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Diabetes Educators in Accountable Care Organizations: Meeting Quality Measures Through Diabetes Self-Management Education and Care Coordination

Mary Ann Hodorowicz, RDN, MBA, CDE, CEC
Diabetes educators are well-positioned to help accountable care organizations meet their business, healthcare, and financial goals. The emphasis on primary care in treating chronic disease calls for an increased emphasis on diabetes educators to achieve better healthcare outcomes in a cost-effective manner.
  ACOs are required to accurately report quality data that are used to assess their quality performance. In addition, an ACO participating in the MSSP will share in the Medicare cost savings it generates if it meets and reports 34 quality measures in 4 domains. A summary of the MSSP-specific measures in the 2016 quality reporting year that diabetes educators can positively influence are summarized in TABLE 1; those involving cardiovascular disease, hypertension, and depression are included, as these conditions are significant comorbidities of diabetes that educators address in DSME. The goal of implementing diabetes measures is to evaluate and improve the quality of care for PWDs cared for by an ACO. These patients, who account for a significant proportion of Medicare beneficiaries in the ACO, experience high morbidity as well as higher rates of emotional stress and depression. This leads to frequent hospital admissions, resulting in high costs for both the PWDs and the ACO. It is well documented that this vulnerable population needs efficient, coordinated, patient-centered, whole-person care management across the continuum. ACOs create infrastructures to furnish this, and promote strong provider and multidisciplinary healthcare team support—all essential ingredients for effective chronic disease management. Research shows that effective care management can lower the risk of hospital admission for PWDs.26 Diabetes educators possess what I call the S.C.R.I.P.T.s, which are required characteristics to be key members of the ACO’s healthcare teams.

S = Skills

C = Competencies

R = Resources

I = Inventiveness

P = Proficiency

T = Training

  These characteristics are especially evident in educators who have achieved the Certified Diabetes Educator (CDE) or Board Certified-Advanced Diabetes Management (BC-ADM) credential.

Diabetes Educators on the Care Coordinator Teams in ACOs

As payment models change from a FFS model to risk-sharing models that reward quality and efficiency, ACOs must strive to meet 4 key goals. These goals are actually the key drivers that impact their bottom-line financial success:

1. Reduce unnecessary, duplicate, and expensive, but preventable services in order to reduce costs

2. Maximize the patient experience

3. Maximize population health

4. Maximize revenue

  Enter, the care coordinator teams (CCTs). Many in the health industry consider these team members the most important medical professionals within a large healthcare system such as an ACO. Why? To meet these goals/drivers, consistent patient care coordination is required when patients access the comprehensive array of health services spanning all levels and intensity of care in the different stand-alone ACO entities. It is not far-fetched that 1 ACO patient will access all 7 basic service categories across the care continuum in the stages of his/her life: wellness/prevention, ambulatory care, acute hospital care, extended care, home care, outreach/community services, and transitional care. The more services accessed, the more care coordination is required to ensure that the goals of the ACO are met in the land of healthcare reform. In the pre-ACA era, care was more “reactive,” meaning, it was dispensed primarily when it was sought by the patient, not when initiated by care coordinators or providers. In the ACA era, care is much more “proactive,” meaning it is typically, and frequently, initiated by the care coordinator team to increase the patient’s health over his/her lifespan. I describe the work of the CCT as “connecting the health care dots” on behalf of the patient.

Diabetes educators understand this framework well, as DSME also requires ongoing coordination across these service categories throughout the lives of PWDs. Educators also understand the bottom-line impact of the ACO’s 4 key business drivers outlined above, as these drivers directly affect the financial success of their DSME programs.  

Diabetes educators also support and help fulfill the 3 goals of the ACA known as the “Triple Aim.” The FIGURE depicts the Triple Aim and how DSME itself supports these key goals. The ACO can thus optimize their own business goals via 2 cost-efficient initiatives: implement DSME programs within the ACO entities (especially in medical homes and physician practices), and include diabetes educators as members of the ACO’s CCTs.

  Care coordinators (CCs) are specially trained medical professionals who help patients navigate the complicated care continuum. For PWDs, reducing barriers to adherence to his/her management plan, and closing care gaps, are especially important due to the many diabetes comorbidities and life challenges these patients are likely to face.   TABLE 2 summarizes the responsibilities of CCs in large health systems such as ACOs. Diabetes educators have the training, skills, and experience to enhance the effectiveness of these teams. This is accomplished by assuming these responsibilities for patients with chronic disease and furnishing DSME for PWDs and prediabetes.

In Summary: Diabetes Educators’ Multiple Roles in ACOs

ACOs continue to transform and expand their infrastructure to address gaps in diabetes care and improve quality measures in order to maximize value-based reimbursement and increase their patient and provider base. Diabetes educators are well positioned to aid ACOs in achieving these business and financial goals. They have the skills and training to furnish cost-effective DSME, to be members of the ACO’s care coordinator teams, and to help these organizations not only meet their diabetes quality measures, but other key measures, as well. Borrowing from our industry’s often used terms to describe many interventions such as “cost-effective” and “proven,” I would ask the reader to note that diabetes educators, themselves, are “cost-effective” and “proven” to be valuable assets to large health systems that offer a wide array of medical and preventive care services.  

Disclosures

  Author information: Mary Ann Hodorowicz, RDN, MBA, CDE, CEC, is the owner of Mary Ann Hodorowicz Consulting, LLC in Palos Heights, IL. She specializes in insurance reimbursement, diabetes care and education, nutrition and health promotion for healthcare professionals, corporations, and government agencies.

  E-mail: hodorowicz@comcast.net.

  Funding Sources. None.
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