New Report Finds Inadequate Investment In Diabetes Services Despite Growing Epidemic

March 4, 2010                                                 David Nachtweih, 212-561-8730, ext. 229

                                                                        Mohammad Levesque-Alam, 212-206-5242

                

March 4, 2010 (NEW YORK) – A new study has found that there is inadequate reimbursement and investment in diabetes prevention and treatment resources in New York, which significantly hampers the State’s ability to contain the growing diabetes crisis.

 

The analysis, conducted by the New York State Health Foundation’s (NYSHealth’s) Diabetes Policy Center and the Center for Health Workforce Studies, examined the certified diabetes educator (CDE) workforce in New York. CDEs are proven resources in preventing and managing diabetes, and yet the analysis revealed that they are in small supply—especially in rural areas—and are not serving New Yorkers with the greatest burden of the disease, particularly low-income and minority populations.

 

“If we are going to reverse the diabetes epidemic, we must ensure that we have the resources and workforce in place to help people prevent the disease and its complications,” said Deborah Zahn, Director of the Diabetes Policy Center. “CDEs and other diabetes educators work with patients, doctors, and other health providers to do that. But unless we build up that infrastructure, we can expect to see more New Yorkers needlessly getting diabetes and losing their limbs, sight, or life.”

 

Numerous studies have shown that diabetes self-management educationcan improve the outcomes for people with diabetes.[1] For example, an analysis of 31 studies showed that self-management education improves blood sugar control at immediate follow-up and increased with more contact.[2] Another analysis of 18 studies found that the benefits of diabetes self-management educationon self-management and lifestyle modification for people withdiabetes are positive and outweigh the costs associated withthe intervention.[3]

Currently, 1.8 million New Yorkers have diabetes and another 3.7 to 4.2 million are estimated to have pre-diabetes. Yet despite the growing prevalence of the disease, the report found that there are only 1,000 CDEs in New York State and more than two-thirds (68%) of those CDEs only provide diabetes self-management education services to patients part-time—fewer than 25 hours per week. The analysis also found that CDEs are predominantly located in urban areas, and that many rural areas have few or no CDEs at all. Finally, the study found that although diabetes disproportionately affects racial and ethnic minorities more than whites, 90% of the State’s CDEs are white and less than 17% speak a language other than English.

 

CDEs and health care organizations and providers cited limited reimbursement for CDEs and diabetes self-management education as one of the main reasons for the shortage of services. Providers reported that the current reimbursement structure does not cover the costs of self-management programs or the CDEs to staff them, and few professionals are getting any financial support to become a CDE.

 

“We have the perfect storm when it comes to diabetes prevention and management programs: limited resources keep providers from offering services, which in turn drives down demand for CDEs, and in the end the State’s diabetes crisis ends up getting worse,” said Jean Moore, Director of the Center for Health Workforce Studies. “Without action, the shortage we face today will pale in comparison to the lack of services we will have in the future. We need to change the funding equation, make more effective use of our existing CDE workforce and get more people into the CDE pipeline.”

 

“There is ample evidence that CDEs and other diabetes educators play an essential role in helping people who have diabetes or at risk for getting it,” said Maureen Spence, Program Director, New York State Department of Health’s Diabetes Prevention and Control Program. “But the growing epidemic means that we can’t wait. We have to get more professionals to become CDEs; increase access to them, especially for New Yorkers that need it the most; and get more physicians to refer to their patients to CDEs early and often.”

 

The report concluded that bolstering reimbursement for CDEs and diabetes self-management services is a critical way to increase the availability of these essential services statewide. The report calls for a number of solutions, such as expanding the existing Medicaid reimbursement for diabetes self-management education services provided in nearly 100 diabetes centers in New York that are recognized by the American Diabetes Association or accredited by the American Association of Diabetes Educators and are already reimbursed by Medicare. The report also recommends reimbursing for pre-diabetes services to encourage preventing diabetes—not just treating it, reimbursing for CDE services provided remotely to increase access in rural areas, and allowing reimbursement for CDEs in all health centers. The report further recommends offering eligible professionals who would like to become CDEs financial support so they complete the certification process.

 

The prevalence of diabetes in New York State has doubled since 1994, and that number continues to rise. In an effort to stem this growing epidemic, NYSHealth launched the Diabetes Policy Center to promote policies that will sustain high-quality clinical care and health environments statewide. Through its five-year, $35 million New York State Diabetes Campaign, NYSHealth is committed to reversing the diabetes epidemic currently plaguing the State and to significantly improving the health of New Yorkers with diabetes.

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