Integration: The Path to Increasing Value and Recognition of our Specialty
Mar 6, 2019, 13:23 PM
by Board Member Kellie Rodriguez, MSN, MBA, CDE
With a long and proud 22-year history in the specialty of diabetes education, I have seen my role evolve from a more traditional position as an educator seeing people with diabetes, to one more focused on program management and coordination. I am currently responsible for directing clinical care and education across a health system comprising a large hospital, specialty clinics, primary care clinics, county jail and community interface.
My focus is not only on diabetes but connected cardio-metabolic, vascular and behavioral health conditions. It’s also expanded to address the holistic needs of populations, rather than being purely focused on individuals. In talking more with colleagues across the nation, integrated roles like this are increasing, creating incredible opportunities and need for our specialty.
The move to value-based healthcare, where payment is made based on achievement of required clinical outcomes, raises the multidisciplinary richness of our specialty.
Diabetes educators have a strong tradition of providing people with diabetes and their family / support persons the knowledge, skills and tools they need to effectively undertake diabetes self-management. However, you only have to look at the NHANES Survey Data to understand that people with diabetes are not achieving core diabetes metrics across A1c, blood pressure and cholesterol (approximately 50%) and are achieving less than 14% across all three areas combined. There is a key disconnect between what we know and the real-life application into the lived world of people with diabetes, where social determinants can drive poor outcomes. Most people with diabetes are not exposed to quality diabetes education and I believe that is a key link to sub-optimal patient outcomes.
The move to value-based healthcare, where payment is made based on achievement of required clinical outcomes, raises the multidisciplinary richness of our specialty. Clinical outcomes require the application of clinical best practice combined with an informed, skilled patient in effective self-care. There is greater recognition that success lies more with what happens with the patient in between office visits rather than at the visit.
In my work place we are looking at the most effective way to capture core social determinants of health data, recognizing this is important both for stratification of the patient and optimal intervention strategies. The 2019 ADA Standards of Diabetes Care have now included a Decisions Cycle that highlights many patient-centered considerations driving outcomes – raising the value of our multidisciplinary intervention.
Workforce training and leveraging in these important non-clinical areas are inherent to the role and capabilities of the diabetes educator. We can train the system on patient-centered guidelines and develop strategies for effective implementation at the patient and population level, through use of face-to-face and electronic training approaches, ensuring core competency achievement. The skillset we have for patient assessment of clinical need and education is what is also critically required for care team and / or system training. We can drive system processes, responsibilities and efficiencies, which incorporate and impact both patient and employee effectiveness, engagement and satisfaction.
Our roles are expanding into cardio-metabolic conditions, including obesity, hypertension and cardiac conditions, as well as micro and macrovascular disease and behavioral health. We are no longer diabetes programs, but rather system programs – utilizing available service lines, especially in the areas that impact behavioral and social determinants of health – because we best assess and understand the patient-centered factors that drive clinical outcomes. In my workplace, we are expanding our workforce to include a robust community health worker infrastructure because we know clinical recommendations demand a lived world that can embrace them – our services likely are most impactful outside of the health system, rather than in it. The educator role in training this community workforce in both clinical and patient-centered diabetes management will be required. It’s clear that diabetes educators have a core role in the integration of clinical management, self-management, prevention and support throughout the health continuum from pre-diabetes to complex diabetes management and cardio-metabolic conditions.
It is critical that diabetes educators reflect on the services they provide, moving from a diabetes program mindset to one that embraces broader opportunities
At my workplace, it has been important to move our mindset from being a diabetes team to one that is a system team of 10,000 employees – integration is purposeful and at the core of our business. An example is our role in preventive foot care education – we have been key resources in developing a system-wide preventive foot care service line that has included the development of a risk stratified clinical management pathway that includes community, primary care, specialty care and hospital personnel. An online and face-to-face training and competency module has been developed collaboratively with specialists and will be rolled out across disciplines throughout the system in these areas. Likewise, educators have been core resources in meeting A1c testing and outcome measures that have utilized strategies including workforce training, EHR assessment and reporting tools, medication adherence, multidisciplinary intervention, social and behavioral health interventions and others. Diabetes educators have the required knowledge, skills and touchpoints to effective in all these areas.
It is critical that diabetes educators reflect on the services they provide, moving from a diabetes program mindset to one that embraces broader opportunities to utilize our inherent clinical, education and training, communication, collaboration and process improvement skills and apply that to related disease states, as well as to the broader system of health care. It requires a strong belief in one’s ability and actively searching the health landscape for opportunities to impact and thrive. Our professional survival demands it!
We must use our multidisciplinary richness to create interdisciplinary brilliance and value. The move from fee-for-service payment to one that is value, outcomes based, raises important opportunities and need to integrate, expand and raise our profile and reach. The NHANES data screams that opportunity and our specialty has the talent to do it!
This is not a time for passivity but action!