QIN-QIO Public Sharing Call – October 11, 2018 · 10/11/2018 · Marketing Plan. 5. Name the key elements to include in the . Operations Plan. 6. Name the key elements to include

QIN-QIO Public Sharing Call:The Basic Business Strategies for Building a Successful DSMT Program

Thursday, October 11, 20183:00-4:30 PM ET

Welcome and Reminders

2

Lindsay KaatzEvent Lead

Susan BrittmanChat Manager

• Please be prepared for sharing and open discussion

• Slides and a recording from today’s session can be found on: https://qioprogram.org/qin-qio-public-sharing-calls-3-part-series

https://qioprogram.org/qin-qio-public-sharing-calls-3-part-series

Purpose

• Audience: Patients, community and healthcare providers, local partners, federal partners, and Quality Improvement Organization (QIO) Program partners (*registration required)

• Purpose: The purpose of this session is to teach participants about DSMT program design, business strategies, operations, and financial planning for program success and sustainability

• Expectations: Participants will gain knowledge that is directly applicable to their work in healthcare quality improvement and acquire information that can be easily shared among their own community, organization, or team

• Topics: Topics will be aligned with the CMS Quality Strategy goals

3

Learning Objectives

• List the key elements to include in the “Key Preliminary Activities” of a DSMT program business plan.

• List the key elements to include in the “Operations Plan” of a DSMT program business plan.

• List the key elements to include in the “Financial Plan” of a DSMT program business plan.

4

Things to Think About

Will you commit to being… • Attentive• Active• Actionable

Show your commitment by clicking the green checkmark!

5

Continuing Education Credit

Continuing education credit is available for:• Physicians and Physician Assistants• Registered Nurses and Nurse Practitioners• Dietitians• Pharmacists and Pharmacy Technicians• Certificate of Attendance

6

Method of Participation & Instructions for Claiming CE

• Attend the entire event• Complete the post-event assessment that will pop up at

the conclusion of the event• There is a separate evaluation required for CE linked

within the post-event assessment• Once you submit your CE evaluation, you will be

provided with a certificate to retain for your records• For technical assistance, please email Nikki Racelis

([email protected])• If you have questions about this CME/CE activity, please

contact AKH Inc. at [email protected].

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mailto:[email protected]


CE Information

Physicians:This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providershipof AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

AKH Inc., Advancing Knowledge in Healthcare designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants:NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.

Pharmacists:AKH Inc., Advancing Knowledge in Healthcare is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.AKH Inc., Advancing Knowledge in Healthcare approves this knowledge-based activity for 1.5 contact hours (0.15 CEUs). UAN 0077-9999-18-032-L04-P; UAN 0077-9999-18-032-L04-T. Initial Release Date: 10/11/18

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CE Information, Continued

Registered Nurses:AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.This activity is awarded 1.5 contact hours.

Nurse Practitioners:This activity has been planned and implemented in accordance with the accreditation Standards of the American Association of Nurse

Practitioners (AANP) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 030803This activity is accredited for 1.5 contact hour(s) which includes 0 hour(s) of pharmacology. Activity ID #218181

Dietitians:AKH Inc., Advancing Knowledge in Healthcare is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 1.5 continuing professional education units (CPEUs) for completion of this program/material. CDR Accredited Provider #AN008. The focus of this activity is rated Level 2. Learners may submit evaluations of program/materials quality to the CDR at www.cdrnet.org.

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http://www.cdrnet.org/

Disclosure of Financial Relationships & Commercial Support

• The planners and faculty do not have any relevant financial relationships to disclose.

• AKH Inc., CRW & Associates, and Telligen do not have any relevant financial relationships to disclose.

• No commercial support was received for this activity.

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Disclosure of Financial Relationships & Commercial Support

Disclosures:It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whoseproducts or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral toNational Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use and Investigational Product:This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Pleaserefer to the official prescribing information for each product for discussion of approved indications, contraindications, andwarnings.

Disclaimer:This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as ageneral guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or otherprofessional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant's misunderstanding of the content.

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Meet Your Speaker

12

Mary Ann HodorowiczRDN, MBA, CDE, CEC

Mary Ann Hodorowicz Consulting, LLC

THE BASIC BUSINESS

STRATEGIES FOR BUILDING A

SUCCESSFUL DSMES PROGRAM

Mary Ann Hodorowicz RDN, MBA, CDE, Certified Endocrinology Coder


Mary Ann Hodorowicz

RDN, MBA, CDE,

CEC

(Certified

Endocrinology

Coder)

Mary Ann Hodorowicz, RDN, MBA, CDE, CEC, is a licensed registered dietitian and certified diabetes educator and earned her MBA with a focus on marketing. She is also a certified endocrinology coder and owns a private practice specializing in corporate clients in Palos Heights, IL. She is a consultant, professional speaker, trainer, and author for the health, food, and pharmaceutical industries in nutrition, wellness, diabetes, and Medicare and private insurance reimbursement. Her clients include healthcare entities, professional membership associations, pharmacies, medical CEU education & training firms, government agencies, food and pharmaceutical companies, academia, and employer groups. She served on the Board of Directors of the American Association of Diabetes Educators from 2013 – 2015, and was the Chair of the Advanced Practice Community of Interest in 2016.


[email protected] 708-359-3864

www.maryannhodorowicz.com

Twitter: @mahodorowicz


http://www.maryannhodorowicz.com/

Learning Objectives

1. List the 6 major plans in the DSMES program business plan.

2. Name the activities to include in the Key Preliminary Activities Plan.

3. Name the key elements to include in the Clinical/Teaching Plan.

4. Name the key elements to include in the Marketing Plan.

5. Name the key elements to include in the Operations Plan.

6. Name the key elements to include in the Financial Plan.

7. Name the key elements to include in the CQI Plan.

There are 6 Major Components of

DSMES Program

Business Plan

Key Preliminary Activities: Define DSMES Team, Stakeholders, Business Concept and Value Proposition

Define DSMES Team, Stakeholders,

Business Concept

and

Value Proposition of Program


• Define DSMES program team:

o Quality coordinator

o FTE educators:

Type by discipline (e.g., RN, RDN, RPh, etc.)

Credentials

Didactic + experiential preparation in DSMES

Experience in other services (MNT, CGM, etc.)

Defined roles and responsibilities


o FTE community health workers (CHWs)

o FTE staff support


• Define program stakeholders:

o Standard 2 of the 2017 NSDSMES: Stakeholder

Input

“The provider(s) of DSMES services will seek

ongoing input from valued stakeholders and

experts to promote quality and enhance

participant utilization.”


• Define “business concept” to use in marketing materials

o What you are selling in “human fulfillment” terms in <4 words

o Why? Quickly captures customer’s attention!

o Example: what does photographer sell?

Memories


o What does DSMES program sell?

DSMES sells______________________?

Wellness?

improved health?

Better quality of life?

Increased coping skills?

Longer life?


Define Value Proposition of Program


Value proposition (benefits of

program)

to sponsoring organization (SO)

are

outlined in the word

V.I.T.A.L.

VValue of sponsoring organization (SO) is enhanced in the eyes of providers, stakeholders and PWDs via patient outcomes.

I

Increases SO’s relationships with providers via DSMES program and other* related referrals.

Increases revenue for SO via DSMES (plus related services*).

Increases collateral insurer revenue from ancillary services…i.e., lab tests, therapies, etc.

*MNT, CGM, chronic care management, shared medical appointments, obesity therapy, DPP.

IIncreases pay-for-performance, pay-for-value reimbursement when DSMES helps meet insurers’ quality diabetes measures.

Inspires employers to team up with DSMES program on-site as part of employee wellness initiative

T Triggers team-based diabetes care

A

Allows advanced roles/responsibilities to be assumed by diabetes educators which enhance quality diabetes management (e.g., care coordinators, case managers).

Aids achievement of NCQA standards for PCMH recognition and for ACO accreditation; NCQA = National Committee on Quality Assurance.

Aids achievement of ACA healthcare reform goals and standards.

Aids achievement of sponsoring organization’s business-related goals.

Aids state department of health and SO’s own population health strategies to diabetes epidemic.

L

Lessens healthcare costs related to decreased: ER visits; therapies; onset and progression of diabetes complications.

Lessens hospital readmissions within 30 days (can thus prevent health insurance payment penalty)

Lets diabetes educators help sponsoring organization achieve 3 most recognized quality measures* via the program that results in “incentive”… “additional”reimbursement payments.

* What are the quality measures?


3 most recognized quality measures in healthcare are:

= QUALITY MEASURES

Key Preliminary Activities: Create Project Management Plan

Create Project Management Plan


• Define a formal plan for how DSMES team will achieve

goals in specific time period (ex: goal = achieve AADE

accreditation):

o Have regularly scheduled team meetings

o Define meeting format and rules:

Create agenda for meetings

Decide who will take meeting minutes

Decide time frame for submitting minutes to team

members


o Ensure action steps are assigned to each

team member

o Ensure resources available to complete

action steps

o Define completion dates for each action step

o Confirm next meeting date


Team work works!

Key Preliminary Activities: Create Knowledge & Resource Library

Create Knowledge and Resource Library


Why

Develop

Your

Library?


• Format

o Paper or electronic

o Can include audio, video, and web-based and mobile apps

• Tips:

o Keep it current

o Continue to grow it over time

Key Preliminary Activities: Conduct Needs Assessment

Conduct Needs Assessment: 3 “P’s”


Needs Assessment: 3 “P’s”

Population Patients

Providers


• Population assessment elements:


• Population assessment:

o Prevalence and type of diabetes population…e.g., Daley County:

Mostly type 2 diabetes, >50 y/o

11.4% >30 y/o have T2 diabetes compared to 8.2% in state

Reference: NIH Publication No. 11–3892, February 2011


• Population assessment:

o Trends

Non-Hispanic white children + adolescents

had highest rate of new cases of type 1

diabetes

Rates of new cases of T2 DM greater among

10 – 19 year age group than in younger

children


• Patient assessment elements:

o Age

o Education

o Literacy

o Numeracy

o Race/ethnicity

o Economic status

o Community type

o Transiency

o Work type and

setting

o Leisure habits

o Marital status


• Provider assessment elements:

o Define who are allowed to refer to DSMES program, per Medicare

DSMES: MDs, DOs, NPs, PAs, CNS’s

MNT: MDs and DOs only

o Define providers…by name…in area

o Define where providers are located


• Determine if providers are referring to other DSMES programs in area

o If not, assess reason(s) why not

Program not meeting providers’ unmet or poorly met needs?

Can you fill this niche?

• If yes, assess how your program can be >10%

better in meeting providers’ needs

Define

PROVIDERS’

NeedsConsider:

--Unmet needs

--Poorly met needs

--What can you do

better?

Consider:

--Unmet needs

--Poorly met needs

--What can you do

better?

Key Preliminary Activities: Define Program Goals

Define DSMES Program Goals


• First: define sponsoring organization’s goals of DSMES program:

Break even? Physician support?

Research support?

Make profit?

Revenue or cost center?

Absorb some/all of program costs?

Community service regardless

of cost?

Lower health costs of

patient care?

Make entity look good to someone

important?

Meet one or more of entity’s

strategic goals?


Help SO meet health insurers’ quality measures to receive incentive (extra)

payment under new system of value-based care.


• Define goals for program

• Create table to show how sponsoring

organization goals are aligned with program

goals

Sponsoring Organization Goals Aligned with Program Goals

Sponsoring Organization Goals DSMES Program Goals

Demonstrate innovative patient education centered in OP chronic care, rather than inpatient acute care (new health care reform).

Implement outpatient DSMES program.

Attract new patients.

Maintain existing patient base.

Obtain positive program outcomes:

• Obtain provider and self-referrals

• Increase referrals each fiscal year

• Maintain high attendance rate in

program

• Increase pt visits each fiscal year

Sponsoring Organization Goals

DSMES Program Goals

Provide highest quality, evidence-based services that improve health and well being of patients.

Adhere to quality, evidence-based standards for DSMES:

• Provide DSMES according to National Standards for DSMES.

• Achieve and maintain accreditation for DSMES Program.


DSMES Program Goals

Support needs of area and staff physicians.

Support needs of area and staff physicians via outpatient DSMES program.

Provide income-generating services.

Obtain DSMES program revenue via:

• Insurance reimbursement

• Patient payments

• OP receipt of other related services:

o A1c, blood lipid tests

• OP receipt of other services not related to program but as result of positive practice setting experience.


DSMES Program Goals

Maintain operational process that are:

• Streamlined

• Cost-efficient

• Reliable (consistently produce desired endpoint with conservation of resources)

DSMES operational processes are:

• Streamlined

• Cost-efficient

• Reliable

Ensure patient satisfaction. Patient DSMES satisfaction is high.

Key Preliminary Activities: Write Mission and Vision Statement

Write Mission and Vision Statement


MISSION STATEMENT VISION STATEMENT

FOCUS Present Future

WHY Reason for program’s existence

Long-term goals to grow your program

INFORMS ABOUT

Core values of your organization

Direction of your organization


• Example: DSMES mission statement:

o Present focus of program

Our mission for _____________ (name of

program) is to improve our patients’ knowledge of

and confidence in changing their key self-care

behaviors through active participation in our

DSMES program with the goal of improving key

health/clinical indicators and their quality of life.


• Example of DSMES vision statement:

o Where program wants to go in future:

In addition to providing DSMES to __________ (name of

the target population), our vision is to provide other innovative

diabetes management services shown to improve glycemic

control and other health indicators, such as continuous glucose

monitoring and insulin pump therapy.

Key Preliminary Activities: Define How Program Success Measured

Define How Program Success is Measured


• Via Patient Outcome Measurement Plan:

oMeasure of success: achieving entire spectrum of

patient outcomes



o Via Program Outcome Measurement Plan:

Measure of success: achieving program quality measures

Program Quality Measures Examples

Structure • Use of evidence-based decision support tools

Process • Patient contacted within 48 hrs of referral receipt

Outcome • 100% of DSMES insurance claims are paid

• Provider referrals are increases yearly

• Number of providers who refer increases yearly

SEE APPENDIX FOR FULL LIST

Key Preliminary Activities: Write Executive Summary

What is the “Executive Summary” of a Business Plan?

Key Preliminary Activities: Write Executive Summary

o Brief, but concise summary of each of

6 components of plan

o Positioned first in plan….but last section written

• Usually ends with 1 or 2 clinching, closing sentencesthat answer

“Why is this a winning program?”

Components of

DSMES Business

Plan

Reminder:

SO = Sponsoring Organization

Marketing Plan

• Set of activities designed to satisfy:

o Human and organizational “N.E.W.G.S.”:

Needs … Expectations … Wants … Goals

Market Analysis

Market Analysis defines your

primary and secondary target markets.

9 Possible Target Markets of a

DSMES program =

Your Customers!

Persons with Diabetes & Prediabetes(PWD-Ps)

Organization That Sponsors

Programs

Providers Who Refer

Employers and Their

Employees

State, Public and Community

Health Agencies

Community Persons with

Diabetes But Not Diagnosed

Senior Services and

Senior Housing

Healthcare Insurers

Community Services and Faith-Based

Organizations

Market Analysis

o Examples of primary target markets:

Type 1, type 2 adults only

Women with type 1 diabetes and GDM only

o Examples of secondary target markets:

Providers who refer to DSMES programs

Area employer groups and their employees

Competition Analysis

• Competition Analysis identifies:

o Alternatives to your DSMES program

o If your program has competitive advantage

• To complete:

o Find out everything about other programs

o Call and pretend you are a patient


• Competition assessment elements:

Where are competitors’ parent sites and external off-site locations?o

Hospitals

Physician offices

Clinics

Pharmacies

Independent practices

Chains and big box stores

RDN private practices

Physician offices Grocery stores Churches Schools Recreation

departments Fitness centers Assisted living

facilities? Adult day care

facilities?


o What are their target diabetes populations?

Type 1, type 2, GDM, adults only, pediatric only?

o How many miles do MOST patients have to travel to get to program?

o Are competitors maximally meeting the needs and expectations of:

Patients?

Providers?

• Include detailed “Competitive Grid” and explanations:

My Program Competitor A Competitor B

Services Offered

Fees

Location

Expertise

Hours of Operation

Referral Required

Length of DSMES Program

Days of DSMES Program

Etc.


• Conduct S.W.O.T. analysis of:

o Strengths and Weaknesses of your program’s

internal characteristics

o Opportunities and Threats from external forces:

Competition

Economic environment

Trends


Your DSMES ProgramStrengths

Weaknesses

From Competition and External Forces

Opportunities

Threats

7 P’s of Marketing

• Flesh out 7 Ps of “service” marketing in business plan:

Products (services)

Packaging

Promotion

Place (physical evidence of quality)

Processes and Procedures

Price

People (educators, CHWs, staff):

o Interpersonal skills; proficiency; team leadership and dynamics

Marketing Plan for a “Service” = 7 P’s


GOAL: be at least 10% BETTER than your

BEST competition in 1 or more of 7 Ps….


Product (services)

• Identify your core “service”: DSMES program

• Identify other services

• Use descriptions that fits with target markets NEEDS and

WANTS:

o Provides quality, team-based continuity of care

o Is culturally and linguistically appropriate and evidence-

based

o Helps meet recognition standards of PCMH and ACO


Packaging

• ‘Packaging’ a DSMES service is different from packaging a product

• Goal: convey “BIG Four Selling Points” of DSMES


“BIG Four Selling Points” of DSMES

1. DSMES is medical service

2. Your brand

3. Perceived value of program

4. Perceived quality of program


• Program “brand” is comprised of:o DSMES program nameo Tag lineo Contact infoo Addresso Color schemeo Font styleo Clip arto Graphicso Info-graphico Value perceptiono Quality perception

S.W.E.E.T.S. Are Your Diabetes Lifesavers

D I A B E T E SDo Monitor Your Blood

Glucose (BG) Regularly

InvolveFamily

andFriends

Acquire OngoingSupport

Bring BGValues to

HealthcareVisits

Exercise Regularly

Take Medication as

Prescribed

Ease into Behavior Changes Slowly

See a Diabetes Educator Regularly

L I F E S A V E R S + ?Lose Excess Weight

IdentifyHealthyCoping

Strategies

Fix Your

Problems

EatHealthy

Sleep Well

EveryNight

AcquireSick Day & Travel

Kit

VisitYour

DoctorRegularly

EnjoyRewardsfor All You Do

ReduceRisks

ofComplications

SetSMART

Goals

Topics and Questions of

YOUR Choice

6 Visit Program (Group and Individual, Day and Evening Times) Scheduled Multiple Times Through the Year.

Just Call to Inquire or Register for a Program. You’ll Be Glad You Did!


Promotion

• If people don’t know you exist, they won’t knock on your door!


FIRST:

Customize… “connect”… your marketing

Promotions to your target markets’

(customers’) specific:

• Characteristics


Examples of characteristics of patient target market:

• Age

• Gender

• Abilities (physical, mental)

• Attitudes, beliefs

• Lifestyle

• Religion

• Education

• Patterns of behavior

• Ethnicity, race (higher

prevalence of diabetes?)

• Health status

• Economic status

• Living environment

• Work environment


SECOND:

Customize… “connect” … your marketing promotions

to your

target markets’ (customers’) specific NEWGs:

Needs…Expectations…Wants…Goals

EXAMPLES OF

PROMOTIONS FOR YOUR DSMES

Promotions

Ask Businesses and Non-Profits

to Add Information on Your

Program to Their Promotions for

Larger Community-Wide Reach

Partner with Community Health

Agencies for Aligning DSMES

Programs with Agencies’

Population Health Strategies

Promotions

Furnish Your Program in

Key Off-Site Locations:

Accountable Care Organizations,

Patient Centered Medical Homes

and

Other Healthcare Entities

Show How Program Can Help Meet NCQA Standards

withinPCMHs and ACOs

Promotions

Furnish Your Program at

Employee Work Sites

For a Fee

Host Diabetes Patient “Self-Care” Community Events(e.g., Yoga Event)

Host Diabetes Fairs for Community People

Host Diabetes Prevention Parties

Promotions

Host Type 2 Diabetes

Screening Events

Participate in LocalFarmers’ Markets

Participate in

Community Health Fairs

Sponsored By

Other Groups

Develop Info Flyers on

Diabetes Self-Help

Topic(s); Distribute

Where PWDs Gather

Promotions

Conduct Grocery Store

Tours and Give

Attendees Healthy

Shopping List

Create for Providers

“Diabetes Calendars”

for Program Services

Create Branded

DSMES Referral Form

(Pads of 50) and Deliver

to Providers

Create Print Promotions

for DSMES Program:

Slim Jims, Brochures,

Flyers

Promotions

Advertise Programs in

Local Newspapers and

in Sponsoring

Organization’s Newsletter

Promote Programs Online

and on

Social Media Sites

Provide Hot Topic

“Infomercials” on Regular

Basis at SO

Host Regular Online

Diabetes Blogs

Promotions

Be Interviewed on

Local Cable TV

Be Interviewed on

Local Radio Stations

Give Away Free, Fun

Diabetes Goodies at

All Public Events

Promotions

Promote Programs to

Employees at Your

Sponsoring Organization

HOW?

On Employee

Bulletin Boards

With “Diabetes Friendly”

Meals in Cafeteria With

“Ask a Diabetes Educator”

Event in Cafeteria

Promotions

Regularly Communicate Patient

and Program Outcomes to

Providers and Stakeholders

Speak at Community Events in Local Area and Promote Program

Ask Local Restaurants to Put

“Diabetes Friendly” Meal on

Menu 1x/Week

Tap into Available Services

from Your State’s Department

of Health

7 P’s of Marketing Place/Physical Evidence of Quality

• Where program is furnished

• Examples:

o Furnished at SO site…and also off-site, where patients congregate:

Churches

Recreation departments and park districts

Fitness centers/gyms

Libraries


• Quality elements:o Adequate seating,

o Space for teaching, supplies, etc.

o Clean

o Furniture in good condition

o Adequate lighting, heat, air conditioning, ventilation

o Bathrooms

o Wheelchair accessible

o Adequate parking and well-lit

o Near public transportation


Processes/Procedures (PPs)

• Part of marketing plan as they impact your BIG FOUR SELLING POINTS:

1. DSMES is medical service

2. Your brand

3. Perceived quality of program

4. Perceived value of program


You can make or break your success with the type* of PPs you create:

*PATIENT - Centered PPs improve:

• Quality of care

• Patient outcomes

• Physician relationships

*CLINICIAN - Centered PPs decrease:

• Quality of care

• Patient outcomes

• Physician relationships


Price

• Determine fee schedule for DSMES program

• Factors used to determine price:

o Insurance reimbursement rates

Medicare, Medicaid, private insurers

o What market will bear (do market research)

o Competitions’ fees

o Patients’ and physicians’ perceived value of programs


People

• Refers to perceived quality of all staff working in

DSMES program:

o Quality coordinator, educators, CHWs, support staff

• Must select, recruit, hire quality people with required

skills to do the job!

More important than everything else in business plan!


People

• We make >12 assumptions… good or bad…in first

12 seconds of meeting someone, and it’s virtually

unchangeable!

• Does your team convey image of quality …or lack thereof?

o Can make or break your success immediately w/o saying 1 word!


• 93% of how we’re judged based on non-verbal data:*

o Demeanor and mannerismso Clothes, shoes, accessorieso Body languageo Grooming: hair, face, makeup, fingernails

• Only 7% on verbal data (person’s actual words):*

o Wordso Voice and toneo Attitude in voice

*THE 7% RULE: FACT, FICTION, OR MISUNDERSTANDING, http://ubiquity.acm.org/article.cfm?id=2043156

http://ubiquity.acm.org/article.cfm?id=2043156



Once a

1st impression

is made,

it’s

virtually

impossible

to change!

NOT

well-groomed?

Others will think:

“Does he pay

attention

to details”?

Components of

DSMES Business

Plan

Operations Plan

• Define structure of program

o Key elements:

Emphasize DSMES program’s alignment with select

standards of:

NCQA standards for PCMH recognition and ACO

accreditation

Joint Commission on Accreditation of Hospitals

Other?

Operations Plan

AADE accreditation or ADA recognition of program

Stakeholders’ purpose and members

Physical space requirements

Polices

Procedures

Organizational chart

Provider referral process

Use of EMR

Use of data tracking system

Operations Plan

• Create design of program:

o Design in initial first year and follow-upsubsequent years:

Number of visits

Type of visits: individual and/or group

Length of each type of visit

Time of each visit

Topics covered in each visit

Operations PlanExample of design to meet initial 10 hours of Medicare DSMT benefit:

Operations Plan

• Create daily schedule for 1 FTE diabetes educator that:

o Is time efficient

o Preserves quality of care

o Assigns time for “non-direct” but key DSMES tasks,

such as:

Marketing

CQI

Operational and financial tasks

Example: 1.0 FTE Educator Schedule in 8 Hour Day + Weekly Totals

Billable DSMES Pt Face

Time

Non-Billable Pre-Visit

Time

Non-Billable Post-Visit

Time

=TOTAL

DSMES TIME

+ Non-DSMESKEY

TASKS

Initial Individual Visit x 1/Day

1 hr + 15 min + 15 min = 1.5 hr

F/Up Individual Visit x 1/Day 0.5 hr + 15 min + 15 min = 1 hr

Group visit x 1/Day 2 hrs + 30 min + 30 min = 3 hrs

Non-DSME Key Tasks 1 hr

DAY TOTALS 3.5 hrs + 1 hr + 1 hr = 5.5 hrs + 1 hr = 6.5 hours

WEEK TOTALS 17.5 hrs + 5 hrs + 5 hrs = 27.5 hrs + 5 hrs = 32.5hours

% of PAID HOURS/WEEK = 54%BillableDSMESTime

= 31%Non-Billable

DSMESTime

= 85%Total

DSMESTime

= 15%Non-DSMES

KeyTasks

Operations Plan

• Create program forms:

o Patient registration

o HIPAA privacy rules notice

o Financial responsibility notice

o Initial intake, referral and appointment form (IRA form)

o Behavior goals monitoring form

o Outcomes monitoring form

o DSMES record

o Provider DSMES referral form (Medicare compliant)

Operations Plan

o Encounter form

o ABN form

o Assessment form

o Progress note

o Program support plan

o Program education plan

o Program attendance sheet (Medicare

requirement)

o Reimbursement tracking form

o Visit tracking form

Operations Plan

• Educator and staff work flow and scheduling

• Patient flow and scheduling

• Space requirements

• Equipment requirements

• Rental contracts for offsite space

• Legal, privacy, safety and health regulatory

mandates

Operations Plan• Define strategies for team work:

o Each educator is assigned roles and responsibilities matching their:

Skills

Training and education

Experience

Credentials and licensure

o Avoid “turf wars”…disastrous!

o Decisions affecting team to be MADE by whole team!

Operations Plan

Can we all

play nice

together,

please?

Components of

DSMES Business

Plan

Financial Plan

• Define:

o Financial quality measures and targets of program

o Timeframe scheduled to meet SO’s goals for

program

o Cash flow projections

o Pro-forma income statement

o Budget

o Breakeven point

Financial Plan

• Breakeven point in 10 hour DSMES program…example:

REVENUE

EXPENSES

Total number of 2 hour group visits = 4 x $40 average reimbursement rate/2 hours/OP = $160 x 4 OPs =

$640 revenue

Total number of 1 hour group visits = 1 x 4 OPs x $20 average reimbursement =

$80 revenue

Total number of 1 hour individual visits = 4 x 4 OPs x $120 average reimbursement rate/hour

$480 revenue

TOTAL AVERAGE REIMBURSEMENT for 10 HOURS $1200

LESS: total estimated expenses* for: 10 hours of DSMES + 5 hours total of pre- and post visit time = 15 hours x $80 per hour =

($1200)

*Expense estimate quick rule of thumb: educator hourly rate of $40 x 2 = $80 per hour

Financial Plan

• Define:

o Fee schedule

o Vendor support

No charge BG meters, strips, software, etc.

o In-network insurance provider status with:

Medicare, Medicaid and private plans

o Malpractice insurance

o State-mandated coverage of DSMES

Financial Plan

• Define financial quality measures

o Monitor quality measures and compared against desired targets

Desired targets are determined by:

Brain-storming with DSMES team

Reviewing with superiors

Benchmarking with other programs

Financial Plan

Example of financial quality measures to define:

• Percent of educator’s hours that is:

o Billable DSMES time

Target = ? (70% ?)

o Non-billable DSMES time

Target = ? (20% ?)

o For non-direct DSMES key tasks (marketing, CQI, etc.)

Target = ? (10% ?)

Financial Plan

• Percent of educator’s DSMES billable hours that are

scheduled vs. billable hours that are completed

o Target: 100% of billable hours that are scheduledare completed

Financial Plan

• Percent of educator’s time scheduled for DSMES vs. percent of time

scheduled for ‘other key tasks’

o Target: 85% is scheduled for DSMES vs. 15% for other key tasks

• Time scheduled for non-billable pre- and post DSMES time for each

1 hour of billable individual visits

o Target: 30 minutes of non-billable time is scheduled for each

1 hour of billable individual visits

Financial Plan

• Billing and reimbursement policies and procedures

• Revenue sources besides insurance reimbursement

• Reimbursement tracking report….see example

Snippet of Mary Ann’s Reimbursement Tracking Report

Financial Plan

• Accounting and bookkeeping system

Components of

DSMES Business

Plan

Clinical/Teaching Plan

• Evidence-based decision support tools to furnish DSMES:

o AND’s Nutrition Practice Guidelines for diabetes, HTN, hyperlipidemia

o ADA Standards of Medical Care in Diabetes

o 2013* Guideline for Overweight and Obesity (most current)

o AADE Accreditation or ADA Recognition of DSMES program

o Evidence-based curriculum for DSMES

*Most current as of Sept. 2018


• Patient empowerment and motivational

interviewing counseling strategies

• Sample of patient educational handouts

• Type of teaching aids


• Documentation (paper forms or EMR modules):

o Referring provider communication after each

DSMES visit

o Patient chart

• Point-of-care tests and CLIA waivers to perform


• Shared medical appointments with provider

o Win-Win for provider, educator and DSMES program

IN ~2 HOURS, ~10 - 12 OUTPATIENTS PARTICIPATE IN

INDIVIDUAL FOLLOW-UP MEDICAL VISITS by PROVIDER

plus

LIFESTYLE/BEHAVIOR CHANGE EDUCATION by EDUCATOR

in INTERACTIVE GROUP SETTING

Shared Medical Appointment: 1 Hour of Diabetes Management+ 30 Minutes of Group DSMES

Traditional Provider Visit:Diabetes Management

Only by ProviderAverage # of OPs 10 10

Total provider time 1 hour (~ 5 - 6 minutes per OP) 3.3 hours (~ 20 minutes per OP)

# of 30 min. units of group DSMES billed by program

1 unit x 10 OPs @ ~$18 per OP None

# of individual E/M visits by provider + reimbursement

10 OPs x code 99214 @ ~ $150 per OP = $1500 for 10 OPs

10 OPs x code 99214 @ ~ $150 per OP = $1500 for 10 OPs

Total average providerreimbursement for E/M

$1000 in 1 hour $1000 in 3.3 hours

Total average DSMESreimbursement per 30 min. $180 for 10 OPs $0

Total average providerreimbursement for E/M

$1000 in 1 hour= $17 per minute

$1000 in 3.3 hours= $5 per minute

Components of

DSMES Business

Plan

Continuous Quality Improvement Plan

Ongoing CQI Plan has 3 distinct activities:

1. Monitor patient behavior change and all other outcomemeasures

2. Complete and report >1 CQI project each year

• Evidence-based CQI process used

• Suggest: Plan – Do – Study – Act (PDSA)

3. Report summary of behavior change and all other outcome

measures to providers, SO and stakeholders regularly

Spectrum of DSMES Outcomes

Continuous Quality Improvement Plan

4 Step CQI Process

Last But Not Least…

Factors Requiring On-Going

Modifications to Your DSMES Business Plan

1. Economic conditions (internal to SO and external)

2. Policies and procedures of your SO

3. Competition forces

4. Provider and patient mix

5. Resources allocated to DSMES program

6. New standards of diabetes care and DSMES

7. New DSMES team members who have different ideas

8. Environmental scanning

o A way to monitor social, political, economic and technological events and trends that may impact DSMES & SO (as new opportunities and threats)

All 6 components of your

DSMES Business Planmust work in synergistic harmony to

maximize Patient, Program and Sponsoring

Organization success.

Time for Questions

DisclaimerThis information is intended for educational and reference purposes only. It does not constitute legal, financial, medical or other professional advice. The information does not necessarily reflect opinions, policies and/or official positions of the Center for Medicare and Medicaid Services, private healthcare insurance companies, commercial entities or professional associations. Information contained herein is subject to change by these and other organizations at any moment, and is subject to interpretation by its legal representatives, end users and recipients. Readers should seek professional counsel for legal, medical, ethical and business concerns. The information is not a replacement for the Academy of Nutrition and Dietetics’ Practice Guidelines and professional resources, American Diabetes Association’s Standards of Medical Care in Diabetes or American Association of Diabetes Educators professional resources. As always, the reader’s clinical judgment and expertise must be applied to any and all information in this document.

Structure, Process and Outcome Quality

Measures

in

DSMES Business Plan

and

2017 National Standards of DSMES

About Structure Quality Measures

• Related to resources (including capabilities, features) of DSMES program’s sponsoring organization (SO)

• DSMES program quality is tied to resources

• When resources available and utilized, results are:

o Maximized efficiency of program’s activities

Maximized efficiency leads to maximized:

Performance of educators and staff Cost control

Examples* of Structure Quality Measures

• IT/software data tracking system to track and monitor:

o Patients’ behavior goal achievement

o Patients’ outcomes (knowledge, confidence, clinical, quality of life, cost-savings, satisfaction)

o Other patient data

o Program data (number of: visits, referrals, etc.)

• Patient appointment reminder systems

Examples* of Structure Quality Measures, Cont.

• Patient registry with filtering ability (e.g., to identify pts due for follow-up DSMES, lab tests, exams,

etc.)

• EHR with essential functions for optimal diabetes care1 and interoperability with other IT systems:

1. Nine Essential Functions of an Information System for Optimal Diabetes Care, National Diabetes Education Program, National Institute of Diabetes and Digestive and Kidney Diseases

Examples* of Structure Quality Measures, Cont.• Evidence-based clinical decision support

tools…examples:

o Diabetes standards of medical care in diabetes

o Diabetes, hyperlipidemia, HTN nutrition practice guidelines

o AADE7™ Self-Care Behaviors

o 2013 Guideline for the Management of Overweight and Obesity in Adults

o Screening for Type 2 Diabetes Mellitus in Adults (U.S. Preventive Services Task Force)

About Process Quality Measures

• Related to the:o Way resources are used to deliver DSMES

programo Way program’s activities and procedures are

executed

• Ask: does the “way” align 100% with established:o DSMES program’s mission, vision and goals?

o DSMES program written policies and procedures?

o National Standards of DSMES?

o Insurers’ DSMES reimbursement rules?o Sponsoring organization’s policies and

protocols?

Examples* of Process Quality Measures• Educators use of:

o Evidence-based decision support tools

o Information technology (IT) systems

o Lab data in EHR

• Regularly scheduled:

o Performance self-appraisals of DSMES team

o In-service education events for DSMES team within sponsoring organization

o DSMES program’s Advisory Committee meetings

Examples* of Process Quality Measures, Cont.

• Pt contacted within 24--48 hours of receipt of referral

• No-show pts contacted within 24--48 hours by educator to inquire about reason and to incent to reschedule

• Educator documentation of adherence to evidenced-based practice guidelines

• Pre-scheduled programs in the year are furnished

• All classes in each program are furnished

• Scheduled classes start and finish on time

About Outcome Quality Measures

• End result of what educators do over period of time

• Indicators of quality of DSMES program and educators

• Desired outcomes measures established by DSMES team

• Type: patient, provider + program outcome measures

• How outcomes established: by DSMES teamo Benchmarking with other DSMES programs

(external data)o Diagnosing internal data related to

measures

Examples* of Outcome Quality Measures

• Patient Outcome Measureso Measurable improvement in outcomes

related to:

Knowledge

Confidence

Behavior change

Clinical—health status

Quality of life

Cost-savings

Examples* of Outcome Quality Measures, Cont.

• Program Outcome Measures:

o A1c measured on all pts improved in the aggregate

o Claims to health insurers with DSMES benefit are reimbursed at maximum rate within 12 months

Examples* of Outcome Quality Measures, Cont.

• Provider Outcome Measures:

o Provider initial referrals increase by 2% in 12 months

o Provider follow-up referrals increase by 3% in 12 months

o New providers refer to program within 3 months of being affiliated with sponsoring organization

DSMES Business Plan

Quality Measures

Adherence to National

Standards of DSMES Plan

Structure Measures

Realization of sponsoring organization (SO) or sponsoring individual for DSMES program

DSMES Business Plan

Quality Measures



Structure Measures:

Realization of written policies and procedures which indicate how each of the 10 National Standards of DSMES will be adhered to by the sponsoring organization or sponsoring individual

DSMES Business Plan

Quality Measures



Structure Measures (Standard 1)

Receipt of letter of support from senior administration of sponsoring organization affirming that organization will recognize and support quality DSMES as an integral component of diabetes care

DSMES Business Plan

Quality Measures




Realization of external stakeholders and experts to promote program quality (aka, Stakeholder Committee)

DSMES Business Plan

Quality Measures




Realization of program coordinator that is designated to oversee the DSMES program and have oversight responsibility for the planning, implementation, and evaluation of the education services.

• Coordinator is CDE or BC-ADM, or annually accrues 15 hours of CE credits based on program anniversary date

DSMES Business Plan

Quality Measures




Realization of instructional staff that includes minimum of RN or RDN or RPh with training and experience pertinent to DSMES, or another professional with certification in diabetes care and education, such as a CDE or BC-ADM

DSMES Business Plan

Quality Measures




Realization of written DSMES curriculum reflecting current evidence and practice guidelines, with criteria for evaluating outcomes, that will serve as the framework for the provision of DSMES

DSMES Business Plan

Quality Measures




Realization of DSMES program in order to fulfill the AADE accreditation or ADA recognition requirement that:

• >1 participant completes the DSMES program

• A copy of participant’s de-identified chart demonstrating the complete education process be submitted with initial accreditation or recognition application

DSMES Business Plan

Quality Measures



Process Measures (Standard 1)

Realization of the documentation of

• An organizational structure

• Mission statement

• Program goals

DSMES Business Plan

Quality Measures




Reliable assessment conducted by provider of the DSMES to identify

• Whom to serve (target population)

• How best to deliver DSMES to that population

• What resources can provide ongoing support for that population

DSMES Business Plan

Quality Measures

Adherence to National Standards

of DSMES Plan


Realization of DSMES program design that defines the:

• Number of total visits/program

• Number of group and/or individual visits

• Length of time of visits

• Maximum number of pts per visit (if number is limited due to space)

• Locations of the program:

o At sponsoring organization

o At off-site locations

DSMES Business Plan

Quality Measures




Realization of each participant’s:

• Individualized assessment of the DSMES and support needs by one or more of the instructors and signed by the participant

• Individualized education and support plan focused on behavior change that is collaboratively developed by an instructor and the participant

DSMES Business Plan

Quality Measures




Realization of written communication regarding each participant’s individualized education plan, DSMES provided, outcomes achieved and the diabetes self-management support plan with:

• Other health care team members

• Referring provider after each DSMES visit

DSMES Business Plan

Quality Measures




Realization of personalized follow-up plan for Diabetes Self Management Education and Support (DSMES) that is reviewed with participant and communicated with:

• Other health care team members

• Referring provider

DSMES Business Plan

Quality Measures


of DSMES Plan


Realization of instructor documentation of:

• Participant’s written behavioral goals and desired outcomes collaboratively developed with the participant and an instructor

• Interventions to achieve behavioral goals and outcomes

• Follow-up assessment of achievement of behavioral goals and outcomes

DSMES Business Plan

Quality Measures


of DSMES Plan


Realization of the:

• Measurement of the effectiveness of the education and support

• Continuous quality improvement activities to improve any identified gaps in services or service quality, using a systematic review of process and outcome data

• Process for following-up and evaluating the participant’s desired outcome(s)…e.g. clinical, quality of life, satisfaction

DSMES Business Plan

Quality Measures



Process Measures

Reliable assessment conducted by provider of the DSMES to identify

• Referring providers in local area

• People in community who are not patients of referring providers but have diabetes

DSMES Business Plan

Quality Measures



Structure Measures and ProcessMeasures (Standards 1 -10)

Realization of each “essential element” of Standards 1 through 10

• For complete listing of essential elements for each of the 10 standards, see separate document titled:

ESSENTIAL ELEMENTS CHECKLIST ANDINTERPRETIVE GUIDANCE FOR AADE DIABETESEDUCATION ACCREDITATION PROGRAM ORADA EDUCATION RECOGNITION PROGRAMCERTIFICATION

DSMES Business Plan

Quality Measures



Outcome Measures (DSMES Program)

Realization of certification of DSMES program as evidenced by:

• Initial AADE accreditation or ADA recognition of program

• Maintenance of accreditation or recognition at each renewal cycle

DSMES Business Plan

Quality Measures


Structure Measures (DSMES Team)

Reliable access to:

• EHR for:

o Lab data

o Providers’ notes

o Diagnoses

o Medications

• Patient registry

• Electronic data management system (e.g., AADE7™ System)

DSMES Business Plan

Quality Measures



• Evidence-based DSMES curriculum

• Decision support tools:

oADA Medical Standards of Care for DM

oAND Online Nutrition Care Manual

oAADE book The Art and Science of DSMES

oChronic Care Model

oOther reference books, journals, online subscriptions, websites, listservs, etc.

DSMES Business Plan Quality Measures


1. U.S. Institute of Medicine's Quality Chasm Report, seven dimensions of patient-centered care for PWD presented on NDPP information site; at:http://ndep.nih.gov/hcp-businesses-and-schools/practice-transformation/patient-centered-interactions/dimensions-of-patient-care.aspx

Process Measures (Patient and DSMES Team)

Regularly demonstrated patient-centered care by DSMES team, as evidenced by1:

• Respect for pts' values, preferences, and expressed needs

• Coordination and integration of care

• Timely and clear communication with pts

• Physical comfort of pts

• Involvement of pts’ family and friends

• Emotional support of pts: relieving fear and anxiety, and screening for depression



Process Measures (Patient and DSMSE Team)

Regularly completed clinical processes by DSMES team within required time frames:

• Completion of patient’s initial assessment

• Rendering DSMES program visits

• Documenting patient visits

• Completing progress notes and forwarding to provider within 48 hours

• Downloading CGM data for provider

DSMES Business Plan

Quality Measures

Operations Plan

Structure Measures:

Right DSMES program design to meet needs, wants and expectations of patients and providers:

• Room/space assigned to program

• Number of total visits/program

• Number of group and individual

visits/program

• Time frame of each visit in program

• Days and times that visits are scheduled

• Number of programs per year and dates of

DSMES Business Plan

Quality Measures

Operations Plan

Structure Measures:

Rendering DSMES program in:

• Other entities (e.g., hospitals w/o

program)

• Branch and/or community sites (off-site)

• Employer work sites

DSMES Business Plan

Quality Measures

Operations Plan

Process Measures (Patient)

Reliable operational processes as evidenced by:

• Patients’ calls/emails returned within 24 hours

• Completion of patient visits attendance sheets

• Maintenance of patient handout inventory

• Classroom fully prepared prior to visits

• DSMES program schedules completed in timely fashion and distributed to pts at 1st visit


Operations Plan

Process Measures (Patient)

• Patient appointment reminder calls made24--48 hours in advance of each visit

• Educators call no-show patients within 24—48 hours to inquire about reason for not keeping appointment and to reschedule

• Training of DSMES team members for functions performed (including CHWs)


Operations Plan

Process Measures (DSMES Team)

• Cross-training of team members to substitute for other roles (in cases of absences)

• Ongoing training to keep up-to-date on all aspects of DSMES

• Clear definition of tasks and of assignment of roles among team members

• Routine communication through regular team meetings and paper and e-information flow


Operations Plan

Outcome Measure (Patient)

Retention of patients in DSMES program

Realization of satisfaction ratings on each survey question as excellent, very good or good by >80% of patients who complete surveys

DSMES Business Plan

Quality Measures

Marketing Plan

Structure Measures:

Reliable support from Marketing Dept. or personnel of sponsoring organization

DSMES Business Plan

Quality Measures

Marketing Plan

Process Measures:

Regular use of various, proven-effective promotion and advertising strategies

• Strategies are summarized in acronym S.U.P.E.R. M.A.R.K.E.T.I.N.G. for obtaining

o Provider referrals

o Patient self-referrals

Quality Marketing Plan Spells:S.U.P.E.R. M.A.R.K.E.T.I.N.G.

Goal:Increase Program Awareness and Value, and

Build Trust In

S Set up screenings markets, malls

at health fairs, farmers’

U Use social program

media + patient blogging to promote

P Pursue free publicity in local newspapers

E Ensure referrals forms are hand-delivered to provider

R Report patient outcomes to providers regularly

M Marketing brochures or slim jimsMailers (single or inside neighborhood ad booklets)

A Ads in local newspapers and church bulletinsArticle writing for local newspapers

R Radio interviewsReferral forms (branded and Medicare compliant)

K Keeping track of ROI for each marketing activity

E Establishing program as employee wellness initiative

T Television interviews on local cable channelsTelephone book yellow pages

I Internet website advertising (sponsoring org, LinkedIn, AADE)

N No charge presentations at community events

G Get program logo, tagline, give-away (Diabetes Calendar)

DSMES Business Plan

Quality Measures

Marketing Plan

Outcome Measures:

Robust Referrals from:

• Providers

• Patient self-referrals


Financial Plan

Structure Measures:

Reliable access to:

• Personnel in Finance/Accounting Dept. of sponsoring organization (bean counters!)

• Personnel in Billing/Coding Dept.

• Timely financial reports related to DSMES program:

o Budget

o Income statement

o Expense report


Financial Plan

Structure Measures:

Realization of:

• How DSMES program structured by administration of sponsoring organization:

o Profit center or cost center

• Expectations of same:

o Break-even?

o Make money?

o OK to lose money (as considered goodwill, community service or loss leader)?


Financial Plan

Structure Measures

• If sponsoring organization or sponsoring individual will bill Medicare for the DSMES, same must:

o Enroll in Medicare Part B as organizational or individual provider

o Be billing Medicare for other services and be reimbursed


Financial Plan

Process Measures:

If billing insurers:

Reimbursement is maximized by the DSMES team insuring that:

• All insurer-billable visits billed

• All patient co-payments collected

• All out-of-pocket payments from uninsured patients collected

• Insurance claims tracked retrospectively for status

o Action taken on denied/rejected claims to determine corrective action and re-billing


Financial Plan

Process Measures:

Reliable monitoring by educators of patient financial outcomes…example:

• Reduction in:

o Medications

o ER visits

o Therapies

o Intermediate care facility visits


Financial Plan

Outcome Measures:

Reimbursement Revenue maximized:

• Claims to health insurers who cover DSMES are reimbursed at maximum rate within 2 months

• 100% of DSMES fees to patients who self pay are collected within 2 months

• 100% of patient co-payments are collected within 2 months


Financial Plan

Outcome Measures:

Reimbursement Revenue maximized:

• Claims to health insurers with DSMES coverage reimbursed at maximum rate within 2 months

• 100% of DSMES fees to patients who self pay collected within 2 months

• 100% of patient co-payments collected within 2 months


Financial Plan

Outcome Measures:

Realization of the sponsoring organization’s financial expectations of DSMES program:

• Make a profit (per methodology used by SO)

• OK to lose money (up to specified amount express as a metric, ratio, etc.)

• OK to break even (per methodology used by SO)


Financial Plan

Outcome Measures:

Rates of diabetes educator productivity meet desired targets

Return on investment in educator hours meets desired targets


Continuous QualityImprovement Plan


Reliable access to:

• Quality management/CQI director of sponsoring organization

• EHR for:

o Lab data

o Providers’ notes

o Diagnoses

o Medications

• Patient registry

• Electronic data management system (e.g., AADE7™ System)



Process Measures (DSMES Team)

Regularly scheduled:

• Performance self-appraisals of DSMES team

• In-service education events for DSMES team within sponsoring organization

• DSMES program’s Advisory Committee meetings

Realization of each team member’s explicitly identified goal for professional development



Process Measures (CQI Plan Specific)

Regularly completed number of pre-identified CQI projects over set period of time

Regular use of evidence-based steps/protocol for conducting CQI projects…example:

• AADE’s Continuous Quality Improvement for Diabetes Education and Support Programs (includes 8 Step CQI Process)

Resolution of identified problems and/or gaps

Realization of improvements in program



Outcome Measures (Patient)

Realization of patient outcomes:

• Knowledge

• Confidence

• Behavior change

• Clinical—health status

• Quality of life

• Cost-savings

• Satisfaction

Retention of patients in DSMES program



Outcome Measures (Provider)

Realization of provider outcomes:

• Satisfaction with DSMES program and educators as evidence by survey responses

• Trust and loyalty in DSMES program and in educators as evidence by survey responses and ongoing and increase in provider referrals

Facilitated Discussion

Chat in your questions and comments.

Press *1 on your telephone key pad to enter the teleconference queue.

224

Call to Action

• Share a strategy that you learned today that you intend to put into practice. (Chat it in!)

• Identify at least one partner you can ask to join you in your DSMT efforts.

• Complete the post-event assessment: https://www.surveymonkey.com/r/7LBPPCM

225

https://www.surveymonkey.com/r/7LBPPCM

CE Credit

• Complete the post-event assessment upon exiting WebEx: https://www.surveymonkey.com/r/7LBPPCM

• It will pop up at the conclusion of the event• There is a separate evaluation required for CE that is

linked within the post-event assessment• Once you submit your CE evaluation, you will be

provided with a certificate to retain for your records• For technical assistance, please email Nikki Racelis

([email protected])

226

https://www.surveymonkey.com/r/7LBPPCM


Save the Date!

Join us for the remaining two calls in the Three-Part QIN-QIO Public Sharing Call Series: Going Back to Basics of Diabetes Self-Management Training

– The 2nd Thursdays of November (11/8) and December (12/13)– Topics: operations, reimbursement, and CQI for DSME/T

programs– 3:00 - 4:30 PM ET– Registration is required!

• Register separately for each call at https://qioprogram.org/qin-qio-public-sharing-calls-3-part-series

227

https://qioprogram.org/qin-qio-public-sharing-calls-3-part-series

Follow the QIO Program on Social Media!

https://twitter.com/QIOProgram

https://www.youtube.com/channel/UCP-3KliHRoKeozEs-7ohQnw

228

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https://www.youtube.com/channel/UCP-3KliHRoKeozEs-7ohQnw

Thank you!

229

This material was prepared by Telligen, the Quality Innovation Network National Coordinating Center, 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. 11SOW-QINNCC-02338-09/25/18

Documents

QIN-QIO Public Sharing Call – October 11, 2018 · 10/11/2018 · Marketing Plan. 5. Name the key elements to include in the . Operations Plan. 6. Name the key elements to include