Diabetes Care and Education Specialists Help Health Systems Achieve Quadruple Aim with Improved Outcomes, Lower Costs

Integrating diabetes care and education specialists into diabetes care delivery models helps health systems achieve the quadruple aim - quality care, improved patient experience, reduced cost of care and improved provider experience - according to an article recently published in Clinical Diabetes, the journal of the American Diabetes Association. The strategy has been proven to reduce costs and improve outcomes in treating diabetes, a condition that affects one in 10 Americans and costs the health system more than $300 billion every year.

Diabetes self-management education and support (DSMES), provided by diabetes care and education specialists, helps people better manage their diabetes by focusing on seven self-care behaviors: healthy coping, healthy eating, being active, taking medications, monitoring, problem-solving and reducing risk. In calling for health systems to incorporate these specialists into their diabetes care delivery, the authors cite the wealth of research documenting the benefits of integration, including reduced emergency and inpatient services, lower Medicare and insurance claims, higher adoption of best-practice treatment recommendations and improved clinical outcomes, quality of life and health care utilization.

Of the more than 37 million Americans who have diabetes, one in five don't know they have the condition and another 96 million American adults - or more than one in three - have prediabetes. People with diabetes and prediabetes are at significantly higher risk for complications such as heart attack, stroke, obesity and amputation.

"Diabetes self-management education and support is about helping the person with diabetes self-manage the condition and preventing all of the complications that come with untreated or undiagnosed diabetes, which is an enormous cost to health systems," said Leslie Kolb, MBA, BSN, RN, chief science, practice and learning officer for the Association of Diabetes Care and Education Specialists (ADCES). "We know that 100% of these complications can be mitigated and, in many cases, avoided with excellent diabetes management. We are making a call to action for health systems to integrate diabetes care and education specialists into the care team to help people with diabetes live a healthier life."

DSMES services, however, remain vastly underutilized. Among people with diabetes, fewer than 5% who are Medicare beneficiaries and 6.8% of those with private insurance receive DSMES.

Because diabetes is a multifaceted issue, health care systems and providers struggle to deliver the extensive, ongoing and proactive care needed to ensure people with diabetes manage their condition most effectively. This can lead to therapeutic inertia, such as when a provider decides it's safer to prescribe additional oral medications rather than a more effective treatment such as insulin, which requires extensive monitoring to ensure a person with diabetes does not have a dangerous event such as hypoglycemia.

HealthPartners in Minneapolis integrated diabetes care and education specialists throughout its system more than 20 years ago and has never looked back. "With the complexity of diabetes management and their limited time with patients, it's difficult for clinicians to keep up with ever-evolving medications and technology," said Erin L. DaRosa, MBA, RDN, LD, CDCES, senior manager of diabetes education at HealthPartners, where 7,500 new patients received diabetes care and education last year. "We are the specialists in diabetes care, so we can make recommendations for medication and insulin adjustment, help patients start using technology and help them understand how to best manage their diabetes. One patient who has had diabetes for many years says she finally understands how to manage her care since she's consulted with a diabetes care and education specialist."

MedStar Health in Washington, D.C. and Maryland launched a telehealth pilot diabetes boot camp at three of its hospitals for people with high A1C (blood sugar) levels in 2014. The boot camp included two initial visits with diabetes care and education specialists and weekly follow-up with the nurse practitioner who is a Diabetes Care and Education Specialist for the next 12 weeks for intensive diabetes medication management and Medical Nutrition Therapy. After 90 days, A1C levels in 366 people with diabetes dropped from an average of 11.2 to 8.1, a significant improvement compared to those who did not participate in boot camp. "We had such great results, we're now deploying the program throughout our 10-hospital health care system," said Gretchen Youssef, MS, RD, CDCES, program director of MedStar Diabetes Institute, Washington, D.C. "Our primary care providers want their patients in this program to improve patient outcomes, quality of life and patient satisfaction."

Rather than replacing other providers, diabetes care and education specialists are integrated into the diabetes care team, which helps ease the primary provider's burden by providing expert and comprehensive care.

The Clinical Diabetes article notes that health systems can engage diabetes care and education specialists using the electronic health record to address and mitigate therapeutic inertia by:

• Embedding automated prompts for diabetes self-management and education services at four critical times: at diagnosis, annually and/or when not meeting treatment targets, when complicating factors develop and when transitions in life and care occur
• Tracking process metrics to assess rates of referrals to diabetes care and education specialists
• Developing treatment algorithms or decision support prompts for referrals to diabetes care and education specialists
• Risk stratifying elevated glucose (A1C) and other cardiometabolic results for diabetes care and education specialist referrals
• Identifying medication-taking processes and outcomes for referral to a diabetes care and education specialist
• Increasing referrals to telehealth education and consultation programs or digital coaching as alternatives to in-person diabetes education and support

About the Association of Diabetes Care & Education Specialists
ADCES is an interdisciplinary professional membership organization dedicated to improving prediabetes, diabetes, and cardiometabolic care through innovative education, management, and support. With more than 12,000 professional members including nurses, dietitians, pharmacists, and others, ADCES has a vast network of practitioners working to optimize care and reduce complications. ADCES supports an integrated care model that lowers the cost of care, improves experiences, and helps its members lead so better outcomes follow. Learn more at DiabetesEducator.org or visit us on Facebook or LinkedIn (Association of Diabetes Care & Education Specialists), Twitter (@ADCESdiabetes), and Instagram (@ADCESdiabetes).

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