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1 Webinar Instructions Thank you for joining today, please wait while others sign in. Phone Dial-in: Access Code: # Due to the large number of participants, all lines will be muted during the call. If you want to ask a question, please type in your question into the chat box. Improving the lives of 10 million older adults by National Council on Aging 1

2 Diabetes and Chronic Disease Self-Management: Moving Towards Sustainability Speakers: Joan Hatem-Roy, Elder Services of the Merrimack Valley, Inc. Jennifer Raymond, Hebrew SeniorLife Grace Derocha, Detroit Area Agency on Aging Maria Oquendo-Scharneck, AgeOptions Timothy P. McNeill, Independent Healthcare Consultant Improving the lives of 10 million older adults by National Council on Aging 2

3 The Massachusetts Healthy Living Center of Excellence : Diabetes Self-Management Reimbursement

4 What is the Healthy Living Center of Excellence? The HLCE is in essence creating an integrated delivery system in which health care systems, community-based social services and older adults collaborate as partners to improve care and lower costs, said Jim Roosevelt, CEO of Tufts Health Plan and president of the Tufts Health Plan Foundation. With all eyes on health care reform, this new model has the potential to set the stage for national change in the way health care is delivered and embraced. ( 4

5 Diabetes Self-Management Pilot Partnership between Elder Services of the Merrimack Valley (Program Implementation) and Hebrew Senior Life (Medicare Provider) to provide DSMP Roles of Program Implementator vs. Medicare Provider First and last week include 1:1 information and assessment with Registered Dietition (PQI) Role of PQI Result is an eight week intervention designed to provide each participant with an individual assessment and education plan that has been developed collaboratively by participant and instructor Includes the six (6) week Stanford Diabetes Self-Management Training Program, given 2½ hours per week 5

6 Diabetes Self-Management Pilot CBO Patient/ Participant Medical Team and CDE Formulation Implementation Followup 6

7 Avoid these traps Unrealistic expectations Thinking too BIG when it comes to scope Think too small when it comes to time commitments 7

8 Helpful Hints Explore partnering with potential competitors (CDE, providers) Start with non-reimbursement pilots (CDSMP, A Matter of Balance, etc) Anticipate needs for CQI Understand billing and reimbursement coding, even if a medical partner is billing 8

9 Contact Information Joan Hatem Roy Assistant Director, Elder Services of the Merrimack Valley Jennifer Raymond Director, Healthy Living Center of Excellence

10 Detroit Area Agency on Aging Grace Derocha, RD, CDE, MBA Diabetes Self-Management Program Manager

11 Introduction & Agenda Accreditation through American Association of Diabetes Educators (AADE) in January 2011 Past Present Future

12 Past Partnered with an FQHC One-on-ones Only billable service Classes Stanford Model Transportation offered

13 Stanford Model 15 hours of education 2 lay leaders for each class Must be trained by 2 Master Trainers No props, PowerPoint slides or educational components regarding diabetes Focus is solely on behavior change

14 Present Medicare number Allows us to bill Medicare directly AADE 7 class curriculum Maximize units of billing MNT individual 4 units = 60 minutes DSMT group 18 units = 9 hours DSMT individual 2 units = 60 minutes Transportation offered

15 AADE 7 Curriculum Must be conducted by RD, RN, PharmD or CDE Education about disease state Behavior change focused Ability to use props, PowerPoint slides and other educational tools to teach Maximize billable Medicare units Hours of class time

16 Recruitment On website Promotion on The Senior Solution radio show Marketing Outreach Specialist Targeting Wellness Centers Food & Friendship sites Senior living facilities Doctors offices Other community locations

17 Process DAAA eligibility Within service area Diabetes diagnosis Not homebound Medicare part B Verification of Medicare eligibility and benefits Signed release of information from patient Signed order from doctor Labs

18 Future Recruitment Expand to other community sites within our service area Develop relationships with physicians offices Contracts Medicare Advantage Health Plans Continue to streamline processes

19 Questions

20 Thank You Grace Derocha, RD, CDE, MBA Diabetes Self-Management Program Manager ext. 5344

21 Take Charge of Your Diabetes Plus; Road to Accreditation Maria D. Oquendo-Scharneck, Health and Diversity Coordinator

22 Take Charge of Your Diabetes Plus Each workshop consists of 8 sessions 6 group sessions each 2 ½ hours per week 2 individual sessions with a Register Dietician Workshop materials are loaned or purchased Group sessions are taught by 2 certified facilitators trained by Stanford University standards

23 Take Charge of Your Diabetes Plus Program Design Designed to develop sustainable funding over time through Medicare Part B reimbursement for Diabetes Self-Management and Medical Nutritional Therapy reimbursement benefit

24 Accreditation Process 1. Received accreditation from the American Association of Diabetes Educators Development of policies and procedures for the delivery of the program that meet the National Standards for Diabetes Self- Management Education. Resumes, job descriptions for assigned Program Coordinator, Clinician and workshop facilitators must all be part of your of the policies manual

25 Accreditation Workshop Implement one pilot workshop which includes all the elements outlined in your policies and procedures manual The workshop must include an individual assessment to set education goals with either a RD, RN or RPH Another individual assessment is required at the end to evaluate if goal has been met. At this time pamphlets and handouts will be provided for ongoing support of participant

26 Participant Billing Each participant must have an individual file. Files will include: Individual assessment Weekly workshop log Weekly progress notes Recent lab work Physician referral Diabetes Self Management Plan

27 Medicare Billing 2. Formalized an agreement with one Medicare Billing Partner and we are in process with another. If you aren t currently billing Medicare for services; you will need to seek out a Medicare Billing partner When a potential partner is identified a memorandum of agreement should be developed indicating roles A budget indicating cost share for each partner should be part of the partnership development process

28 Marketing Materials 3. Marketing materials for outreach to healthcare providers need to be developed to encourage clinical referrals Materials should give providers a clear idea of the workshops They should include a referral forms and way for the practice or clinic to advertise Organizational website should include information on the program and how to refer patients

29 Accreditation Submission One participant file will need to be submitted. The package which includes the policies and the participant file online for review. 4-6 weeks of review by the Accreditation Board for adherence to the 10 National Standards. Your organization will be contacted with the outcome of the review.

30 After Accreditation Workshop recruitment Facilitator recruitment Program variations Physician referrals Annual reports Regular input from Advisory Council

31 Thank You For more information : Maria D. Oquendo-Scharneck at maria.oquendo-scharneck@ageoptions.org Call

32 Diabetes Self-Management Program Model for Aging Network Providers Timothy P. McNeill, RN, MPH DSMT Consultant

33 History of DSMT Benefit The Centers for Medicare & Medicaid Services (CMS) provides reimbursement for DSMT Benefit began in 2002 Benefit provides compensation for up to ten (10) hrs of DSMT per 12 month period All recognized Medicare providers can submit for reimbursement Medicare coverage 80% Payment 20% Co-insurance required 33

34 Program Considerations As a Part B service, beneficiaries without Part B cannot receive the service paid for by Medicare Part B Beneficiaries that have elected Medicare Part C (Medicare Advantage) must receive their benefit from a Medicare Advantage approved provider Medicare recognized programs can contract directly with a Part C plan provider to provide these services Once approved by Medicare, negotiate directly with the dominant Medicare Advantage Plan in your market 34

35 Purpose of Program Accreditation CMS mandates that DSMT programs obtain accreditation from a CMS approved accrediting organization American Diabetes Association (ADA) American Association of Diabetes Educators (AADE) Accreditation provides evidence that a program adheres to a minimum level of quality standards in the delivery of DSMT The quality standards encompass the program structure, curriculum, and internal quality controls 35

36 Program Considerations The Stanford Model is an approved curriculum for an accredited DSMT program, as long as it has additional infrastructure to meet the Ten National Standards An accredited program Does Not require the participation of a Certified Diabetes Educator (CDE) A physician or medical provider must certify that DSMT services are needed and provide an order/referral Physician or provider order is required prior to the initiation of services 36

37 Partnership A Significant barrier can be establishing a partnership with a Medicare Provider One program can have more than one partner Relationship must be mutually beneficial If the negotiations are difficult in the beginning, they will likely remain difficult for the duration of the relationship Both organizations must have a process to track and monitor services Class participants Services delivered Timely filing of claims Claims reconciliation Revenue sharing 37

38 Opportunity Identify the types of insurers in your area Investigate to see if they cover disease self-management education and training Review how to become a provider under this plan Accreditation provides leverage in the negotiation You should know how to price your service before beginning negotiations 38

39 CMS Medicare Data At the following link, CMS provides monthly Medicare enrollment data: opofpage Once at this page you can make a quick assessment of the numbers in your area by reviewing the Medicare Advantage Penetration Table. State_County_Penetration_MA 39

40 Questions Questions can be submitted in this open forum or by Timothy P. McNeill, RN, MPH DSMT Consultant Direct: (202)

41 Q&A Improving the lives of 10 million older adults by National Council on Aging 41