New funding mechanisms offer opportunity to improve access to diabetes education

Diabetes is one of the most costly chronic conditions. Teaching patients to manage their own condition is a cost-effective approach resulting in reduced complications and improved health outcomes.

However, the current reimbursement model leads to gaps in access to diabetes self-management education and existing program designs are not convenient for patients. Recent innovative policy changes and funding models offer the opportunity to test new diabetes education delivery methods. There is no one-size-fits-all approach to diabetes education, and in order to extend programs to a wider audience, a combination of in-person and digital/telephonic programs should be used. Utilizing telehealth and designing programs that fit into patients’ lives will dramatically expand participation. 

Availability of diabetes education classes is limited

Education and disease management programs are commonly used by insurers to encourage behavior change. Programs that offer in-person group classes have been found to have a mixed impact. Medicare Part B reimburses accredited in-person diabetes self-management education (DSME). There are fewer DSME programs in rural areas due to a shortage of accredited providers, as a result of an expensive and laborious accreditation process. Even in areas where there are diabetes self-management programs, patients may not find the class times convenient for their schedule; ten hours of classroom education is hard to juggle between work and family commitments. In order to make lasting behavior change, programs have to meet people where they are and fit into their lives. We can bridge this gap and help providers touch patients outside of the office through telephonic diabetes education programs with one-on-one coaching focused on improving lifestyle, behavior and medication adherence. Utilizing telehealth allows patients to schedule education at a time that works for them.

Current reimbursement model limits accessibility

While Medicare Part B reimburses diabetes education and self-management programs, coverage varies among Medicaid and commercially insured populations. A recent study found that only 30 state Medicaid programs cover DSME programs and only 6.8% of privately insured diabetes patients took part in a DSME class. The most commonly reported barriers that prevent patients from engaging in DSME are 1) coverage and cost, 2) access and logistical issues such as scheduling and 3) patient believing they do not need the education. This same study found that insurers who reduce or eliminate patient cost-sharing for diabetes education programs will realize significant cost savings and higher participation. Another concern with the DSME program is that it is reimbursed under a fee-for-service model, where a provider is reimbursed a fixed amount for providing the training whether a person only goes to one class or graduates, completing all sessions. With this reimbursement model, there is little incentive to provide the thorough education necessary for successful self-management.

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