Diabetes Education in a New World of Healthcare Delivery System Innovation:
A Workforce Analysis
Findings from a 2011 AADE research study
Listen to AADE President Donna Tomky sharing her insights.
In 2011, AADE commissioned Dobson DaVanzo & Associates, LLC to investigate workforce challenges and opportunities for diabetes educators. The goals was to understand how various systems of care integration and clinical organization are shaping the roles of diabetes educators, as well as the types of skills and abilities that will be required for diabetes educators over the next 15 years as their roles change.
The study was comprised of several research components, including a literature review, a series of key informant interviews, a review of health care innovations exchange, a systematic search of employment websites to examine job postings for diabetes educators, a claims analysis using Medicare claims from the years 2006-2009, and the development of a quantitative workforce model of the supply and demand for educators through the year 2025 under several scenarios.
Key messages from the research:
- A strength of the profession is its multidisciplinary composition. Diabetes educators represent professionals from a variety of health disciplines, including (but not limited to) advanced practice and registered nurses, registered dietitians, pharmacists, physicians, mental health professionals, podiatrists, optometrists, and exercise physiologists.
- There is a growing body of research supporting and quantifying the effectiveness of diabetes education in improving metabolic outcomes for diabetes patients. The literature also shows that increased contact with diabetes educators was associated with lower hospitalization rates and reduced costs.
- As healthcare systems move toward greater integration (e.g., accountable care organizations), each service type will become a cost center to the larger organization. In this circumstance, administrators will be looking for the services that produce the greatest value at the most reasonable price. Diabetes educators provide demonstrable value, both in metabolic outcomes and reductions in health care utilization, and should result in a high demand for diabetes education over next 15 years.
- Based on the current provision of diabetes education, it is estimated that we need 43,000 diabetes educators to care for the U.S. diabetes population. (Note: It’s estimated there are currently 30,000 diabetes educators.)
- By 2025, based purely upon the incidence of diabetes in the population and assuming there are no changes in how care is currently being delivered and reimbursed, there will be an estimated demand for 54,000 diabetes educators, a growth of approximately 60 percent in less than 15 years. If even a small change such as offering DSMT as a covered benefit for pre-diabetes was enacted, that number would nearly double.
- In terms of the future employment market for diabetes educators, it’s anticipated that the range of work settings will broaden, and will include not only the traditional hospital outpatient and physician office positions, but also some non-traditional settings, such as industry sales positions, retail clinics, management consulting, medical weight management and other specialty clinics, community health centers, home health and long term care facilities, and workplace wellness programs.
- In terms of future job responsibilities of diabetes educators, it’s anticipated that more diabetes educators will be serving as program managers, coordinators and care managers. It’s also projected that diabetes educators will also be asked to design technology interfaces, such as patient web portals and remote monitoring technologies that will allow more services to be delivered outside the current paradigm of place and time. And it’s likely that future diabetes educators will be asked to expand their scope into the realm of performance and quality measurement, as well as provide ongoing support for patient behavior change.
- Healthcare organizations will begin employing lower level diabetes educators (levels 1 and 2) to deliver group sessions, with advanced-level educators (level 3-5) supervising them, creating curricula and meeting with patients one-on-one.
- An analyses of current job postings found that holding a credential (e.g., CDE or BC-ADM) is important to employers. Furthermore, as transitional care management becomes the norm rather than the exception, higher level critical thinking and clinical judgment will become more important. The trend toward advanced preparation at the master’s and doctoral levels should continue.
- Diabetes educators will increasingly be challenged to provide sufficient depth in knowledge of diabetes, sufficient breadth in knowledge of care management and wellness, skills in counseling and supporting patients in achieving behavior change over time, program management, and knowledge of the business of care provision in terms of health IT and quality measurement.
- Level 1 and 2 diabetes educators, such as medical assistants, counselors, health educators and social work assistants are logical professionals to recruit into diabetes education due to the fact they are often younger and seeking a form of career ladder. On the other end of the spectrum, due to the growth in the nursing profession, continued recruitment of nurses is promising.