Use of Medicare's Diabetes Self-Management Training Benefit

• Published in: Health education & behavior 2015-08, Vol.42 (4), p.530-538
• Main Authors: Strawbridge, Larisa M., Lloyd, Jennifer T., Meadow, Ann, Riley, Gerald F., Howell, Benjamin L.
• Format: Article
• Language: English
• Subjects: Access to Health Care; Age Differences; Age Factors; Aged; Aged, 80 and over; Chronic Illness; Comorbidity; Continental Population Groups - statistics & numerical data; Diabetes; Diabetes Mellitus - psychology; Diabetes Mellitus - therapy; Disease management; Eligibility; Ethnic Groups; Female; Gender Differences; Geographic Location; Health Behavior; Health Insurance; Health Services; Health Status; Humans; Male; Management Development; Medicaid; Medicare; Medicare - utilization; Middle Aged; Multivariate analysis; Patient Education; Patient Education as Topic; Personal health; Prevention; Racial Differences; Regression (Statistics); Regression analysis; Regular Articles; Self Care - methods; Self Care - statistics & numerical data; Self Management; Sex Factors; Social Services; United States; Use Studies; White people
• ISSN: 1090-1981; 1552-6127
• DOI: 10.1177/1090198114566271

Medicare began reimbursing for outpatient diabetes self-management training (DSMT) in 2000; however, little is known about program utilization. Individuals diagnosed with diabetes in 2010 were identified from a 20% random selection of the Medicare fee-for-service population (N = 110,064). Medicare administrative and claims files were used to determine DSMT utilization. Multivariate logistic regression analyses evaluated the association of demographic, health status, and provider availability factors with DSMT utilization. Approximately 5% of Medicare beneficiaries with newly diagnosed diabetes used DSMT services. The adjusted odds of any utilization were lower among men compared with women, older individuals compared with younger, non-Whites compared with Whites, people dually eligible for Medicare and Medicaid compared with nondual eligibles, and patients with comorbidities compared with individuals without those conditions. Additionally, the adjusted odds of utilizing DSMT increased as the availability of providers who offered DSMT services increased and varied by Census region. Utilization of DSMT among Medicare beneficiaries with newly diagnosed diabetes is low. There appear to be marked disparities in access to DSMT by demographic and health status factors and availability of DSMT providers. In light of the increasing prevalence of diabetes, future research should identify barriers to DSMT access, describe DSMT providers, and explore the impact of DSMT services. With preventive services being increasingly covered by insurers, the low utilization of DSMT, a preventive service benefit that has existed for almost 15 years, highlights the challenges that may be encountered to achieve widespread dissemination and uptake of the new services.