How DSME Helped HealthSource of Ohio Empower Patients
HealthSource of Ohio, a provider that primarily serves the Cincinnati area, partnered with Ohio’s Medicaid Managed Care Plans to explore ways of increasing utilization of DSME services among their patients. Chief among them was a common-sense solution: increasing payment.
During a pilot period, HealthSource of Ohio committed to promoting the diabetes programs to increase referrals to the program and make it more successful for all. The plans simultaneously committed to continuous monitoring to see if increased payment would result in increased utilization of DSME services.
If utilization increased during the pilot period, the Medicaid Managed Care Plans agreed to work with the Ohio Department of Medicaid to see if those rate changes could be made permanent.
Spreading the Word to Increase Referrals
To increase DSME utilization, the pilot team first set about increasing referrals to HealthSource of Ohio’s Association of Diabetes Care & Education Specialists (ADCES)-accredited DSME program.
The HealthSource of Ohio diabetes care team:
- Visited or contacted each HealthSource of Ohio office to promote the program.
- Opened additional slots on the schedule to accommodate more patients.
- Assigned a diabetes program assistant to complete patient reminder calls.
- Sent communications to all offices regarding the program and referral process.
The HealthSource of Ohio marketing team:
- Developed flyers to promote the program.
- Added program information to all waiting area TV monitors.
- Created a webpage for the program.
The efforts of the HealthSource of Ohio team resulted in a marked increase in referrals, encounters, and kept appointments for DSME services over the prior year.
Referral Outcomes Q1 (January-March) 2023 vs 2022
| 2023 | 2022 | +/- 2022 | |
|---|---|---|---|
| Referrals | 218 | 107 | +111 |
| Encounters | 279 | 117 | +162 |
| No Shows | 12.7% | 18.9% | -6.2% |
| Kept Appts | 76.4% | 62.2% | +14.2% |
Approachable, Evidence-Based Curriculum
Once patients were referred to HealthSource of Ohio’s DSME program, they underwent a curriculum based off the ADCES-approved seven self-care behaviors for managing diabetes approach, and guided by a certified diabetes care and education specialist.
In individual in-person and telehealth sessions:
- Patients received individualized care and discussion of their diabetes goals over a 45 minutes to one hour session.
- Received a diabetes education binder with tools and resources to assist them with managing their diabetes.
- Received two to six follow-up sessions depending on patient need.
In group sessions:
- Patients patients participated in one intake session and five group sessions for 90 minutes every other week.
- Received a diabetes education binder with tools and resources to assist them with managing their diabetes.
- Experienced hands-on activities, including meal planning with food models, dining out activities, and chair exercises with resistance bands.
Improved DSME Utilization
The outcome of the pilot has yet to be determined, as data is still being actively collected. But program data collected to date shows improvements in diabetes-related health and DSME utilization, with the number of total patients already exceeding the prior year. The number of patients completing the program and the number completing more than one session are also on pace to exceed the prior year at only the reporting midpoint, indicating a preliminary result of increased utilization.
Patient Outcomes 2023 vs 2022
| 2023 (9/4/22-4/5/23) | 2022 (9/4/21-9/3/22) | |
|---|---|---|
| Total Patients | 251 | 238 |
| Patients Completed Program | 80 | 127 |
| Patients Completed >1 Session | 161 | 167 |
| Average A1C Change | -3.1 | -2.9 |
| Average Weight Change | -2.6 | -5.6 |
Partners in the pilot program expressed positive attitudes about its success, both in recognizing the importance of DSME across the state and acknowledging innovative solutions to the challenges of expanding DSME utilization.
Patients also had positive things to say about the program and DSME education, including:
- “I think everyone who gets diagnosed with diabetes should have classes like this. There are so many people out there that don’t get offered classes and have no clue on what to do.”
- “All my questions and concerns were answered with kindness.”
- Without these classes, “it’s like putting someone behind the wheel of a car with no knowledge of how to drive and making them to drive with no help.”
Additional Reading
The following peer-reviewed literature explores the success of DSME in managing diabetes.
Lynch EB, Mack L, Avery E, Wang Y, Dawar R, Richardson D, Keim K, Ventrelle J, Appelhans BM, Tahsin B, Fogelfeld L. Randomized Trial of a Lifestyle Intervention for Urban Low-Income African Americans with Type 2 Diabetes. J Gen Intern Med. 2019 Jul;34(7):1174-1183. doi: 10.1007/s11606-019-04894-y. Epub 2019 Apr 8. PMID: 30963440; PMCID: PMC6614233. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614233/
Kellie Rodriguez, Donna Ryan, Jane K. Dickinson, Victor Phan; Improving Quality Outcomes: The Value of Diabetes Care and Education Specialists. Clin Diabetes, 1 July 2022; 40 (3): 356–365. https://doi.org/10.2337/cd21-0089
Carole A. Chrvala, Dawn Sherr, Ruth D. Lipman, Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control, Patient Education and Counseling, Volume 99, Issue 6, 2016, Pages 926-943, ISSN 0738-3991.
https://www.sciencedirect.com/science/article/pii/S0738399115301166