FAQ

Evidence-based diabetes self-management education (DSME), in conjunction with ongoing support, leads to better self-management and outcomes.1 However, studies show only 2-7% utilization of DSME among Medicare and commercially-insured Americans.2,3 One reason for low utilization is that many people in the U.S. do not have a quality, reimbursable, AADE-accredited or ADA-recognized DSME program, or any DSME program, within their geographic reach.

Everyone with Diabetes Counts (EDC) provides access to DSME in rural, ethnically/racially underserved populations through evidence-based, peer-led curricula. Instructors tailor their approach and teaching methods to the learning level and culture of each community. The overall aim is to improve health equity, as diabetes prevalence is higher and complication rates are disproportionately higher among rural and minority groups. EDC is one of many Centers for Medicare & Medicaid Services (CMS) quality improvement programs across the continuum of care, aimed at improving population health and lowering overall healthcare costs. EDC is funded directly by CMS as a program, not a Medicare benefit, and is not billed to or reimbursed by Medicare, so there is no charge to participants.

The EDC Program is Medicare-focused and administered through CMS contractors, or Quality Improvement Organizations (QIOs), structured in groups of two to six states called Quality Improvement Networks (QINs). EDC is a national program, with all 50 states participating as well as Washington DC, Puerto Rico, and the U.S. Virgin Islands.

Is EDC only for Medicare recipients?

Medicare recipients and those receiving both Medicare and Medicaid with diabetes that are within rural, ethnically/racially underserved populations are the target audience. However, due to the community nature of the program, EDC may include a small percentage of other participants who hear about the program but are not included in the target populations.

Community Partners

States within each QIN are encouraged to work with existing healthcare entities to recruit referring providers and community-based organizations to find potential lay leaders and participants. Here is a composite list of some current partners among the states’ QINs:

  • Primary care practices that serve minority underserved and rural populations, Federally qualified health centers (FQHCs), and rural health clinics (RHCs)
  • Community hospitals in ethnically/racially underserved and/or rural areas
  • Accountable care organizations (ACOs)
  • Community-based private and public organizations such as Area Agencies on Aging (AAAs), faith-based organizations, health and wellness foundations, and American Diabetes Association (ADA) local offices
  • Community health workers (CHWs) and CHW associations
  • Federal, state, and local agencies, such as state health departments
  • American Association of Diabetes Educators’ local AADE chapters and other allied health associations
  • Post-secondary schools of allied health (nursing, pharmacy, dietetics)
  • State medical associations/societies

How does EDC help me?

Participants are offered six group classes, depending on which of the two main evidence-based diabetes education curricula a QIO chooses, usually over a 6-12 week period. Participants are taught very basic anatomy and nutrition, the importance of prescribed medication adherence, how to self-monitor their blood sugars, how to self-perform foot exams daily, how to maintain dental/oral health, and the importance of having regular eye exams and seeing their physician at least twice a year. Classes are held in the communities at sites such as libraries, schools, churches, pharmacies, and grocery stores.

Physician Practices

By a greater pool of their people receiving DSME, physicians should see improved clinical and behavioral measures in their people with diabetes, which directly impacts the quality of healthcare delivered and, in some instances, the financial status of their practice. Partnering with a state’s QIO can bring benefits well beyond diabetes management. Many states are combining their EDC physician recruitment with assistance to those practices in improving cardiac health, coordinating prevention through meaningful use of HIT, and helping them implement the Medicare physician value-based modifier and physician feedback reporting program.

Professionals

CMS also acknowledges the expertise and shortage of Certified Diabetes Educators (CDEs) by requiring QIN-QIOs to facilitate increasing the numbers of CDEs in each state. QIN-QIO staff can refer clinicians in the communities of interest to the National Certification Board for Diabetes Educators’ (NCBDEs’) CDE Eligibility Requirements and directly provide contact hours needed as part of these requirements by inviting them to teach in EDC DSME classes. Some states’ QIN-QIOs staff host study groups to prepare them for the CDE exam. If a student in a health field wants to gain some diabetes teaching experience, the EDC Program allows these emerging clinicians and potential future CDEs hands-on exposure to the specialty.

Quality

Each state’s QIN-QIO has a professional quality improvement (QI) team whereby one or more of the team members becomes a trainer of an evidence-based DSME curriculum to train peer leaders, which can be licensed healthcare professionals, lay persons from the community, or community health workers. The QI teams are responsible for overseeing adherence to the guidelines of the evidence-based DSME curriculum they choose, in order to maintain fidelity of the programs they oversee in their state. QIN-QIOs use innovative methods to foster engagement from the community, tailor the DSME to cultural and learning needs, and improve the quality of healthcare provided to the Medicare population. Promising and successful practices are shared with each other, with partners, and with stakeholders to continuously improve the quality of care for the Medicare population. Behavioral and clinical outcomes are being tracked.

Sustainability

QIN-QIOs can help existing AADE-accredited and ADA-recognized diabetes education programs with strategies to increase the numbers of their participants, including marketing strategies and technical assistance in correct Medicare billing procedures to ensure adequate reimbursement. Additionally, QIN-QIOs identify underserved communities with few or no diabetes education programs and seek out potential partners/stakeholders with interest in developing sustainable reimbursable programs in order to provide them with technical assistance in meeting the ADA/AADE standards. This will enable a program to be reimbursed for the Medicare diabetes self-management training (DSMT) benefit, as well as allow for potential reimbursement from other insurers.

References:

  1. Pillay J, et al. Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis. Annals of Internal Medicine 2015.
  2. Rui L, Sundar S, Lipman R, Burrows NR, Kolb LE, Rutledge S. Diabetes Self-Management Education and Training Among Privately Insured Persons with Newly Diagnosed Diabetes – United States, 2011-2012. MMWR, Nov 21, 2014: 63(46); 1045-1049. 
  3. Strawbridge LM, Lloyd JT, Meadow A, Riley GF, Howell BL. Use of Medicare’s Diabetes Self-Management Training Benefit. Health Education and Behavior. 2015 Aug; 42(4):530-8.

To learn more about the EDC Program, please visit www.qioprogram.org/EDC.

If you are interested in partnering with the EDC Program in your state or region, go to www.qioprogram.org.

Click on Locate Your QIO. Hover over QIN and click on View Map.

Lastly, hover over your state to see the QIN name and toll-free phone number.