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Evidence-Based Diabetes Management September 2018

Is It Time to Remodel Diabetes Self-Management Education and Support?

Hope S. Warshaw, MMSc, RD, CDE, BC-ADM
A former president of the American Association of Diabetes Educators addresses the need to remodel diabetes self-management education and support, to create a reimbursement system that better meets the needs of today's providers and patients. 
Two currently available diabetes care digital health solutions from for-profit entities, One Drop and Livongo, have received DSMES recognition (ADA)19 or accreditation (AADE),20 respectively. However, neither presently bills Medicare for its service because of lack of coverage for online platforms or virtual DSMES. Another digital health solution entity, Welldoc, has licensed AADE’s DSMES curriculum and has integrated it into its BlueStar FDA-cleared mobile medical app within a 12-week patient journey,21 and translated into Spanish.

Although the hurdles of reimbursement and coverage of services will not disappear quickly, the evolution to new models of care and the increased willingness of private payers and Medicare to implement and allow billing for connected care solutions will assist this transition. In recent years, even Medicare is revising previously rigid definitions of telehealth and adding new codes to allow for services like chronic care management (Current Procedural Terminology [CPT] code 99490)22 and remote patient monitoring, including glucose monitoring (unbundled CPT code 99091).23 Using remote patient monitoring is considered an improvement activity under the Medicare Merit-based Incentive Payment System. As part of the 2018 federal budget agreement, Medicare will make additional changes to its telehealth and telemedicine regulations.24 In addition, the CMS proposed 2019 Medicare Physician Fee Schedule pushes the envelope of reimbursement for telehealth and remote patient monitoring even further.25

In conclusion, the answer to the central question posed here is yes. It is time to remodel DSMES. This includes revamping the design of the Medicare benefit and the payment structure for coverage to better mesh with the current and impending needs of healthcare delivery and primary care providers. More important, we need innovative and successful models of care that meet the needs of people with these conditions and their caregivers. Reflexively, these changes will necessitate changes in the roles of diabetes educators and perhaps lead to a more accurate name for these increasingly valuable healthcare providers, to improve diabetes outcomes while achieving costs savings.

Author Information

Hope S. Warshaw, MMSc, RD, CDE, BC-ADM, owns Hope Warshaw Associates, LLC, a diabetes and nutrition consultancy based in Asheville, North Carolina. She served as president of AADE during 2016.


Warshaw serves as a consultant to Welldoc, Inc.
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