AADE Issues Statement Supporting Need for Patient Choice in Coverage Decisions
Earlier this month, news broke that starting July 1, 2016, Medtronic will be the preferred insulin pump supplier for those covered by UnitedHealthCare insurance. The communication in part indicates that:
- This policy does not apply to children 18 and younger or to United Sierra Health, Life Commercial and Medicare Advantage plans.
- Supplies for existing in-warranty pumps won’t be affected as long as the pump is still under warranty and not malfunctioning.
- Other brands of pumps may be covered but the criteria have not yet been clearly defined.
See Page 7 of this recent UnitedHealthcare bulletin for additional details.
The Diabetes Online Community (DOC) quickly expressed concerns regarding access to appropriate supplies, particularly by the diabetes community. (See Twitter hashtags #DiabetesAccessMatters or #MyPumpMyChoice for a sampling of the reaction.)
AADE reached out to both UnitedHealthcare and Medtronic (organizations with which we have ongoing working relationships) to better understand the issue, and then had considerable internal deliberations about how we could best share diabetes educators' perspective on this important issue.
We know the entire healthcare system is undergoing change and at its core is the balance between quality, access and cost. While we understand market pressures driving choice issues in the insurance industry, we looked to our core values to craft a statement reminding all that diabetes is not a one-size-fits-all disease and that selecting the tools that a person with diabetes needs to manage their condition should be a decision made between them and their diabetes care team.
We posted the following on May 9:
Diabetes is not a one size fits all disease. As an organization committed to helping people with prediabetes and diabetes, along with their caregivers, successfully manage their condition, we believe that health plans and insurance companies should offer a variety of choices among diabetes devices and products.
We urge all insurers to join with diabetes educators in recognizing that people have individual needs and that allowing the person with diabetes to obtain the tools that make diabetes care easier to achieve will help them over the long term. Additionally, this will benefit our healthcare system to realize clinically- and cost-effective outcomes.
Diabetes educators play a significant role in counseling people and their caregivers on the selection of devices, learning how to use them effectively, and utilizing the data to make adjustments and help them improve their control. We strongly encourage diabetes educators to continue to counsel their patients to ask questions — of their health care providers, health plans and insurance companies — and to insist that they are covered for the equipment that best suits their individual needs.
We also call on insurers to more proactively seek the input of those affected in their decision making. Making decisions without the clear input of those who are paying for the coverage and are the most impacted is not acceptable.
AADE’s strategic plan places the needs of the person with diabetes and their caregivers front and center. We have long been on the front lines advocating for choice, most recently working with the Centers for Medicare and Medicaid Services to fix flaws in the Medicare Competitive Bidding Program. AADE will continue to work on these issues and on arming diabetes educators with the information and tools they need to advocate for people with diabetes.
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Proposed Change to AADE Bylaws
This communication is to provide official notice that an amendment to the bylaws of the American Association of Diabetes Educators has been recommended by the Board of Directors.
The proposed amendment has been submitted in a manner consistent with all requirements of Article XIV (“AMENDMENTS”), Section 2 of the Bylaws.
In accordance with Article XIV, Section 2, notice is hereby given to all members that the following amendment proposal will be voted upon at the 2016 AADE Annual Business Meeting, on Sunday, August 14, 2016 at 1:00 pm, in Hall E of the San Diego Convention Center during the Annual Conference.
To be approved, the amendment requires a majority of the general membership present and eligible to vote.
View the full version of the AADE bylaws.
|Bylaws Section || ||Proposed Change || ||Rationale |
|ARTICLE VI – BOARD OF DIRECTORS; Section 1. COMPOSITION || ||f. one (1) director, … |
| ||Following a 2015 Foundation Bylaws change, the AADE President now serves as the Chair of the Foundation. Since the AADE President already sits on the Board of Directors, this language is redundant. |
The AADE Education and Research Foundation was founded to serve as a fundraising arm to support the mission and goals of the association. Since that time, the Foundation has searched for its unique place in a crowded field of diabetes-related fundraising organizations.
In 2015, the AADE Board of Directors and the AADE Foundation Board of Trustees worked collaboratively to improve the Foundation’s efficiency and to expand its ability to support diabetes educators through continuing education scholarships. To achieve this, both Boards approved a recommendation to designate the AADE Board of Directors as the Foundation’s Board of Trustees (“overlapping Boards”).
It is important to note that although the AADE Foundation bears the name of the professional association, it is a completely separate, independently governed organization. While they remain two separate organizations, having boards which completely overlap ensures the alignment of the association’s mission and philosophy by directing the Foundation’s resources to opportunities which most fully assist the association in advancing its mission.
By unanimous vote last year, the Foundation’s Board of Trustees amended the Foundation’s bylaws, which established the overlapping Board structure, effective January 1, 2016.
An artifact remains in the association’s bylaws that requires an editorial change. Article VI, Section 1 states that the Chair of the AADE Education and Research Foundation shall be a member of the association’s Board of Directors. Pursuant to the changes in the Foundation’s Bylaws, the AADE President serves as Chair of the Foundation.
Monday, Monday, So Good to Me
By Laurel Fuqua, RN, MSN, CMC
I had the enviable opportunity this year to be a member of the AADE Annual Meeting Planning Committee (AMPC). It’s been very rewarding, actually a blast. I think you are really going to enjoy the entire meeting, from general sessions to all the concurrent sessions. I am also excited to have had a program submission accepted.
Then, the other day, I realized that this session is scheduled for the last day of the conference, Monday, August 15. We all know no one really wants to be in a speaker slot on the last day of a conference, right? People are heading home, people are tired by then, people are brain dead, or people want to have a few last hours to enjoy our fine city of San Diego (yes, I live in this fabulous city!). As the timeless song by The Mamas and The Papas goes, “Every other day, every other day of the week is fine, yeah…but whenever Monday comes, but whenever Monday comes…”
Not so at AADE16! The program on Monday will be one more fantastic day of programming.
I can promise that if you can stick around, Monday can be all you (back to The Mamas and The Papas) “hoped it would be!” We have an amazing lineup of topics and speakers planned.
Of course, I have to start by plugging my Monday morning session at 9:15 AM, M04-Diabetes Wheel of Fortune: Help People Choose the Best Mobile Health Solutions for Them where you will get to play a little diabetes mobile app wheel-of-fortune and learn how to evaluate and recommend targeted mobile health solutions for your patients.
But, if that’s not your cup of tea, there are a lot of other engaging sessions happening.
How about kicking off the day at our last general session with your morning cup of coffee to hear the expansive panel discussion we’ve titled Current Challenges, New Ideas among diabetes experts Dr. Steve Edelman, Dr. James Gavin and Linda Siminerio, moderated by none other than Virginia Valentine or going home armed with new knowledge about increasing insurance reimbursement from attending Mary Ann Hodorowicz’ session: MO8 – Money Matters in Medical Nutrition Therapy (MNT) & Diabetes Self-Management Training/Education (DSMT/E): Increase your Insurance Reimbursement NOW!
So, please don’t leave AADE 2016 early. You’ll miss out on the “Monday, Monday So Good to Me” sessions! Trust me, you won’t be disappointed and you never know - you might even get to sing along to The Mamas and The Papas.
Introducing the IAC Spotlight with Our 2016 Public Policy Forum Sponsors
The AADE Industry Allies Council (IAC) is a group of key industry partners who demonstrate strong commitment and support to the professional community of diabetes educators and the organizational goals and work of AADE. About 18 industry companies participate on the council each year, and a majority of these partners serve a global audience.
In a new effort to highlight members of the IAC and their partnership with AADE, we are launching IAC Spotlight. This will be a brief feature in the monthly eFYI newsletter to share how the various IAC partners work in conjunction with AADE to support diabetes education and diabetes educators.
For this month’s IAC Spotlight, we are highlighting the industry sponsors of the 2016 Public Policy Forum – which was held May 13-14 near Chicago. With the gracious support of the following IAC members, more than 60 AADE members representing 28 states attended this event:
- Lilly Diabetes
- Johnson & Johnson Family of Diabetes Companies
- Novo Nordisk
The Public Policy Forum (PPF) is an annual two-day event that gives Coordinating Body (CB) Leaders, State Grassroots Coordinators (SGCs), the AADE Board of Directors, the diabetes advocacy community, and our industry partners the insight and training to establish long-term relationships with key members of Congress. It also provides them the tools they need to become better advocates and spokespeople for AADE and diabetes issues. In the past, the PPF has been held in Washington, D.C. but this year, through a new facet of state-targeted grassroots initiatives, there was additional training for members who live in key states to help advance our federal legislation and an assessment of our state-level legislative initiatives.
In addition, through the support of IAC members, this year we will make some of the PPF sessions available to all of our members. To view presentation slides and legislator communication resources visit the AADE Advocacy Files page on MY AADE NETWORK.
Sustaining your DSME Program
You’ve built a successful DSME program, but you are ready to push the limits. It’s time to learn how to maximize your resources, stimulate creativity and start thinking like a business to increase your referrals.
Sustaining Your Diabetes Education Program workshop is making its debut on Thursday, August 11 in San Diego, CA. As a preconference course at AADE16, this is the perfect way to kick off four full days of CE-earning potential.
Over the course of the day, you will dive into a case study that exemplifies a successful program and cover the six essential components of a DSME program business plan. You will learn strategies for monitoring and reporting DSME outcomes to providers and how to survey an onsite Medicare audit. You’ll be able to create your marketing and financial plan to expand your program’s reach and increase referrals while also ensuring these align with new models of care.
This course is ideal for program managers interested in pushing the limits of their program’s reach and capabilities.
Please note you will be taken to the AADE16 Annual Conference registration site. When completing the registration form, select Sustaining Your Diabetes Education Program listed in the "Preconference" section. This preconference course requires a separate registration fee and offers 7 CE.
Prepare for the CDE Exam in San Diego
AADE16 isn’t the only event coming to San Diego this summer! For the first time, CORE Concepts Course is co-located with the annual meeting. If you are preparing for the CDE exam, August 12 – 15 is your opportunity to attend this course while also enjoying some major benefits of AADE16.
Learn how to do the following for persons with or at risk for diabetes:
- Compare/contrast the pathophysiology of each type of diabetes
- Discuss strategies for promote healthy eating
- Explore approaches to being active
- Discuss types, tools, frequency and targets of blood glucose monitoring
- Identify tactics to promote healthy coping
- Integrate approaches to reduce health risks
In addition, you will get access to the following AADE16 events at no extra cost:
- Attend AADE16 General Sessions. Drop in each morning to catch the general session speakers before CORE Concepts begins.
- Browse the AADE16 exhibit hall. Explore the latest in diabetes technologies, medications and products while getting answers to your most pressing questions.
- Enjoy fun-filled AADE16 evening events.
Why I Pursued the BC-ADM Credential
Jasmine D. Gonzalvo, PharmD, BCPS, BC-ADM, CDE
I decided to pursue the Board Certified-Advanced Diabetes Management credential early in my career to help represent my level of expertise among colleagues and practitioners. I focused my exam preparation on areas of diabetes or related complications of which I was less familiar. I successfully obtained my BC-ADM in 2011.
Over the years, the BC-ADM has provided me a personal sense of accomplishment as a diabetes educator and a clinician. As a pharmacist, healthcare professionals of other disciplines are sometimes not familiar with the responsibilities of a pharmacist operating under a collaborative practice agreement with an expanded scope of practice. As such, the BC-ADM is the recognizable credential that signifies the types of activities for which I’m responsible.
The BC-ADM demonstrates to myself and colleagues that I have accomplished a high level of expertise within the field of diabetes, including the ability to adjust medications safely, to treat and monitor acute and chronic complications associated with diabetes, to engage in research activities, and to mentor developing clinicians with a desire to focus on diabetes care. The BC-ADM credential has been a valuable asset to my professional identity.
Learn more about the BC-ADM.
Who You Gonna Call?
Do you have a concern about Medicare reimbursement? Do you need an answer on private payor coverage? You better call AADE’s Reimbursement Expert (and since it’s no longer 1984, by call we mean access Ask the Reimbursement Expert online).
An exclusive member benefit as part of your annual dues, the AADE Reimbursement Expert helps answer your toughest questions. To get started, check out the Reimbursement Q&A. This page provides a summary of DSME/T reimbursement-related questions that have been answered by the AADE Reimbursement Expert.* Review the topics to see if your question has already been answered.
If not, it’s time to contact the AADE Reimbursement Expert.
*The information provided in this Q&A is intended as guidance only and is not intended as legal advice. Please contact each payer to determine the specific coverage and reimbursement practices and policies.
Learn How to Earn Free CE
Are you aware that AADE members receive more than 20 hours of free CE? As one of your many member benefits, you have free access to a wide variety of archived webinars along with three online courses. Don’t miss out on free CE and check out the list of webinars and courses available to you at no charge.
Among the available webinars include:
View the full list of free webinars and online courses included with your membership. Looking for additional CE opportunities? Don’t forget that AADE members also receive substantial discounts on other webinars and online courses, along with publications and events.