Cecelia Health recently hosted a webinar in partnership with The Leona M. and Harry B. Helmsley Charitable Trust. The discussion was moderated by Amy Tenderich (Patient Advocate and Journalist, DiabetesMine) and included David Panzirer (Trustee, Helmsley Charitable Trust), Dr. Ruth Weinstock (Medical Director, The Joslin Diabetes Center at SUNY Upstate Medical University), Dr. Susan Beane (Vice President and Executive Medical Director, Healthfirst) and David Weingard (CEO and Founder, Cecelia Health).
The panelists engaged in a rich discussion with a central theme of advocating for a holistic, “whole-person” approach to diabetes care in a blended care delivery model that incorporates telehealth as a critical compliment to in-person care. This shift to a new paradigm will inevitably force changes to the healthcare value chain and care delivery process that are long overdue.
6-minute recap of key takeaways
Current State of Diabetes Care
How would you describe the current state of diabetes and related mental health care in America? What has been the impact of COVID-19?
View from David Panzirer:
The current state is honestly horrible. In the U.S., we treat symptoms but don’t treat people. Additionally, so much money is spent on healthcare, but our outcomes are some of the worst in the developed world. The shifts in diabetes-related healthcare due to COVID-19 have opened up virtual care opportunities in a matter of weeks that normally would have taken years.
Tips for success:
- Advocate for patient-centered care, instead of simply using it as a buzzword.
- Look at the underlying problem patients face and use this to empower them to take charge of their healthcare.
- Treat mental health as a key component of lifestyle change in the same way we provide mental health resources for other chronic conditions, like cancer.
What care delivery challenges do diabetes specialty clinics and patients face? How have these issues been exposed during the COVID-19 pandemic?
View from Dr. Ruth Weinstock:
In these clinics, we see people from all walks of life, including people living in rural areas and those experiencing poverty. With increasing use of new and changing technology, management of diabetes has become more complex. As a result, in-patient visits have become inefficient due to the time taken to download data from devices. Ultimately, there is not enough staff to prepare patients and address these challenges. COVID-19 has exacerbated all these problems, particularly due to the overnight change from in-person care to virtual.
Tips for success:
- Invest in training patients to use medical devices, particularly if they require significant time to learn how to use.
- Utilize remote Certified Diabetes Care and Education Specialists (CDCESs) like those from Cecelia Health to ensure they can provide emotional support, explain how injections work, and are able to work through the financial concerns of patients.
- Handle remote visits by working closely with CDCESs and providers as a team to reduce diabetes comorbidity and mortality.
How has COVID-19 changed how your organization thinks about supporting members with diabetes?
View from Dr. Susan Beane:
There is an emerging new way that healthcare will be delivered, with face-to-face visits still available, but many visits happening through telehealth. COVID-19 has emphasized obvious challenges such as working around not meeting face-to-face with providers, but it has also highlighted other challenges members face, such as food insecurity.
Tips for success:
- It is important to look at diabetes as a condition that impacts all facets of a person’s life, and treat the whole person, not just isolated symptoms.
- Consider the impact of anxiety, depression, and stress. While A1C levels are important, there needs to be consideration of other related health issues.
What have you learned about virtual diabetes care that enabled Cecelia Health to respond to the challenges of COVID-19?
View from David Weingard:
A major challenge has always been getting people to initiate and adhere to their medications and devices. One area of focus for us has always been skill-building in order to have more efficient provider visits for patients.
Tips for success:
- Empower patients to interpret data on their own.
- Employ CDCESs that can help people stick to their wellness plan and educate them on how to use the newest medical technology.
Ideal State of Diabetes Care
What’s your vision for high quality, affordable diabetes and related mental health care?
View from David Panzirer:
Geography dictates your ability to see specialists and receive specialty care. One of the most important tools for diabetes management is a CGM, but most devices like these can only be prescribed by specialists. Fortunately, telehealth can level the playing field by linking patients to specialists, regardless of location.
Tips for success:
- Ensure everybody has equal access to quality of care regardless of where they live.
- Put CDCESs front and center of the diabetes care equation.
- Layer in mental health care in virtual care and provide referrals to psychiatrists for more serious mental health issues.
- Seize this moment in time due to COVID-19 as an opportunity to integrate virtual care into diabetes management long-term.
What can Cecelia Health do to execute against the vision for affordable high-quality diabetes & mental health care?
View from David Weingard:
There is a shrinking population of endocrinologists, with most being located on either the East or West coast. Cecelia Health has set up a legal infrastructure of nation-wide endocrinologists and is able to make recommendations for adjustments in medication. Our model of virtual care provides a continuity in the care received by patients that meets them wherever they are.
Tips for success:
- Take into account the socioeconomic profiles of patients. Doing so will allow for the provision of culturally competent care.
- Develop trust between the patient and their care team by engaging them both from a behavioral and medical perspective.
What’s the optimal way to deliver quality care to diabetes patients based on what you’ve learned from Covid-19?
View from Dr. Ruth Weinstock:
The current model of care needs to change.
Tips for success:
- Include a combination of remote and in-person visits that are tailored to the individual. Build in flexibility for when a problem arises, or a new device is introduced.
- Supplement provider visits with support from CDCESs, mental health providers, and social workers in between visits. An interdisciplinary team model needs to be constructed.
- Insurers need to continue to pay for remote visits. We cannot go backwards from where we are now.
How would payers like to see diabetes care evolve?
View from Dr. Susan Beane:
Telehealth is here to stay, and payers want it to stay.
Tips for success:
- Ensure patients continue to have access to valuable resources like CDCESs.
- Identify if a patient has a life event that makes them more vulnerable (like anxiety, depression, loss of home, etc.). By actively “owning” their diabetes management and finding what works for them, patients don’t always have to experience complications.
Are you seeing an emphasis on people using coaching apps as we move more into a telehealth world?
Views from David Weingard, David Panzirer, and Dr. Ruth Weinstock:
Many people living with diabetes need support from a CDCES and the person-to-person contact they provide in order to motivate them to make lifestyle changes. Apps solve for the “how” by suggesting ways to alter your diabetes care routine, but for many getting to the “why” is the critical first step to optimizing diabetes management care.
Tips for success:
- Educate patients on the fundamentals first and then integrate apps and devices.
- Do your homework to make sure any apps used or recommended have been proven to be reliable. Those that are FDA approved have been tested, but many apps offered have never been tested.
What needs to be done to bring on the next generation of providers that are ready for this blended care that has been talked about?
View from Dr. Ruth Weinstock:
Major roadblocks to this are reimbursements offered for specialists. For example, endocrinologists are often the lowest paid of physicians.
Tips for success:
- Rethink training that is done for specialists, but also for nurses, dieticians, and other professions.
- Recruit people who have a passion for helping people with diabetes.
Will coverage for telemedicine reimbursement fall off as time goes on?
View from Dr. Susan Beane:
There will be a shift to telemedicine in a blended model, but how quickly we get there is dependent on payers.
Tips for success:
- Encourage physicians and providers to qualify for ongoing telemedicine reimbursement. This is an ongoing process which includes making sure that practices are equipped to perform telemedicine.
What else can be done to address the behavior health need of patients, considering the stigma and inefficient access to specialists?
Views from David Panzirer, Dr. Susan Beane, and David Weingard:
Data shows that including mental health services is cost-efficient to payers. With many apps, it is imperative that engagement needs to take place in a medically proven protocol. Clinical pathways need to consider emotional and behavioral perspectives and address this in a safe way.
Tips for success:
- Decentralize knowledge and engage patients in the manner that is easiest for them.
- Acknowledge social determinants of health. Consider food insecurity and community resources, which are critical in looking at the whole patient.
Full event recording