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In a changing health care landscape, diabetes educators hold unique advantage
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BALTIMORE — A changing health care climate that emphasizes value and the prevention of complications over procedure-based care is creating new opportunities for certified diabetes educators and specialists, who are positioned better than most to put coaching and care management skills to work in new ways, according to a speaker here.
“Given the changes in health care, in particular, shifting from fee-for-service to value-based care, diabetes educators have a number of amazing opportunities to redefine their roles,” Robert Gabbay, MD, PhD, FACP, chief medical officer and senior vice president at Joslin Diabetes Center in Boston, told Endocrine Today. “Amongst other things, they can position themselves as the experts to help with challenging patients as care managers. The broader climate of health care change favors a more critical role for them in so many ways.”
Recent changes
Recent changes in reimbursement formulas for providers are about to revolutionize diabetes care, Gabbay said during a keynote presentation at the American Association of Diabetes Educators annual meeting. Those changes include the 2015 Medicare Access and CHIP Reauthorization Act, or MACRA, which combines parts of three incentive programs into one known as the Merit-based Incentive Payment System, or MIPS. MIPS, Gabbay said, is a complex formula that augments the fee-for-service model with an incentive for improved care and performance. Every provider gets a MIPS score based on four categories — quality, resource utilization, engagement and practice improvement activities and use of the electronic health record — that can determine the provider’s rate of reimbursement. The MACRA legislation, Gabbay said, fundamentally changed the way providers are compensated for the first time in 25 years.
Additionally, accountable care organizations, or ACOs, are shifting responsibility for a population of patients to a health system, providers of whom are incentivized to deliver better care for that patient group.
“You might say, what does all this have to do with diabetes?” Gabbay said. “Well, it turns out that many of the quality measures (for the MIPS score) are diabetes measures. They’re not obscure measures, they are measures that you know.”
Gabbay said the reimbursement changes elevate diabetes in the health care system and provide an incentive for better diabetes care — and an opportunity for the CDE.
“You’re relatively inexpensive for the system and, therefore, you are high value,” Gabbay said during his presentation. “What we need to do is reposition who we are recognized as within the health care system — as the people who really can provide value. These reimbursement changes that I’m talking about? They’re not happening in the future. They are happening right now.”
New roles for CDEs
In a health care landscape that is shifting to value-based reimbursement, it is important to reposition the CDE to take advantage of those changes, Gabbay said.
“There will always be a role for education, but there will be lots of new ways to provide education at scale,” Gabbay said. “At the same time, there is a huge need for self-management support. Knowledge is necessary, but not sufficient. It’s really thinking about using evidence-based methods to change behaviors. It’s valuable for diabetes, but also for all chronic illnesses.”
Gabbay outlined three new roles for the CDE to best utilize the skills of self-management education, coaching and decision support, including:
- Practice coaching: The CDE can use his or her self-management skills at the practice level to engage that practice and help them implement change, using the skills of goal setting and empowerment, essentially becoming the “quality person” of the practice.
- Care management: A high-level intervention that is added to “planned care” by practices. The CDE should position himself or herself as the “go-to” person for high-risk patients who are not responding to a treatment plan, reaching out to the care manager, if there is one in place, and letting that person know that, as the CDE, they have the resources needed to best meet these patients’ needs.
- Augmenting digital care: Reach out to digital therapeutic companies, who are looking for real people to augment their platforms. “If you talk to these companies ... they’re all desperately looking for people like you, that can augment the digital approach and have someone a patient can talk to in order to go that last mile,” Gabbay said. “And that is another huge opportunity that will only increase over time.”
“I’m not saying you should be quitting your day jobs tomorrow, but these are things to be aware of,” Gabbay said. “Even if you don’t engage full time in any of these, they may be things that you can add to your current practice.”
There are important changes CDE can make today, Gabbay said. Those include making a “mental shift” toward being responsible for a population, even if that population is the group of patients they see, and work to measure data for those patients and begin thinking about how to risk stratify them. CDEs should also market themselves as the “go-to person” for high-risk patients with diabetes, Gabbay said, look for opportunities to partner with digital health platforms, and most important, be proactive.
“You undoubtedly bring that value, but they don’t always know it,” Gabbay said. “I would argue that, in so many ways, there has never been a better time for diabetes educators and specialists like you. These changes in reimbursement that I described make you so much more valuable to the system. Once they realize what you do, they will be beating a path to your door.” – by Regina Schaffer
Reference:
Gabbay R. The changing health care environment — finding the right it for the diabetes specialist. Presented at: American Association of Diabetes Educators; Aug. 17-20, 2018; Baltimore.
Disclosure: Gabbay reports he serves on advisory boards for Health Reveal, Lark and Onduo.