Evidence-based diabetes self-management education with ongoing support (DSMES) leads to better self-management and outcomes.1 However, studies show only 2-7% utilization of diabetes self-management education among Medicare beneficiaries and commercially-insured Americans.2,3 One reason for low utilization is many people in the U.S. do not have a quality, reimbursable, AADE-accredited or ADA-recognized DSMES program, or any DSMES program, within their geographic reach.
What is EDC and where is it offered?
Everyone with Diabetes Counts (EDC) provides access to evidence-based, peer-led DSMES in rural settings and among underserved minority populations. Instructors of EDC 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 racial/ethnic 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.
EDC 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 Beneficiaries?
The target population for EDC incluces Medicare beneficiaries and those receiving both Medicare and Medicaid that have diabetes and are members of underserved minority and rural populations. 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 population.
Who can partner with EDC?
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 underserved minority and rural populations, Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs)
- Community hospitals in 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
- Local American Association of Diabetes Educators (AADE) chapters and other allied health associations
- Post-secondary schools of allied health, such as nursing, pharmacy, and dietetics
- State medical associations/societies
How does EDC help people with diabetes?
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, maintaining dental/oral health, undergoing regular eyes exams, and seeing their physician at least twice a year; and how to self-monitor blood sugars and perform self foot exams daily. Classes are held in the communities at sites such as libraries, schools, churches, pharmacies, and grocery stores.
How does EDC help physician practices?
By having a greater pool of their patients receive DSMES, physicians should see improved clinical and behavioral measures in their patients 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 in improving cardiac health, coordinating prevention through meaningful use of Health Information Technology, and implementing the CMS Quality Payment Program.
How does EDC help future CDEs?
CMS also acknowledges the expertise and shortage of Certified Diabetes Educators (CDEs) by requiring QIOs to facilitate increasing the numbers of CDEs in each state. QIO staff can refer clinicians in the communities of interest to the National Certification Board for Diabetes Educators (NCBDE) CDE eligibility requirements, and directly provide contact hours needed as part of these requirements by inviting them to teach in EDC DSMES classes. Some states’ QIO 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, EDC allows these emerging clinicians and potential future CDEs hands-on exposure to the specialty.
How does EDC ensure quality?
Each state’s QIO has a professional quality improvement (QI) team whereby one or more of the team members becomes a trainer of an evidence-based DSMES 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 DSMES curriculum they choose in order to maintain fidelity of the programs they oversee in their state. QIOs use innovative methods to foster engagement from the community, tailor the DSMES 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.
How is EDC to be sustained?
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, 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.
- Pillay J, et al. Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis. Annals of Internal Medicine 2015.
- 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.
- 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 EDC, please visit qioprogram.org/EDC.
If you are interested in partnering with EDC in your state or region, go to qioprogram.org.
Click on Locate Your QIO. Under Quality Innovation Network (QIN)-QIOs, click on View Map.
Lastly, hover over your state to see the QIN name and toll-free phone number.