Diabetes is a serious public health concern in the United States. According to the National Diabetes Statistics Report, 2014 from the Centers for Disease Control and Prevention, it affects 29.1 million people, or approximately 9.3 percent of the population. There are 21.0 million people diagnosed with diabetes, and an estimated 8.1 million people who have the disease but are undiagnosed. In addition to the 29.1 million people with diabetes, another 86 million are estimated to have pre diabetes, a condition that puts people at risk for the disease. Among U.S. residents aged 65 and older, 11.8 million - or 26 percent - were diagnosed with diabetes in 2010 (http://www.diabetes.org/diabetes-basics/statistics).
Health disparities exist among racial/ethnic and other minority populations. African American adults are 1.8 percent more likely than non-Hispanic white adults to have been diagnosed with diabetes by a physician. American Indian/Alaska Native adults are 2.4 times as likely as white adults to be diagnosed with diabetes. Hispanic adults are 1.7 times more likely than non-Hispanic white adults to have been diagnosed with diabetes by a physician. Native Hawaiians/Pacific Islanders are 2.4 times more likely to be diagnosed with diabetes as the white population (Source: U.S. Department of Health and Human Services Office of Minority Health. Source: CDC 2016. Summary Health Statistics: National Health Interview Survey: 2014). Diabetes is more common among people who live in rural counties versus urban areas (16.7% versus 13.5%) (Source: Federal Office of Rural Health Policy, 2011 statistics).
In response to these statistics, the Centers for Medicare & Medicaid Services (CMS) launched Everyone with Diabetes Counts (EDC), a diabetes self-management education program offering evidence-based diabetes self-management training. The program is designed to improve health outcomes and quality of life among disparate and underserved Medicare populations. It is administered by 14 Quality Innovation Network (QIN)-Quality Improvement Organizations (QIOs), which are mandated to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries.
Everyone with Diabetes Counts (EDC) Goals and Program History
Everyone with Diabetes Counts (EDC) is a disparity reduction program. The goals of the program are to:
- Improve health equity by improving health literacy and quality of care among people with diabetes and pre-diabetes, including Medicare beneficiaries and individuals dually eligible for both Medicare and Medicaid. Accomplish this through knowledge empowerment, enabling patients to become engaged and active participants in their care.
- Target Medicare beneficiaries from medically underserved racial/ethnic minority and/or rural populations.
- Engage beneficiaries and providers to decrease the disparity in diabetes testing by improving eye exams, foot exams, blood pressure control, weight control and testing for HbA1c and lipids.
- Improve actual clinical outcomes of the above measures.
- Facilitate sustainable diabetes education resources by engaging public/private/agency/organization partnerships at the community, state and national level.
EDC has five components:
1.) Recruitment and education of beneficiaries
QIN-QIOs and their partners recruit, enroll and teach beneficiaries using evidence-based Diabetes Self-Management Education (DSMES*) curricula.
For the purposes of this website, we are differentiating between DSME and Diabetes Self-Management Training (DSMT). DSMT is reimbursable by Medicare, while DSME is not.
Examples of DSME curricula include the Stanford University model or the Diabetes Education Empowerment Program (DEEP) from the University of Illinois, Chicago (UIC). Stanford and DEEP classes are taught by diabetes trainers (lay persons, QIO staff, or community health workers (CHWs) and consist of weekly group sessions over a six week-week period. The curriculum teaches participants to effectively self-manage their diabetes through nutrition, exercise, self-monitoring, diabetes medications and community resources and support, among other important topics. There is no cost to participate.
2.) Recruitment and education of physician practices and staff
QIN-QIOs recruit health care providers to improve their adherence to standards of care for people with diabetes, improve their data collection and data analysis skills, and educate provider staff. Providers may include physician practices, clinics, Medicare Advantage Plans and Federally Qualified Health Care Centers (FQHCs).
3.) Recruitment of partners/stakeholders
The success of the EDC programs relies on partnerships formed to collectively reduce health disparities and improve health outcomes. QIN-QIO partnerships include federal, state, and local agencies, universities, communities, and private businesses.
4.) Data collection and analysis
QIN-QIOs obtain clinical results of diabetes measures for 10 percent of beneficiaries who complete DSME. They then match this information to Medicare claims data, tracking information from DSME graduates over time.
5.) Sustainability planning/Implementation
QIN-QIOs develop and implement a sustainability plan to increase the numbers of certified diabetes educators (CDE) in their state; develop train-the-trainer programs; facilitate the use of community health workers (CHWs) in their state; and increase the numbers of AADE-accredited or ADA-recognized diabetes education programs in their state. Completing one of these two processes allows programs to bill for the Medicare diabetes self-management training (DSMT) benefit.
EDC began in 2007 as a single-state pilot project in Florida. Based on key findings from this pilot, the project was expanded between August 2008 and July 2012 to include Maryland, Washington, D.C., Louisiana, Georgia, New York, Mississippi, the U.S. Virgin Islands, and specific regions in Texas. Findings from these initial projects were featured in an article in Family and Community Health. Read More
In August 2014, CMS further expanded the EDC program to all 50 states and U.S. territories covered by the Medicare program.
*When EDC began, this type of diabetes education was called DSME. In 2017, the AADE Standards have been updated to DSMES, diabetes self-management education and support, in order to reflect the aim and value of ongoing support and multiple services. For more information, see https://www.diabeteseducator.org/practice/practice-documents/national-standards-for-dsmes.