don gettinger cms qin-qio cardiac health & everyone with diabetes counts overview sharon barclay
TRANSCRIPT
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Don Gettinger
CMS QIN-QIO Cardiac Health & Everyone With Diabetes Counts Overview
Sharon Barclay
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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.
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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
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atom Alliance
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Multi-state alliance for powerful change composed of three nonprofit, healthcare QI consulting companies.
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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
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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
Join www.millionhearts.org
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Patient Education
Key tools and resources
Health literature
Spanish translation version Many tools or patient resources
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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
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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**
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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For More Information
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Visit new Website for details
www.atomAlliance.org
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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 [email protected]
Cathie Pritchard, LPN, RHITQuality Improvement [email protected]
Deborah Garrison-Downey, MSHE/MBA-SSGAHIT [email protected]
Don Gettinger Quality Data Reporting [email protected]
Jill Peterson, RN, CRRN Quality Improvement [email protected]
Jean Brizzi, RHIAHIT [email protected]
Sharon Barclay, RN, MSNQuality Improvement [email protected]