December 22, 2022
The Association of Diabetes Care & Education Specialists (ADCES) The Association of Diabetes Care & Education Specialists (ADCES) is an interdisciplinary professional membership organization on the forefront for better care. A community of collaborators, advisors and supporters, the organization translates evidence-based research into accessible resources so members can stay on top of best practices and propel the specialty forward. With a shared purpose and a singular focus, ADCES features an integrated care team that lowers the cost of care, improves experiences and helps its members lead so better outcomes follow.
The Opportunity
Previously, ADCES engaged Atrómitos and our Advisor, Lavondia Alexander of Evolve Health Strategists, to develop resources and training material to help CHCs integrate the National DPP into their overall model of care. We accomplished this through the development of resources that helped CHCs ensure patients participating in their National DPP lifestyle change program received comprehensive primary care services, as well as identified opportunities in payer contracts to receive incentive dollars based on performance against diabetes-related quality measures. ADCES sought to expand on this work by helping CHCs move from integrating the National DPP to finding ways to financially sustain the program beyond the life of their CDC cooperative agreement. The Association returned to Atrómitos to re-engage Ms. Alexander and us to support them with this sustainability work.
Goals
The outcome of this engagement would again help ADCES achieve the key strategic goal of increasing coverage of the National DPP lifestyle change program.
ADCES looked to achieve this strategic goal by:
- Developing collateral to assist CHCs in sustaining their National DPP as part of their larger diabetes care framework; and
- Conducting one-on-one training and technical assistance (T/TA) sessions with a cohort of CHCs on most effectively using developed collateral to address primary pain points the CHC experienced with sustaining the National DPP.
As with previous engagements with ADCES, the organization chose Ms. Alexander and us as consultants to support their initiatives given our extensive familiarity with CHC operations, background in change management principles, and capability to synthesize and directly apply policy and regulatory guidance. We committed to supporting ADCES by developing collateral specific to sustaining the National DPP within a CHC setting and providing targeted T/TA sessions with CHCs participating in ADCES’ cooperative agreement.
The engagement would require us to effectively query CHCs on their primary pain points related to sustaining their National DPP, review policy and regulations controlling both the National DPP and CHC billing practices (including guidance on what type[s] of staff can provide which service[s]), and deliver targeted, individualized T/TA to a cohort of CHCs looking to overcome challenges with sustaining their National DPP efforts.
Approach
Strategic Planning
The first part of our engagement was creating a diabetes care framework for CHCs, which leveraged the National DPP as the foundation of their diabetes-related services. We identified four Pillars upon which CHCs could further build their diabetes infrastructure upon the National DPP: (i) understanding Clinical Quality Measures related to diabetes care [CQM]; (ii) increasing the delivery of behavioral health services for patients at-risk of developing Type 2 diabetes [Service Integration]; (iii) leveraging virtual platforms to increase patients’ ability to engage with National DPP and other diabetes-related services provided by the CHC [Access to Care]; and (iv) improving the collaboration between CHC team members to streamline workflows and more effectively deliver care to patients participating in the CHC’s National DPP [Workforce]. These four Pillars became the groundwork for how CHCs would engage with the information and T/TA provided throughout the project year, with each CHC identifying the Pillar they were either most interested in focusing on or experiencing the most significant barriers to standing up.
Market Analysis
The second part of our engagement involved developing, deploying, and analyzing data from a survey completed by CHCs participating in the National DPP lifestyle change program under ADCES’ cooperative agreement with the CDC. The survey intended to ask CHCs to identify and rate the likelihood of using potential resources within each Pillar and which Pillar their CHC was looking to focus on throughout the project year. In addition, the virtually deployed survey collected demographic information about the individual respondents and the CHC overall. We asked the National DPP Coordinator within each CHC to complete the survey and, in support of our Workforce Pillar, asked the Coordinator to identify other team members within the CHC who could most effectively help them think through what resources would be most useful for the CHC.
Legislative and Regulatory Analysis
Analysis of the survey data identified a primary type of resource under each Pillar CHCs wanted to have developed to support their teams in sustaining their National DPP. This phase of our engagement involved conducting research on legislation, regulations, and programmatic guidance related to the following topic areas: licensing guidelines for behavioral providers, telehealth regulations for the National DPP, advanced quality improvement methodologies, and standard practices within CHCs for improving interdisciplinary team collaboration.
Brief and Whitepaper Development
Once we completed our research, we developed a series of collateral that outlined specific and practical steps CHCs could take to sustain their National DPP. These collateral-identified steps included the process for helping Licensed Clinical Social Workers (LCSWs) employed by the CHC become a Certified Diabetes Care and Education Specialist (CDCES), as well as best practices for developing and managing a panel of patients interested in receiving diabetes-related care, including the National DPP, virtually.
Meeting Facilitation
The next stage of our engagement involved conducting a virtual training for all CHCs participating in the National DPP under ADCES’ cooperative agreement. We delivered all finished collateral to CHC staff registered for the training and facilitated a sixty-minute review of the collateral. During the training, we also outlined how CHCs could use each of the collateral as part of their T/TA, and the type(s) of barriers they could help the CHC address.
Change Management
The final stage of our work during this project year was conducting individualized T/TA sessions with a cohort of four (4) CHCs. These sessions aimed to provide CHCs an opportunity to identify a challenge they were experiencing with sustaining their National DPP, align with one of the Pillars, and troubleshoot solutions with us. We used this opportunity to identify for CHCs collateral we had developed earlier in the project year that was relevant to the challenge they identified. The final outcome of these sessions was a tactical plan each CHC could implement in the coming year to address their identified challenge.
Conclusion
We produced seven (7) collateral items for ADCES and the CHCs they support.
Under the CQM Pillar, we developed:
- Creating a PDSA walks CHCs through the necessary steps to effectively utilize the Plan-Do-Study-Act model as a quality improvement tool.
- Forming a Quality Improvement Team discusses the roles in an effective quality improvement team, as well as the dynamics to expect when using such a team to create change within the CHC setting.
- Quality Improvement Action Plan is a template CHCs can use to document their quality improvement initiatives related to the National DPP and their delivery of other diabetes-related care.
Under the Service Integration Pillar, we developed:
- Integrating a LCSW CDCES into the National DPP identifies the steps necessary through two pathways LCSWs must follow to become a CDCES.
Under the Access to Care Pillar, we developed:
- Opportunities for Patient Engagement identifies three primary ways in which CHCs can leverage virtual platforms to engage patients in diabetes-related care.
- Increasing Patient Engagement reviews best practices from across care settings to working and managing panels of patients interested in receiving care virtually.
Under the Workforce Pillar, we developed:
- Tools to Support Care Team Development and Utilization describes what a Care Team is and how it can be implemented within the CHC setting to deliver care more effectively to CHC’s National DPP participants.
