules

Revised every two years (or as needed) to reflect the most current knowledge and information.

DEEP DSME Modules

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Monitoring Your Body

• Teach signs, symptoms, and monitoring of hypoglycemia and hyperglycemia and ways to monitor

• Teach diabetes management using glucose meter

Get Up and Move: Diabetes and Exercise

• Teaching physical activity as a method to control diabetes

• Making time for regular physical activity

Understanding the Human Body

• Exercises to establish trust and solidarity

• Systems and organs diabetes affects

• Description of what diabetes does to the Organs

What is Diabetes

• Diabetes defined

• Risk factors

• Signs and symptoms of diabetes

DEEP DSME Modules (Continued)

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Introduction to Medications

• Medications for control of diabetes, hypertension and cholesterol

• Medications actions, cautions, and side effects

• Self-management care guides

Coping with Diabetes

• Emotional aspects of diabetes (e.g., stress, depression and patients’ rights)

• Involving family and friends in care management

Nutrition

• Basic nutritional concepts

• How to read food labels (calories) carbohydrates, salt, and trans fats

• MyPlate method and food portions

• Exercises on salt and fat hidden in food

Preventing Diabetes Complications

• Smoking and circulatory problems

• The importance of daily foot care

• Reporting abnormalities to providers

• Visiting different specialists for prevention and control

DEEP Goals

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Improve and maintain quality of life

Prevent complications and disabilities

Improve eating habits and maintain adequate nutrition

Increase physical activity

Develop self-care skills

Improve patient and health care team relations

Increase use of available resources

DEEP - Methodology & Teaching

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Teaching Strategies

• Brainstorming

• Problem-solving

• Feed-back

• Demonstrations

• Modeling

• Role-playing

Methodology Based

• National medical care and self-care education guidelines

• Participatory education

• Adult education principles

• Group work techniques

• Progress towards a healthy lifestyle

• Role-playing

DEEP – Target Audiences

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DEEP is directed towards:

• Persons with diabetes

• Their relatives and caregivers

DEEP is written to be implemented by:

• Professionals who care for persons with diabetes

• Community Health Workers

DEEP – Participatory Education

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Adults learn best when they are actively engaged and when they learn by doing

Participants learn through discussion and experience

Uses the facilitator concept

Responds to needs of the group

Group involvement for planning and action

• Facilitator and students set goals

DEEP - Participatory Education (Continued)

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Learning:

WE REMEMBER:

of what we read

of what we hear

of what we see

of what we see and hear

of what we do

Activity Example

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Visual representation of the amount of sugar and fat in a typical diet.

Photo taken by Nancy Semrau, Quality Improvement Advisor

DEEP – Flexibility

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Modules can be covered in any order in 6 sessions without compromising the program’s integrity

Two trainers for each workshop is recommended but not required

Designed to be adapted to the needs and abilities of the organization and group

• Missed sessions can be made up at the discretion of the trainer and participants

• Supplies & materials can be made or purchased

Becoming a Part of EDC

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Person with diabetes or pre-diabetes

• Attend diabetes education classes when available in the community

• Encourage others to attend diabetes education classes

• Ask community leaders to volunteer a site for education in the community

Partners and Stakeholders

• Contact the QIN-QIO to discuss potential collaborations related to increasing diabetes educators and/or diabetes education sites and cross spreading aligned tools, information and resources

Becoming a Part of EDC (Continued)

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Providers

• Volunteer to become an education site

• Refer patients to the free Medicare diabetes education classes

• Encourage diabetics and pre-diabetics to attend available classes

• Contact us to learn more about free QIN-QIO assistance in becoming a certified diabetes education site for Medicare billing and training appropriate staff to facilitate the DEEP DSME classes

Becoming a Part of EDC (Continued)

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CDE and Coordinating Body/Local Networking Group Collaborations

• Encourage health care providers to take the Certified Diabetes Educator (CDE) exam

• Volunteer to be a “CDE Champion” and speak on QIN hosted webinars

• Volunteer to be a “CDE Champion” for QIN hosted CDE exam study groups

Collaboration ideas are always welcome!

Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

Presentation Acronyms

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AADE American Association of Diabetes Educators

ABCS Aspirin, Blood Pressure, Cholesterol, and Smoking

ADA American Diabetes Association

BFCC-QIO Beneficiary and Family-Centered Care-Quality Improvement

Organization

CDE Certified Diabetes Educator

CHW Community Health Worker

CMS The Centers for Medicare & Medicaid Services

DEEP Diabetes Education and Empowerment Program

DSME Diabetes Self-Management Education

EDC Everyone With Diabetes Counts

EHR Electronic Health Record

Presentation Acronyms (Continued)

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HAI Healthcare Associated Infections

HHA Home Health Agency

HHQI Home Health Quality Improvement

HHS Department for Health and Human Services

HIT Health Information Technology

LAN Learning and Action Network

PQRS Physician Quality Reporting System

QI Quality Improvement

QIN-QIO Quality Innovation Network-Quality Improvement Organization

QIO Quality Improvement Organization

REC Regional Extension Center

SoW Scope of Work

For More Information

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Visit new Website for details

www.atomAlliance.org

Indiana atom Alliance Team

This material was prepared by the atom Alliance, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO), coordinated by Qsource for Tennessee, Kentucky, Indiana, Mississippi and Alabama, under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Content presented does not necessarily reflect CMS policy 14.A1.08.009

Angela GoodeQuality Improvement Advisor317-670-6407agoode@qsource.org

Cathie Pritchard, LPN, RHITQuality Improvement Advisor765-505-3529cpitchard@qsource.org

Deborah Garrison-Downey, MSHE/MBA-SSGAHIT Specialist317-646-0201ddowney@qsource.org

Don Gettinger Quality Data Reporting Manager812-243-0847dgettinger@qsource.org

Jill Peterson, RN, CRRN Quality Improvement Advisor812-562-0006jpeterson@qsource.org

Jean Brizzi, RHIAHIT Specialist219-302-1458jbrizzi@qsource.org

Sharon Barclay, RN, MSNQuality Improvement Advisor317-646-0887sbarclay@qsource.org