Diabetes

Better health management can help people with diabetes live longer and healthier lives, and evidence-based services exist to help people with diabetes and their healthcare teams prevent or delay diabetes complications.

People with diabetes are at higher risk for severe health complications, such as blindness, kidney failure, heart disease, stroke, and lower-limb amputations. Diabetes is also associated with increased risks for some types of cancer, including liver, pancreas, colon, breast, and bladder. In addition, studies show that type 2 diabetes increases the risk of vascular dementia and Alzheimer’s disease.

The health burden of diabetes in the United States is significant. Millions of Americans experience diabetes-related morbidity, mortality, and reduced quality of life each year. There are 37.3 million Americans with diabetes, with nearly one-fourth (23%) remaining undiagnosed. The disease costs the United States an estimated $327 billion annually due to increased medical costs and lost wages. People with diagnosed diabetes have on average 2.3 times higher medical costs than those without diabetes.

For people with diabetes, numerous studies report associations between diabetes self-management education and support and improved health. DSMES services have been shown to have a positive impact on lifestyle changes, such as eating patterns and activity levels, ultimately leading to decreases in hemoglobin A1c levels, prevention or delay of diabetes complications, and improved quality of life.

OHCA offers Diabetes Self-Management Education and Support (DSMES) as a covered benefit for SoonerCare members. DSMES services can be ordered for members diagnosed with Type I or Type II Diabetes by any physician or qualified non-physician provider actively involved in managing the member’s diabetes. Providers and/or SoonerCare members can find a list of DSMES providers enrolled with OHCA here.

DSMES services are comprised of one hour (1) of individual instruction (face-to-face encounters or via telehealth between the Certified Diabetes Educator and the member) and nine hours (9) of group instruction on diabetes self-management. Members can receive up to 10 hours of services during the first 12-month period beginning with the initial training date. After the first 12-month period has ended, members are eligible for two hours of individual instruction on DSMES per cal­endar year.

The following providers are eligible to enroll as a Diabetes Educator type:

• A licensed healthcare professional who is individually certified as a:
  Certified Diabetes Care and Education Specialist (CDCES) by the National Certification Board for Diabetes Education (NCBDE)
  Board-Certified Advanced Diabetes Management (BC-ADM) by the Association of Diabetes Care and Education Specialists (ADCES)
• A registered dietitian, registered nurse or pharmacist licensed in the state in which they practice and has training and experience pertinent to diabetes self-management.

Providers can only enroll if they are part of an accredited DSMES program certified by either the ADA or ADCES. Note that there are TWO enrollments: 1) First enroll the DSMES group then 2) En­roll individually, each provider associated with that group.

Group enrollment: Click on “new contracts” on the left column, create a user account, select “business,” “group,” then “Diabetes Self-Management Group,” and it will walk you through enrolling your program. You will need to supply a signature page (Appendix A) listing all the providers affiliated with the DSMES group along with a copy of your national DSMES program certification.

Individual provider enrollment: Each provider will follow the same link below and create their own provider account selecting Diabetes Educator as the specialty. All providers will need to submit a copy of their health care license. All CDCES and BC-ADM providers will submit a copy of their certification. Pharmacists, RDs and RNs who are not certified (CDCES/BC-ADM) will need to submit a copy of their DSMES group certification along with their license as verification they have completed the DSM education hours required by the national standards. Eligible DSMES programs and individual providers can go to the OHCA provider enrollment page to enroll.