The Medicare Diabetes Screening Project: A National Drive to Find the Undiagnosed

1. 05 February 2012 The Medicare Diabetes Screening Project: A National Drive to Find the Undiagnosed

2. Slide no 2 05 February 2012 Medicare Diabetes Screening Project Find the 17 million Americans in Medicare with undiagnosed diabetes or pre-diabetes Co-chaired by the American Diabetes Association, Healthcare Leadership Council and Novo Nordisk Inc. Medicare Coverage: free, annual test for anyone over 65 with one diabetes risk factor; every six months for those with pre-diabetes

3. Slide no 3 05 February 2012 The Medicare Diabetes Screening Project: A National Drive to Find the Undiagnosed Partners: Administration on Aging America�s Health Insurance Plans � AHIP American Academy of Physician Assistants American Association of Diabetes Educators American Clinical Laboratory Association American College of Physicians American Diabetes Association (Co-Chair) American Dietetic Association American Medical Association American Optometric Association Avalere Health Center for Health Transformation DMAA: The Care Continuum Alliance Healthcare Leadership Council (Co-Chair) Healthways National Association of Area Agencies on Aging National Association of Manufacturers National Association of State Units on Aging National Black Nurses Association National Council on Aging Novo Nordisk Inc. (Co-Chair) Nurse Practitioner Healthcare Foundation Vision Service Plan � VSP XL Health

4. Slide no 4 05 February 2012 Medicare Diabetes Screening Project Goals Encourage HHS, CMS, and other federal, state and local agencies to make diabetes screening a priority Conduct survey and focus group research with both patients and providers to assess barriers to utilization of this Medicare benefit Produce measurable result that current 10% utilization rate is rising Pilot projects in Columbus GA, New Hampshire and Minnesota

5. Slide no 5 05 February 2012 Diabetes in America 20.8 million Americans have diabetes 14.6 million diagnosed 6.2 million undiagnosed. 54 million have pre-diabetes most not diagnosed

6. Slide no 6 05 February 2012 Diabetes Impact on Medicare

7. Slide no 7 05 February 2012 Diabetes Screening and Prevention Works Lifestyle interventions (diet and moderate exercise) for those with pre-diabetes can reduce the development of diabetes by 58% People age 60 and older with pre-diabetes can lower their risk of developing diabetes by 71%

8. Slide no 8 05 February 2012 A Fact Worth Repeating People age 60 and older with pre-diabetes can lower their risk of developing diabetes by 71% -- by walking 30 minutes 5 days a week and making a modest change in their diet.

9. Slide no 9 05 February 2012 Results of DCCT/EDIC Trial Show Early diagnosis is essential for achieving the recommended level of HbA1c control early in the course of the disease when it may be most effective in preventing long term complications. Report on Closing the Disparity between Hemoglobin A1c Treatment Guidelines and Practice HHS/NIH/NIDDK

10. Slide no 10 05 February 2012 Diabetes Detection and Intervention Works Detecting and treating diabetic eye disease can reduce the development of severe vision loss by 50% - 60%. Comprehensive foot care programs can reduce amputation rates by 45%-85%. Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce kidney function decline by 30% - 70%.

11. Slide no 11 05 February 2012 Diabetes Screening under Medicare Once per year for beneficiaries 65 years of age or older with any one of the following risk factors: Hypertension (High Blood Pressure) Dyslipidemia (High Cholesterol) Obesity or overweight (BMI >25) Family history of diabetes History of gestational diabetes or giving birth to a baby weighing >9 lbs Two screening tests per year for those identified to have pre-diabetes

12. Slide no 12 05 February 2012 Diabetes Screening under Medicare No co-payment or deductible required Ordered by a: Physician Physician�s assistant Nurse practitioner Clinical nurse specialist Fasting Plasma Glucose (PPG) or Oral Glucose Tolerance Test (OGTT)

13. Slide no 13 05 February 2012 Medicare Coverage for Diabetes Diabetes equipment and supplies Diabetes self-management training Medical nutrition therapy A1C tests to check blood glucose control Dilated eye exam to check for diabetic eye disease and glaucoma screenings Foot care and exams if there is nerve damage to the feet due to diabetes

14. Slide no 14 05 February 2012 Coverage Does Not Mean Utilization Nearly 50% of Medicare beneficiaries have undiagnosed diabetes or pre-diabetes. There is a free, annual diabetes screening benefit for all Medicare beneficiaries at risk for diabetes. Screening and early diagnosis are critical for managing diabetes or for preventing diabetes. In 2006 less than 10% of Medicare Beneficiaries were screened for diabetes

15. Slide no 15 05 February 2012 Improving Diabetes Care in Medicare The Medicare Modernization Act will improve diabetes care only if� Seniors go to a doctor and are screened, diagnosed, and treated Those with pre-diabetes are diagnosed and get care � including follow up screening � that can prevent or delay diabetes

16. Slide no 16 05 February 2012 Agencies Kick-Off Diabetes ProgramBY ANDREA V. HERNANDEZ

17. Slide no 17 05 February 2012 Pilot Initiative: Columbus, GA Launch Event � July 19, 2007 CMS� A HealthierUS Prevention and Wellness Tour Religious Community Leader Outreach Fellowship Luncheon � Congregation Briefings Civic and Community Group Educational Sessions Veterans of Foreign Wars (VFW) and American Legion Urban League Provider Outreach Physicians� Dinner Nurse & Diabetes Educator Dinner; briefing for practice managers - tbd Material Distribution and Education Churches, senior centers, health fairs, public events

18. Slide no 18 05 February 2012 Columbus Launch Partners:  Center for Medicare Services Center for Health Transformation Columbus Research Foundation and Dr. Stephen Leichter City of Columbus � Mayor Jim Wetherington Columbus Chamber of Commerce Georgia Legislative Delegation

19. Slide no 19 05 February 2012 Columbus, GA Pilot Project Columbus Media Clip WOKS-AM WGSY-FM WKCN-FM WDAK-FM WRLD-FM WEAM-FM

20. Slide no 20 05 February 2012 CMS Chooses the MDSP! MDSP � CMS� Prevention Challenge for Georgia! The CMS central office asked each regional office to designate a key partner in each state to focus on prevention and healthy living after the A HealthierUS Starts Here Prevention Tour was completed. The CMS regional office in Atlanta, GA chose the Medicare Diabetes Screening Project in Columbus to be the Prevention Challenge for the State of Georgia.

21. Slide no 21 05 February 2012 MDSP New Partners in Columbus Since Launch Lower Chattahoochee Area Agency on Aging (material distribution at local mall, health fair, newsletter) The Source Program (an organization of 12 caseworkers that visit more than 500 home healthcare patients on a regular basis) Columbus Housing Authority (3 communities of predominately seniors age 65 +) The �Divine 9� (the local association of sororities and fraternities adopting Medicare screening as a community service project)

22. Slide no 22 05 February 2012 Columbus Clergy Get Involved

23. Slide no 23 05 February 2012 Churches as Advocates for Health Target date: Sunday before World Diabetes Day 15 Churches distribute more than 5,000 bulletin inserts Leading clergy appear in newspaper and radio ads On-going: church-based senior events with MDSP, nurse, dietitian Sunday morning church services

24. Slide no 24 05 February 2012 New Columbus Initiatives in 2008 Columbus Fire and EMS Department Information distribution and risk assessment screenings by EMS personnel Vision Service Plan (VSP) Free eye exams (and free glasses, if needed) for all Columbus seniors and others � along with diabetes risk assessment screenings (with referral to physicians if needed) Pharmacists Outreach to pharmacists for information distribution and written risk assessment test for customers

25. Slide no 25 05 February 2012 Pilot Initiative � New Hampshire A state-wide Coalition of 15+ Partner Organizations Localized materials for seniors and healthcare providers More than 25 Senior and Provider Outreach Events Bureau of Elderly and Adult Services and ServiceLink Resource Center key outlets of information to seniors Coverage in papers and on radio around the state Briefing material to presidential campaigns and congressional offices

26. Slide no 26 05 February 2012 New Hampshire Public Radio Health Literacy, Prevention and Medicare By Laura Knoy on Thursday, July 26, 2007 Dr. Charlotte Yeh � CMS Regional Administrator (Region I � Boston, MA) Dr. Rick Pollack � Family Doctor with Concord Family Medicine Tom Maher, Director of the Medicare Diabetes Screening Project in New Hampshire

27. Slide no 27 05 February 2012 Consumer Brochure

28. Slide no 28 05 February 2012 Risk Checklist and Palm Card

29. Slide no 29 05 February 2012 Some Barriers to Wider Screening? Physicians are not likely to screen for diabetes during acute care visits. If seniors only see a doctor for acute care, they may not be screened for diabetes as often as necessary. Many physicians doubt that pre-diabetic patients over the age of 65 will change their lifestyle enough to prevent the onset of Type 2 diabetes. Providers are not paid to counsel patients, in general, about disease prevention, nor diabetes or pre-diabetes specifically. In Columbus GA, half of non-diabetic seniors are �not at all concerned� that they may develop diabetes. Most seniors do not ask about getting specific tests for any disease or condition whey they go to the doctor � when they do they are more likely to ask about conditions they see as more immediately dangerous like heart disease or cancer.

30. Slide no 30 05 February 2012 Action Steps� Providers must order diabetes screening for those at risk, not just those with symptoms. Groups need to inform seniors about diabetes risk factors and urge them to ask their doctors about screening and prevention. HHS, CMS, and other federal, state, and local agencies need to promote aggressively Medicare diabetes screenings and preventive services Seniors should be active about their health, know their risk for diabetes, and use screening benefits. Those with pre-diabetes need access to necessary prevention services.

31. Slide no 31 05 February 2012 Policy Questions� Should federal and state agencies provide funds to promote Medicare diabetes screening? Since as many as 80% of seniors 65+ may have, or be at risk for, diabetes or pre-diabetes � and less than 10% are screened annually � should diabetes screening be required for all Medicare beneficiaries? Should providers be given an incentive for diagnosing beneficiaries with diabetes or pre-diabetes? Should coverage for counseling by providers be extended to beneficiaries with pre-diabetes?

32. Slide no 32 05 February 2012 For More Information For updates and materials on Medicare screening for diabetes and pre-diabetes, or to join a coalition effort to build a national drive to get seniors screened: www.screenfordiabetes.org Sarah Nordstrom Medicare Diabetes Screening Project Novo Nordisk, Inc. 500 New Jersey Ave, NW, Suite 350 Washington, DC 20001 shno@novonordisk.com 202-626-4526