1. DEBORAH F. CHRISTIAN, PA-C
Diabetes Self-Management Education Program Manager
Health Services Advisory Group (HSAG)
Everyone with Diabetes Counts:
Diabetes Self-Management Education
2. HSAG: Your Partner in Healthcare Quality
• HSAG is the Medicare Quality Innovation
Network-Quality Improvement Organization
(QIN-QIO) for California, Arizona, Florida, Ohio,
and the U.S. Virgin Islands.
• QIN-QIOs in every state and territory are united in
a network administered by the Centers for
Medicare & Medicaid Services (CMS).
• The QIN-QIO program is the largest federal
program dedicated to improving health quality at
the community level.
3. HSAG’s QIN-QIO Responsibility
HSAG is the Medicare QIN-QIO for Arizona, California,
Florida, Ohio, and the U.S. Virgin Islands.
Nearly 25 percent of the
nation’s Medicare beneficiaries
4. QIO Task Areas
Patient is at the
center of care.
5. Everyone with Diabetes Counts (EDC)
• Diabetes was the seventh leading cause of death in the US
• Nearly 30 million Americans have diabetes.
• 8.1 million Americans are undiagnosed
• Upwards of 86 million Americans prediabetes
• Among the Older Adults
– More than 25 percent of Americans age 65 and older have diabetes.
– 51 percent are estimated to have pre-diabetes.
• 11th Scope of Work
– Reduce health disparities
– Initiative: Everyone with Diabetes Counts or EDC
– Economic burden $245 billion annually (2012)
Data Source: CDC National Diabetes Statistics Report, 2014, available at:
6. The Burden of Diabetes in California
• Over 4 million Californians have diabetes (13.4% of adult
• Over 11 million Californians have pre-diabetes (38% of
• Diabetes costs an estimated $37.1 billion / year
– Direct medical expenses $27.6 billion in 2012
– Indirect cost $9.5 billion in 2012
Data Source: Centers for Disease Control & Prevention (CDC)
7. • African Americans
• American Indians/Native
• Asians/Pacific Islanders
• People living in rural
• California Incidence
– AA & Hispanics: 14%
– Asian population
• Filipino: 15%
• South Asian: 16%
• Pacific Islanders: 18%
Disparities Exist in Diabetes Care
8. HSAG’s Role in EDC
• Increase adoption and implementation of diabetes
self-management education (DSME)
– Diabetes Self-Management Program, Stanford University
– Project Dulce, Scripps Health Whittier Diabetes Institute
– Diabetes Empowerment Education Program™ (DEEP),
University of Illinois at Chicago (UIC)
• Train organizations & individuals statewide to offer
• Provide assistance to organizations offering DSME
• Impact more than 7,000 Medicare beneficiaries with
diabetes or pre-diabetes
9. Goals and Target Population
– Reduce diabetes care disparities
– Prevent and/or reduce adverse health outcomes
related to diabetes
– Reduce risk factors associated with diabetes
– Increase self-management skills
– Facilitate short- and long-term behavioral change
Special consideration for:
– Includes low-health literacy and low-literacy individuals
– Evidence-based program
– Six weekly workshops
– Each class is two hours long
– Taught by one certified DEEP Peer Educator
– Can be delivered in any language
• Interactive, hands-on, group learning activities, and games,
including visual aids and demonstrations
11. DEEP Modules
• Diabetes risk factors and complications
• Physical activity
• Use of the glucose meter
• Building partnerships with diabetes healthcare team
• Psychosocial effects of illness
• Problem-solving strategies
• How to access community diabetes resources
12. “Tell me and I forget,
teach me and I may remember,
involve me and I learn.”
13. Why DEEP Works
• Incorporates adult education,
empowerment principles, and
• Speeds changes in knowledge and
behavioral and clinical indicators
• Meets the needs of
participants in real time
• Connects the dots in easy-to-
16. Visualizing Fats and Carbohydrates
Cheeseburger Cola Soda Fries
Total Fat 24 g = 6 teaspoons 0 g 29 g = 7 teaspoons
Total Sodium 897 mg = .16 teaspoons 15 mg = negligible 328 mg = .06 teaspoons
Total Carbs 39 g = 8 teaspoons 35 g = 7 teaspoons 63 g = 13 teaspoons
Total Fat, Salt, and Carbs
13 teaspoons of lard
½ teaspoon of sodium
28 teaspoons of sugar
17. • Certified peer educator/ workshop leader
• Only one leader required to lead workshop
• Allows for make-up sessions
Program Delivery Method
18. Training Requirements
• Attend a three-day, train-the-
trainer workshop, and receive
certification to facilitate DEEP
workshops as a peer educator.
• Peer educator training is taught
by lead trainers.
• Lead trainer training is taught by
• No-cost training offered.
19. Goals are Outcomes-Based and Data-Driven
• HSAG will help track and analyze data.
• HSAG tracks pre- and post-activation measures.
• HSAG tracks clinical outcomes for 10 percent of
– Blood pressure
– Foot exams
– Eye exams
20. • 1,124 Medicare beneficiaries with diabetes or pre-diabetes
graduated from a DSME workshop.
• 470 Medicare beneficiaries completed both the Pre- and
Post-Patient Activation Surveys.
– Male: 27 percent
– Female: 73 percent
• Average age: 72
• Reported Health Conditions
– High Blood Pressure: 61 percent
– High Cholesterol: 52 percent
– Arthritis: 35 percent
– Eye Disease: 18 percent
– Heart Disease: 14 percent
– Lung Disease: 5 percent
(January 2015 to April 2016)
22. Pre- and Post-Patient Activation Survey
• 14 total questions
– 4 questions: Diabetes knowledge
– 5 questions: Coping with diabetes
– 5 questions: Self-care methods
• Administered during first week and then again at
23. Diabetes Knowledge
97% 94% 92% 90%
affects blood sugar
How to take care of
What is a retinal
break down in body
27. Program Costs
• Organizational License: $600/five-year license
• Peer Educator Certification: $100/three-year certification
• Training Cost (for UIC):
– Peer educator training fee: $800 per person
– Off-site training fee: $10,500, plus travel expenses
• Training Cost (for HSAG): None
• Participant Cost: None
28. Program Costs (cont.)
For a limited time, HSAG will provide:
• Leader training at no charge to organizations committed
to offering this program in their community.
• Materials for conducting workshops.
• Licensing and certification fees may also be provided.
• $40 per DSME completer who meets
– Medicare beneficiary (65+) and
– Has diabetes or pre-diabetes and
– Completes five of six classes
29. Will You Join Us?
• Offer DEEP internally
• Outsource DEEP to partnering organizations
• HSAG will provide training
and assistance to your
organization and your
31. This material was prepared by Health Services Advisory Group, the Medicare Quality
Improvement Organization for California, under contract with the Centers for
Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and
Human Services. The contents presented do not necessarily reflect CMS policy.
Publication No. CA-11SOW-B.2-08162016-01
Committed to improving quality of healthcare for more than 35 years
Provides quality expertise to those who deliver care and those who receive care
Engages healthcare providers, stakeholders, Medicare patients, families, and caregivers
Provides technical assistance, convenes learning and action networks, and analyzes data for improvement
Drives quality by providing technical assistance, convening LANs, collecting and analyzing data for improvement
Works on initiatives to improve patient safety, reduce harm, improve clinical care
Engages healthcare providers, stakeholders, and beneficiaries to improve health quality, efficiency, and value.
25 percent of our nation’s Medicare population.
45 percent of our nation’s Medicaid population.
19 percent of our nation's dialysis population.
Reworking prescription labels; understanding food labels; lard/sugar example involves literacy, numeracy and nutrition literacy (carb/sugar/salt- one of the hardest for people to learn; teach how we teach it. how we try to meet the person where they are