May 15, 2024

Building the Business Case for DSMES

Diabetes affects around 1 in 10 Americans and costs the nation an estimated $413 billion each year. Diabetes-related costs are expected to increase as diabetes rates continue to climb. DSMES services improve health outcomes for people with diabetes, reducing hospital visits and saving money.

Chalkboard with words benefit and cost separated by a vertical chalk line.

Overview

Building the business case for DSMES services is critical to long-term success and sustainability. DSMES can increase use of primary and preventive services and lower use of acute, inpatient hospital services. Research shows that when physicians and diabetes care and education specialists collaborate, positive clinical quality and cost savings result.

Although DSMES services have not always been able to cover their costs and expand, that trend is changing. In 2017:

20% of DSMES services were revenue- or cost-neutral.
9% ran at a profit.
21% did not charge for services.
15% ran at a loss (a steady decline from the high of 43% in 2007).

Source: 2017 Diabetes Educator and the Diabetes Self-Management Education National Practice Survey

Benefits of DSMES for people with diabetes

DSMES gives people the essential tools and skills to self-manage diabetes, and participation offers proven benefits. Hemoglobin A1C can improve by 0.6%, as much as many medications and without side effects.

Health care costs are lower for people with diabetes who attend at least one DSMES session. One study found that at least one DSMES visit lowered the hospitalization rate for people with diabetes by 34%.

People who participate in DSMES are more likely to follow best-practice treatment recommendations and have lower claims costs. In a 3-year retrospective claims analysis of 250,000 Medicare beneficiaries, those who participated in DSMES had an average cost savings of $135 per month.

Benefits of DSMES for employers and insurers

Employers and insurers benefit from DSMES through improved employee productivity and reduced health care costs. A cost analysis of disease management services combined with diabetes education reported a return on investment of more than 4 to 1. State health departments can work with their diabetes councils or partner networks to inform and educate employers and insurers on the benefits of DSMES services and to encourage coverage.

Employers are eager to hear that insurers have strategies to address the rising costs of diabetes. Encourage employers to talk with their insurance carriers about adding DSMES services as part of the employee health benefits package.

Value of diabetes care and education specialists

Diabetes care and education specialists (DCESs) are critically important in providing DSMES services. They have the knowledge and skills necessary to educate people about diabetes and its complications. They also have the communication and support skills needed to deliver comprehensive yet individualized diabetes education. This is essential in helping people manage daily challenges while working toward long-term behavior change.

Better outcomes, lower costs

Studies indicate that when delivered by DCESs, DSMES services are both clinically beneficial and cost effective, especially when people attend more than one session. Participants are more likely to take medications as prescribed and receive recommended care. They also have lower health care costs than people with diabetes who don't attend DSMES.

Increased participation

Unfortunately, even though many third-party payers cover DSMES in part or in full, participation remains low. Low participation may be because eligible people with diabetes are not receiving referrals to DSMES services or because of barriers to participation. Increasing DSMES referral rates and access for underserved populations are promising strategies for increasing health care quality and reducing costs.

That's where DCESs serve a doubly important role. They not only provide DSMES services but also educate insurers, physicians, health care providers, and people with diabetes and their families about the importance of referrals to DSMES. See the DSMES Promotion Playbook for resources to help DCESs talk about the benefits of DSMES services.