Medicaid WorkGroup

First Report

Findings

• 1- Contacted AADE about the status of payment for DSME and they have sent us a document showing that most states Medicaid pays for DSME Except Virginia2- Have contacted Virginia DMAS and they stated that they will not pay for DSME and it will take legislative and other efforts to make that happen3- I have discussed this issue with Terry Saunders and Joyce Pastors from UVA and Kathy Gold from VDC who have addressed this issue in the past and they stated that there are many road blocks to getting that done

Decision

• Will pursue this goal by enlisting ADA, AADE, legislatures and Stakeholders and will report any progress next meeting

• Our group members have expertise in Telemedicine and MTM will be happy to serve as a resource for the Certified Programs in the concepts of creating a referral system, revenue building, and sustainability of DSME programs

Telemedicine and DSME

• UVA team headed by Dr. Terry Saunders and Joyce Pastors will discuss their telemedicine program

MTM and DSME

• Pharmacist Alliance team will Improve Sustainability and Outcomes of your Diabetes Program by adding Medication Therapy Management services (MTM) provided by our pharmacists

MTM and DSME Cont.

• Our Pharmacists will • Setup your diabetes program as a medication

Therapy Management (MTM) provider• Refer patients who are seen by your medical

providers from your organization who are eligible for MTM and also needing DSME classes to your program

• Provide you with pharmacists and diabetes educators to help you expand

MTM-DSME Cont.

• Provide you with Telemed platform to use to extend your reach or to expand your services

• Generate revenue based on your program size and patient mix. A rough estimated would be that for every 30-50 providers in your organization, you will see an increase of about 150 DSME referral and 300-500 MTM referral which will translate to an annual revenue of $60,000- $90,000 to your program