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Engaging Patients in Education for Self-Management in an Accountable Care Environment

A ccountability for quality health outcomes at low cost is a priority discussion in nearly all medical circles, but particularly among primary care providers of diabetes care. Accountable care organizations (ACOs) and patient-centered medical home (PCMH) models have assigned accountability to providers who, in turn, are reengineering the way they provide care, integrating evidence-based practice guidelines, quality metrics of success, and algorithms that improve quality and reduce costs. However, physicians, payers, and employers are only beginning to understand and appreciate their underutilized resource for enhancing accountability: the patients.

Engaging patients to make good decisions about their health and health care is recognized as crucial but requires incentives and techniques with which most are unfamiliar. At the heart of assuming responsibility for this shared decision making is the well-tested concept of the educated patient. Indeed, PCMH pilot projects of integrated care management that have been successful have placed a high premium on educated patients who actively share in decision making for assuming self-management and personal responsibility.1,2

The value of patient education in diabetes self-management need not be debated. Studies demonstrate that knowledge and skills facilitating key self-care behaviors are successful in improving metabolic and psychosocial outcomes, as well as providing cost savings.3,4 Patient education certification programs based on evidence-based standards for diabetes self-management education (DSME) have been in existence for more than 20 years, and reimbursement for these programs is steadily improving.

Although this type of education intervention is meant to improve patients' ability to self-manage diabetes through knowledge and skill development, the educational benefit itself is underutilized, particularly in people living in underserved areas.4 Physician variability in referring patients for DSME suggests that poor access to certified programs may not be entirely responsible for underutilization.

Just as provider education is continuous throughout a …