Q&A with Sue Fleck: Everyone with Diabetes Counts

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Photo of Sue Fleck, CMS
Sue Fleck, CMS

Sue Fleck, RN, MMHS is the subject matter expert (SME) for the Everyone with Diabetes Counts (EDC) program at the Centers for Medicare & Medicaid Services (CMS). An 18-year employee of CMS, she has expertise in quality improvement, operations and strategic management, risk management, health policy, health information technology, utilization review, hospital administration, medical malpractice claims investigation and nursing. Fleck’s previous roles at CMS include serving as a project officer and contracting officer’s representative for four Quality Improvement Organization (QIO) contracts and as a government task leader (GTL) and SME for three special innovation projects. She also has served as a GTL for various other CMS initiatives. She holds a Diploma in Nursing from Massachusetts General Hospital in Boston, a Bachelor of Science degree in Health Care Administration from Emmanuel College in Boston, and a Master of Management in Human Services degree from Brandeis University in Waltham, Massachusetts.

CMS' Everyone with Diabetes Counts (EDC) program was first established in 2007 and expanded nationwide in 2014. How is the program shaping up in the final months of 2017?

Over the past 10 years, EDC has expanded nationally and now also includes Puerto Rico and the U.S. Virgin Islands. In the last decade, QIN-QIOs have excelled at developing critical partnerships that have helped accomplish EDC’s goal: improving health equity by improving health literacy and quality of care among Medicare beneficiaries with pre-diabetes and diabetes, through knowledge empowerment. This empowerment has enabled beneficiaries to become active participants in their care.

Presently, QIN-QIOs are concentrating on sustainability planning. This involves increasing the numbers of certified diabetes educators (CDEs) in each state and increasing the numbers of American Diabetes Association (ADA)-recognized, and American Association of Diabetes Educators (AADE)-accredited diabetes education programs in each state.  

What are some of the biggest lessons learned since the program’s inception?

We’ve learned a lot over the years, but four lessons stick out in my mind. First, no two communities are alike. What works in one community does not necessarily work in another similar community. We can utilize high-level concepts, but they must be “tweaked” and tailor-made to meet the needs of each community and population. This is not a one-size-fits-all program.

Second, engaging beneficiaries, providers, partners and stakeholders takes time and persistence. To paraphrase a famous baseball movie: just because we build it doesn’t mean they will come. Today, everyone has multiple conflicting priorities, which can make it challenging to encourage people to participate in this program.

A third lesson is to not take anything for granted. Working with communities and underserved populations has many ups and downs; people change jobs, lose funding and encounter circumstances beyond their control. Be prepared for constant change. But also remember that working at the community level, directly with beneficiaries, is some of the most rewarding work anyone will experience. It enables one to see the many ongoing positive changes that occur and to be an active participant in the change process.

Lastly, this is not a solo program. Improving the quality of health care involves many stakeholders and partners at the national, state, community, health care provider and beneficiary levels, in order to have an impact on reducing both diabetes rates and the risk of complications for those people who already have diabetes.

Are there any recent success stories you would like to highlight?

Through partnerships with senior centers, QIN-QIOs have been able to provide diabetes self-management education classes in 14 different languages that are taught by lay educators to beneficiaries in locations with no education resources. This reflects the diversity of the Medicare beneficiaries’ populations that EDC is attempting to reach.

What have been some of your successful strategies in reaching rural and minority beneficiaries with diabetes?

Our state and local partnerships have shown the most gains in reaching rural and minority beneficiary communities. QIN-QIOs are partnering with state health departments, large health plans/practices, large rural health care systems and critical access hospitals. They are also working with Federally Qualified Health Centers (FQHCs) and Area Agencies on Aging (AAAs), as well as hosting classes at sites in communities frequented by Medicare beneficiaries and in affordable housing complexes.

What can other areas of the QIO Program learn from the work being done on diabetes prevention and self-management?

Prevention, specifically through education, is critical if we are going to make any substantial changes to improve the quality of health care. The information obtained from beneficiaries through the EDC Program shows that 53 percent of respondents reported having diabetes for four or more years; and 61 percent of respondents reported never having received diabetes education. There is much room for improvement in the domain of education. 

Is there anything else you would like QIO News readers to know?

As we observe another National Diabetes Month, I encourage everyone to get involved in their communities’ efforts to help improve the lives of people living with diabetes. This could mean anything from driving older neighbors to Diabetes Self-Management Education classes to sharing tips from the EDC program or the ADA websites.