A Diabetes Care Q&A with Susan Fleck

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Sue Fleck, CMS
Sue Fleck, CMS

Susan 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. Ms. 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.

Q. Last year, the CMS QIO Program launched a new national initiative to help patients, families, providers and communities address the diabetes problem. How is that work going?

From a national standpoint, we are ahead of goals on all measures, including the numbers of providers recruited, numbers of beneficiaries completing diabetes self-management education (DSME) classes, and numbers of beneficiaries from whom we have collected clinical data. It has been a favorable experience thus far for both providers and beneficiaries, and a number of their stories have been featured in videos produced by our nationwide Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs). In many states, there isn’t an infrastructure for diabetes education programs, so QIN-QIOs have been a catalyst for the formation of coalitions, bringing together the necessary infrastructure and resources. It is important to point out that QIN-QIOs are reducing disparities in diabetes care by focusing their efforts on beneficiaries who belong to particular minority groups, or who live in rural areas.

Q. What makes CMS’ Everyone with Diabetes Counts (EDC) program successful in helping Medicare beneficiaries manage their diabetes?

EDC classes are taught in communities where people actually live. In the past, DSME classes were located too far from peoples’ homes; transportation and other challenges got in the way. Also, whenever possible, classes are taught in the native language of class participants in order to promote cultural competency and health literacy; previously, many participants did not understand what they were being taught. Finally, QIN-QIOs help ensure the long-term viability of diabetes education by working with community partners to develop sustainable education resources.

Q. How are QIN-QIOs collaborating with community partners in their diabetes care activities?

A number of community partners host the DSME classes, including faith-based organizations, libraries, grocery stores, pharmacies, schools and colleges. Also, community health workers (CHWs) can be trained in the diabetes education curriculum – either the Stanford Diabetes Self-Management Program or the Diabetes Empowerment Education Program (DEEP). This requires QIN-QIOs to work with community partners to register CHWs for classes and train them. QIN-QIOs also are working with Certified Diabetes Educator® (CDE) local networking groups, and assisting with pre-CDE exam study groups, in order to facilitate increased numbers of licensed health care providers taking the CDE exam, which will result in increasing the numbers of CDEs nationally. Finally, QIN-QIOs are working with community-based hospitals, federally qualified health centers (FQHCs), rural health clinics (RHCs), accountable care organizations (ACOs), and pharmacies to develop sustainable diabetes education programs.

Q. What types of clinical improvements will you be looking for in beneficiaries’ health over the coming years?

One of our goals is to ensure that beneficiaries who are not receiving the recommended diabetes testing, start receiving the testing. For those who already are undergoing these routine tests, the goal is to help them improve their results, such as improvements in lipids, hemoglobin A1C, eye exams, foot exams, blood pressure and weight. 

Q. How does the QIN-QIOs’ diabetes care work tie in with the QIO Program’s other areas of focus? 

There is a lot of cross-over and synergy between the EDC diabetes program, cardiac health, electronic health records (EHRs), and care coordination activities. QIN-QIOs can recruit the same physicians/​providers to pursue improvements in both diabetes care and cardiac health. Many people with diabetes also have cardiac conditions or other chronic conditions, so it makes sense to tie that work together. The QIN-QIOs’ efforts to develop sustainable diabetes education resources helps to improve care coordination by potentially decreasing hospital readmissions for diabetes complications; and their assistance with optimizing EHR usage helps providers notify patients about recommended tests, as well as track the frequency and results of these tests.

Q. Anything else you would like QIO News readers to know?

Through EDC, the QIN-QIO Program distinctly supports the Three-Part Aim: improving the individual experience of care, improving the health of populations, and reducing the per capita costs of care for populations. QIN-QIOs participating in EDC are providing improved individual experiences of care through DSME classes; improving the health of populations by facilitating improved clinical outcome data; and demonstrating how these efforts reduce health care costs for populations by matching beneficiary clinical data results to Medicare claims data. This is a powerful combination of efforts helping to improve the quality of life for people living with diabetes. You can read more about QIN-QIOs’ EDC work on the QIO Program website.