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PATHS: Providing Access to Healthy Solutions
An Analysis of Opportunities to Enhance Type 2 Diabetes Prevention and Management
Maggie Morgan and Sarah Downer
The Center for Health Law and Policy Innovation
Harvard Law School
May 30, 2014
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PATHS Structural AnalysisPATHS Structural Analysis
• Food• Physical Activity
Disease Prevention
• Access• Quality
Disease Management
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TYPE 2 DIABETES: PREVENTION
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Economic Access to Healthy Food
Nutrition and Cooking Education
Geographic Access to Healthy Food
Early Childhood, School Food, and
Wellness Programs
Physical Activity/ Built Environment
Diabetes Type 2 Prevention ThemesDiabetes Type 2 Prevention Themes
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• Ease of application• Improved online services• EBT at farmers marketsParticipation
(SNAP)
• Invest in interagency pilot programs
• Scale up successful programsInteragency Collaboration
SNAP and WICSNAP and WIC
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Healthy Food RetailersHealthy Food Retailers
New Food Retailers• Grants and loans to
incentivize in low-access areas
• Zoning policies
Existing Food Retailers• Tax Incentives for
offering healthy food
Farmers Markets• Development in new
areas• EBT acceptance
Transportation• Invest in sidewalks
and public transportation
• Leverage existing transportation
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Results from Study Committee on Food Desert Zones
Results from Study Committee on Food Desert Zones
Snap Ed Implementation
Local Government
ActionSchool Gardens
School Breakfast Further study
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Complete Streets vs. Transportation Funding
Health Impact Assessments
Sidewalk Requirements
Data Collection
Built EnvironmentBuilt EnvironmentC
omm
unity
Aw
aren
ess
and
Phy
sica
l Act
ivity
Info
rmat
ion
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Early Childhood InterventionsEarly Childhood Interventions
Best practices
Home visiting programs
Revise Star Rated License
SystemFinancial
Incentives for Centers that
Excel
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Direct Certification
School Breakfast
Community Eligibility
Technical Assistance
Summer Feeding
Programs
School FoodSchool Food
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Wellness Policy Implementation
Shared Use Agreements
Tax Credits for Workplace
Wellness Programs
WellnessWellness
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TYPE 2 DIABETES: MANAGEMENT
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Goal: Whole-Person Patient Centered Diabetes Management
Goal: Whole-Person Patient Centered Diabetes Management
Primary Care Specialty Care
Lifestyle Modification
and Management
Services
Community Resources
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Access to Key Services
Managing Health
Disparities
Access to Providers
Healthcare Delivery System
Whole-Person Diabetes Care
Teams
Type 2 Diabetes Management ThemesType 2 Diabetes Management Themes
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Expanding Access to Key ServicesExpanding Access to Key Services
Diabetes Equipment &
Supplies
Innovative Use of Health
Technology
Diabetes Self-Management
Programs
Behavioral Health Services
Diabetes Prevention
Program
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Diabetes Prevention Program Diabetes Prevention Program
5-7% weight loss
150 min/week physic
al activit
y
58% Reduction
in Diabetes
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NC Recommendations: Diabetes Prevention Programs
NC Recommendations: Diabetes Prevention Programs
Medicaid reimbursement
Increase state funds for targeted,
evidence-based prevention efforts
Extend postpartum Medicaid benefits
beyond 60 days
Increase support for clinical practices through funding for AHEC, Office
of Rural Health, etc
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Durable Medical Equipment, Supplies and Insulin
Durable Medical Equipment, Supplies and Insulin
Cost-Sharing; Quantity Limits; Brand ChangesNeed to Test Frequently
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NC Recommendations: DME and Insulin NC Recommendations: DME and Insulin
Provide assistance to help patients with
copays and coinsurance to access insulin
Lower costs of testing supplies for patients who
follow best-practices approaches to diabetes
management
Expand access to health insurance for low-income people
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Need for Statewide and
Local Coordination
Billing and Reimbursement
Challenges
NC Successes in DSME, DSMP and
MNT Continuing
Barriers to Access
Diabetes Self-Management ProgramsDiabetes Self-Management Programs
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NC Recommendations: Diabetes Self-Management Education and Support NC Recommendations: Diabetes Self-Management Education and Support
Establish statewide Diabetes Self-
Management Task Force
Recognize “gold seal” diabetes
education programs
Develop strong DSME care
teams
Offer reimbursement for clinical practices
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Behavioral Health Services and Diabetes Management
Behavioral Health Services and Diabetes Management
Three Highlights1. Poor behavioral health lowers patient’s
ability to provide effective self-care2. Integrating behavioral care into patient’s
primary care improves health outcomes3. Two barriers to integration:
Shortage of behavioral health providers
Lack of coordination between primary care and
behavioral health care systems
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NC Recommendations: Behavioral Services NC Recommendations: Behavioral Services
(1) Expand the use of
telepsychiatry
(2) Implement Pay-for-Performance
incentives to improve provider coordination
(3) Incentivize behavioral health providers to join
the state’s Health Information Exchange
(4) Better incorporate behavioral health
education into diabetes care
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Health Information Exchange
Technical Assistance to Clinical Practices
Telemedicine Opportunities
Geographical Mapping-Durham Diabetes Coalition Project
Innovative Use of Health Information Technology
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Increasing Access to ProvidersIncreasing Access to Providers
Enrollment and Recruitment of Providers
• In-state physician recruitment and retention • Recruitment of minority providers • Incentives for primary care providers• Nursing/nurse practitioner shortages
Promoting comprehensive health care teams
• Opportunities for valuable providers such as pharmacists to serve on diabetes care teams• Role of community health workers
Focus on undeserved areas and areas with high health disparities
• Geographic and racial disparities • Transportation • Promise of Telemedicine
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NC Recommendations: Retention and Recruitment
NC Recommendations: Retention and Recruitment
Expand current residency programs
and create new ones
Target in-state residents for medical school and residency
programs
Expand the number of Primary Care NPs
within the state
Maintain increased Medicaid
reimbursement rates
Encourage recruitment of minorities into
medical and nursing schools
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NC Recommendations: Promoting Comprehensive Healthcare Teams NC Recommendations: Promoting Comprehensive Healthcare Teams
Support Medication Therapy Management ProgramsFurther Embed Clinical Pharmacists into NC MedicaidIncorporate Pharmacists into NC’s Medicaid Chronic Health Homes
PHARMACISTS
Increase Financing of CHW Programs Gather Data on CHW Certification Programs
COMMUNITY
HEALTH WORKERS
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NC Recommendations: Reduce Health Disparities
NC Recommendations: Reduce Health Disparities
Expand the use of promising
telemedicine programs
Promote successful loan
repayment/incentive programs
Explore transportation challenges and opportunities
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• Shift towards shared savings and bundled payments may help diabetes prevention and management
• Medicaid Health Homes through CCNC; Patient-Centered Medical Homes
• Opportunities for Provider Coordination
• Increased Health Outcomes??
Financial Incentives for
Providers
Coordinated Care Models
for People with Diabetes
Health Information Technology
Accountable Care
Organizations
Healthcare Delivery System
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QUESTIONS?