What will diabetes education look like in 5-10 years? Or moving into 2030 for that matter?
One thing that became clear at the recent annual meeting of the American Association of Diabetes Educators (AADE) in Indianapolis is that there's some serious concern about this profession, which has been at a crossroads for at least a decade now, and we've wondered in the past if the organization was "lost at sea" in adapting to current trends.
To keep up with the changing times, some wonder now if we've reached a point where CDEs (Certified Diabetes Educators) might need to drop that official title in favor of something with more of a coaching bent, like "diabetes care coordinators," facilitators, managers, or possibly even "Diabetes Champions" (!)
Whatever the term, a big theme at the AADE conference was the fact that these healthcare team members have some of the highest potential to help PWDs (people with diabetes) by recognizing what's working and what isn't, and identifying other health or social issues that may be lurking beneath the surface. Yet CDEs are struggling to redefine their roles in a changing healthcare landscape, and are battling economic realities that prevent many patients from accessing them, or even knowing about the services they provide.
Technology & Reimbursement Challenges
Ten years ago, the big crisis in diabetes education that people were talking about most was the shrinking pool of people going into the profession. But today's crossroads are more about the onslaught of new technology, and uncertainties around insurance coverage and overall access to these professionals who can really help PWDs manage their condition.
In this brief video interview filmed at the August annual meeting, current AADE President Nancy D'Hondt and 2018 President-elect Donna Ryan provide a bit of detail on those big challenges for CDEs in these times of great change.
First off, being able to stay current on all the new data tools, and then adopting and integrating the new technology, is not easy for many educators -- which was certainly the impetus for the digital health theme of this year's meeting. Numerous presentations covered technology and digital tools -- from D-devices, to social media, interconnected diabetes management tools, to the newly announced Welldoc Digital Diabetes Learning Network – an example of an industry partnership formed to help CDEs do their jobs better.
The AADE as an organization is addressing this challenge by working with leading business technology consulting firm PSC Group to build a new Technology Institute, that they say will "serve as one-stop shop for educator to access and learn about new technology."
Meanwhile, changes in the healthcare landscape – reimbursement, payors, and managed care – make it potentially more difficult than ever to get needed referrals and authorizations for patients to see CDEs.
In fact, just before this big event, AADE issued a policy statement on how it believes educators should be better recognized on insurance formularies and given more authority to recommend/prescribe medications and devices for patients.
On top of all this, the parameters of care are changing as well. New #BeyondA1C Measures will call on diabetes HCPs to stop looking at A1C as the only gold standard of care, but instead work with patients more intensely on improving time in range, reduction of hypoglycemia, and Quality of Life areas like mental health. Some of the presentations talked specifically about how CDEs might tackle these topics in this new age:
And don’t forget that new automated insulin delivery systems are on the horizon, which will literally change the job of many CDEs and especially insulin pump experts, challenging them to support patients on these dynamic new systems.
Follow the Money
Clearly, costs are a huge issue that everyone dealing with diabetes is facing these days – especially patients who can't afford medications, such as insulin. Educators are on the front lines seeing this, but often don't have the bandwidth or ability to step in and help solve these lack-of-access problems.
From another angle, keynote speaker Dr. Robert Gabbay of Joslin Diabetes Center talked about the impact of new “value-based” payment models in healthcare and the "triple aim" of improving patient experience, improving the health of populations, and reducing costs of healthcare. He urged educators to learn more about these goals and their possible roles helping achieve them.
Of course, any talk about money sparks the whole debate about how educators are reimbursed and compensated, a touchy issue as all agree they aren't paid adequately right now. Medicare's decision to expand coverage for educator hours in 2018 is a big change, but many believe it doesn't go far enough.
Soul-Searching, with a Positive Spin
AADE as a professional organization is clearly going through some self-reflection. They’ve even hired a visionary consulting firm to evaluate their current structure and offerings, according to President D'Hondt. In the video interview referenced above, she explains how that firm held focus groups and stakeholder interviews at the August conference to assess what their members, supporters and partners think.
And at official business meeting held during the annual conference, the organization posed the question openly to its members: Where will diabetes education end up in 2030? That led to a lively forum in which educators from across the country were able to share their thoughts on this:
Despite all the unknowns, AADE leadership is sounding resoundingly upbeat.
"One of the great things about AADE is its future vision,” D'Hondt says. “As an organization we’re going through a deep dive into our strengths and opportunities… to help us define where we are and where we want to go.”
"It’s a very exciting time for us as diabetes educators," future President Ryan says.
From the patient POV, we certainly hope so!