Even if you weren’t able to attend AADE18 in Baltimore, there are plenty of opportunities to learn and grow! You can download the AADE18 app and the presentation handouts are available to all AADE members.
Congratulations to Montana presenters at AADE18: Deb Bjorsness and Jennifer Troupe! You both did an awesome job discussing your work in the DPP, Deb discussing delivering the DPP via telehealth, and Jennifer outlining ROI (return on investment) for the DPP and discussing the 'business case' for implementing the DPP. Again, great job!
One of the best parts of the annual meeting is the networking that happens! I have met exceptional educators from around the country, and it’s so fun to connect and learn from them. One the people that has mentored me over the years in the public health realm is Ann Constance from Michigan. Ann is a former National AADE Diabetes Educator of the Year, and is currently the Public Health COI co-leader. Ann wrote a blog about her AADE18 ‘take aways’ and has offered to share it with us. This next segment is hers (to be followed by more of my thoughts and experiences at the annual meeting).
From Ann (thanks, dear friend!):
The person to person networking, exhibits, presentations, poster sessions, meetings and fun of AADE18 are over, but the education and potential impact on practice remains. Dr. Robert Gabbay, the Chief Medical Director of the Joslin Diabetes Center, began our conference by reinforcing the value of the Diabetes Educator (Specialist). With the change from Medicare’s fee-for-service to merit based payment system, patient outcomes become more valuable. Typically seen as a cost center, diabetes care, will become a saving center. Dr. Gabbay also stated that revenue centers like CT surgery, PTCA and orthopedic surgery will become cost centers. We are entering an era of keeping people healthy instead of waiting for them to develop problems that we can try to fix. This is especially important in the diabetes field as DIABETES IS COSTLY, COMMON, COMPLEX AND COMPLICAITONS CAN BE PREVENTED. In addition, we know that we can delay or prevent type 2 diabetes.
This change in Medicare payments presents Diabetes Educators with more opportunities. One is to assist with practice coaching (helping clinic staff enhance their of support those living with diabetes and other chronic condition). In addition, our work can be augmented through digital care. Perhaps one of the most important roles in care management is using risk stratification to identity the different needs of people living with diabetes. The skill set of the Diabetes Educator makes him or her the perfect person to work with the highest risk clients. Dr. Gabbay stated that ‘There has never been a better time for diabetes specialists. Patient engagement and adherence are key, and they are the big buzz in health care right now.’
Another pearl of wisdom discussed how complex obesity treatment is –Dr. Kevin Hall of the NIDDK has done lab- based research –people come to his lab and stay for up to 2 months where he has control over the food they eat. Dr. Hall has studied the keto diets for up to 2 months where he found there was no change in the number of calories burned and that the shift to fat adaptation lasted only one week. In addition, the loss of body fat slows post keto diet and the amount of fat free mass loss increases. Another negative side effect of low carb diets is that they can impair glucose tolerance.
Dr. Hall also has studied the participants in the TV Biggest Losers show. His ‘Bigger Loser’ research indicated that dieters have a greater slowing of metabolism than expected and that the altered resting metabolic rate remained low despite weight regain. The ‘Losers’ who regained the least amount of weight maintained a high level of physical activity. More good news is that despite a 2/3s weight regain, the average Biggest Loser still maintained a mean weight loss of 12%!!
If you were not able to attend AADE18, I would encourage you to download the app and take at look at the speaker handouts. You may garner some ideas and then connect with speakers, if more info is desired.
References:
KD Hall, E Fothergill, et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. May 2016. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1002/oby.21538
KD Hall. A review of the carbohydrate-insulin model. European Journal of Clinical Nutrition volume 71, pages 323–326 (2017)
KD Hall, TBemin, et al.Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity. Sept 2015. Available at: https://www.sciencedirect.com/science/article/pii/S1550413115003502
Fact Sheet: 2019 Merit-based Incentive Payment System (MIPS) Payment Adjustments based on 2017 MIPS Final Scores. Available at: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2019-MIPS-Payment-Adjustment-fact-sheet.pdf
RGabbay. Driving change and innovation, AADE 2017. Available at: https://www.diabeteseducator.org/docs/default-source/annual-meetings/aade17/d05.pdf?sfvrsn=2
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Back to my own thoughts… here are what I saw as three overarching themes to the conference:
- Population health
- Technology
- Peer support
AADE had a pre-conference ‘summit’ on population health and the evolving roles of diabetes educators. There was a lot of great discussion about the changing models of care and how that is driving roles and emphasizing the value for the work we do. As Ann described in her blog above, diabetes care has previously been a ‘cost center,’ whereas in the new models of care, diabetes care is being described as a ‘savings center.’ This provides huge opportunities for diabetes educators as a proven and evidence-based strategy for behavior change that positively impacts health outcomes.
There were a number of sessions highlighting population health. Session F10 (Friday): Kellie Rodriguez and Joan Olveda provided some real ‘pearls’ from their years of experience in moving into population health. Some of the things that were highlighted included:
- Have you actually read the 2018 ADA Standards of Medical Care in Diabetes? The first chapter is about population health! “Improving Care and Promoting Health in Populations.” Diabetes Care 2018; 41(Suppl 1):S7-S12 https://professional.diabetes.org/content-page/standards-medical-care-diabetes
- Get smart about the language that you use. Use the same language as the decision-makers/leadership in your organization.
- “Risk stratification” - means using resources to reach those at highest risk. High risk requires ‘high touch.’ Those patients categorized as higher risk require more touchpoints and strategies to mitigate risk. It involves effective and efficient resource utilization.
- “Quality” – this includes the ‘richness’ of what diabetes We are experts at deploying evidence-based, specialized diabetes care and education that is culturally sensitive and respectful of social determinants of health. We work in team-based structures that emphasize quality.
- “Outcomes” – There are outcomes that are important to your organization, as well as individual person-centered outcomes: clinical/health outcomes, psychosocial outcomes, behavior outcomes, financial outcomes, patient and provider productivity outcomes, etc. Outcomes data is what has elevated our value in this new model of care.
- The population that is being identified depends on the payer. Carrie Nagy-Marsh gave a great presentation on population health as well, saying that the huge problems that we have in our current healthcare system are because of how we built it. 1 in 3 Americans are on either Medicare or Medicaid. There is also a huge healthcare workforce shortage, and millennials are not going into the health professions. We have changed as a society, with ‘consumerism’ driving the healthcare markets, and healthcare has been slow to adapt. Technology will be required to reach vast numbers of people with health needs, but also balancing that with true patient-centered care. It’s “more than a graphic” – it respects the patient’s values, needs, traditions, decisions. Shared decision-making is one of the methods to ensure patients’ needs are being considered.
- A few resources and websites to consider regarding population health:
- AADE’s new Population Health Practice Area Discussion Group: http://www.myaadenetwork.org/p/co/ly/gid=356 (you must ‘join’ on the right hand side of the page)
- Healthcare Payment Model Learning Network: hcp-lan.org
- connectedhealthinitiative.org
- ihi.org
- himss.org
- rchnfoundation.org
- Johnson and Johnson Diabetes Institute webinar “Managing Populations, Treating Individuals” by Teresa Pearson jjdi.com
Technology was ‘front and center’ with the release of DANA…Diabetes Advanced Network Access. If you haven’t checked it out yet, I’ll tell you that this is one of the things that makes membership in AADE totally worth it! https://www.danatech.org Keeping up with all things ‘tech’ in the diabetes world is a challenge, and this resource is designed to help diabetes educators do just that! Check it out! Also, there’s a great article in the Sept 2017 edition AADE In Practice: “Are You Ready to be an e-Educator?”
One of the sessions I attended related to technology was on ‘patient reluctance to adopt technology.’ One of the key take-aways was to be genuinely curious and to ask more questions with these kinds of clients. Have those difficult conversations about ‘what makes them tick’ and what their barriers truly are. It may take more time up front, but doing so can help them identify the ‘sticking points’ and help them to overcome fears and perceived roadblocks. Don’t jump to solutions too quickly or ‘be seduced’ by addressing numbers first. Bring your humanity to the table so that they feel that they’ve been heard.
Lastly, the traditional model of how we’ve done diabetes education is really changing. Using technology to reach and engage people is where things are moving (and actually we are there already!), but we cannot lose that ‘touch’ when necessary. Augmenting digital care with diabetes educators and our relationships with our patients to guide self-care is vital. “Digital therapeutic companies desperately need diabetes educators.” Finding that mix of ‘reach’ via technology and that personal ‘touch’ is a challenge, but one that diabetes educators are diving into and can be so very effective.
Peer support was another topic that seemed to be highlighted in a large way. Because the balance of power has changed for those living with diabetes (i.e. they have the ‘lived experience’), they are searching out ways to gain knowledge, skills, and support to live a joyful, meaningful life…without waiting for the healthcare ‘structure.’ It’s an ‘I want it now’ kind of society in which we live…the consumer/client/PWD (person with diabetes) is figuring out to help themselves, and they are going to the DOC (diabetes online community) and other sources of peer support. And that support system is incredibly important, not to mention that peer leaders find joy and meaning in being positive change agents.
In looking at the ‘big picture,’ peer support is something that we need to embrace and recognize the value of its potential in helping PWD to not just get by, but to thrive. We have to shift our thinking and “change from being the bucket brigade to stopping the tanker from pouring gas on the fire.” The most recently revised National Standards of Diabetes Self-Management Education and Support added that last word – support – as an intrinsic part of providing the vital service that is DSMES. And that support can come from those who intimately understand what it’s like to live with diabetes 24/7/365.
Finally…(whew, finally!)…a couple of things that, for me, were of utmost value in attending this annual meeting included the mantra of “BE BOLD.” In our actions, in our unwavering support and advocacy, in our curiosity and in our caring…be bold. We have the opportunity to be “change agents with unprecedented goals.”