Maryland s Partnership with Medicaid and DSME

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1 Maryland s Partnership with Medicaid and DSME October 31, 2013 Adelline Ntatin MPH, MBIM, MA Heart Disease, Stroke, and Diabetes Program Administrator Maryland Department of Health and Mental Hygiene Prevention and Health Promotion Administration

2 MISSION AND VISION MISSION l The mission of the Prevention and Health Promotion Administration is to protect, promote and improve the health and well- being of all Marylanders and their families through provision of public health leadership and through community- based public health efforts in partnership with local health departments, providers, community based organizations, and public and private sector agencies, giving special attention to at- risk and vulnerable populations. VISION l The Prevention and Health Promotion Administration envisions a future in which all Marylanders and their families enjoy optimal health and well- being. 2

3 Presentation Outline l Overview of Public Health/Medicaid partnership l Maryland Medicaid DSME coverage l Assessment of State DSME programs and Gindings l Lessons learned and challenges l Next steps and opportunities for collaboration 3

4 Diabetes Prevalence in Maryland 4

5 Maryland versus National Data 5

6 DHMH Infrastructure 6

7 Diabetes Self- Management Education (DSME) l An interactive, collaborative process that can equip adults with basic knowledge to manage their type 2 diabetes while focusing on their self- identigied problems and goals. l Goals: Improve metabolic control and quality of life Reduce diabetes- related complications Minimize health care costs l Delivered by health professionals and public health practitioners 7

8 Medicaid Program and DSME Coverage l Healthchoice Program l AMERIGROUP Community Care l Jai Medical Systems l Maryland Physicians Care l MedStar Family Choice l Priority Partners l Riverside Health of Maryland l United HealthCare 8

9 HEDIS Measures l l HEDIS Measures selected for HealthChoice and Primary Adult Care reporting Comprehensive Diabetes Care (CDC), all indicators except HbA1c good control (<7.0%) Comprehensive Diabetes Care (CDC) HbA1c testing; HbA1c poor control >9.0; HbA1c control <8.0* Comprehensive Diabetes Care (CDC) Eye exam (retinal) performed Comprehensive Diabetes Care (CDC) LDL- C screening; LDL- C control <100mg/dL* Comprehensive Diabetes Care (CDC) Medical attention for nephropathy Comprehensive Diabetes Care (CDC) Blood pressure control <140/90 mm Hg Comprehensive Diabetes Care (CDC) Blood pressure control <140/80 mm Hg* 9

10 Regulation Language l COMAR Services for Primary Adult Care (PAC) Enrollees with a Diabetes Diagnosis. An MCO shall provide the following medically necessary services to a PAC enrollee who has a diabetes diagnosis: l Diabetes education; l Diabetes nutrition education; An MCO shall provide to its enrollees all medically necessary pharmaceutical services and pharmaceutical counseling, including but not limited to: l Disease Management 10

11 Maryland DSME Programs l DSME programs in Maryland 39 ADA accredited Diabetes education programs. 14 AADE accredited diabetes education programs. 45 Chronic Disease Self- Management Program workshops in 7 counties. 24 Diabetes Self- Management Program workshops in 8 counties. 11

12 State Capacity Needs Assessment l The project assessed the current status of DSME in Maryland with a focus on ADA and AADE recognized programs. l 36 program coordinators were contacted via , out of which 20 responded to the survey. 12

13 Survey Results l Total patient capacity per quarter and utilization. 13

14 Indicators 14

15 Efforts to Enhance DSME Programs in Maryland l Maryland DIRECT: Monthly Diabetes Newsletter Enhanced DPCP website Diabetes Awareness Campaign 2014 Maryland Diabetes Symposium Town hall meetings Offering training in regards to billing for DSME at ADA and AADE sites 15

16 Opportunities for Enhanced Coordination l Maryland Million Hearts l Maryland Multi- payer PCMH l Health Enterprise Zones l State Innovation Model l Local Health Improvement Plans l Maryland Health Resource Commission 16

17 For Questions: Adelline Ntatin, MPH, MBIM, MA [Date] 17

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