Diabetes Care: Building a Foundation for Better Health

Join host Anna Gurdak, her colleague Robina Montague, and Chris Yocom, Diabetes Prevention Program Manager at Pottstown Medical Specialists (PMSI), in a deep dive into the transformative world of PMSI's Diabetes Self-Management Education and Support (DSMES) program. This episode explores the impact of DSMES across Pennsylvania, emphasizing the importance of teamwork in managing diabetes effectively. The discussion covers the core principles of DSMES, the relevance of lifestyle changes in diabetes prevention, and strategies to overcome participation barriers. It also includes insights into PMSI's Diabetes Prevention Program (DPP). A must-listen for healthcare providers, patients, and anyone interested in health innovation.

Contact PMSI.

PADOH-DM-011425-GK

Transcript

Hello listeners and welcome back to our quality insights podcast series where we dive into the heart of healthcare transformation and innovation. My name is Anna Gurdak and I will be your host for today joined by my colleague Robina Montague. Robina, would you like to introduce yourself?

Sure. Good morning. My name is Robina Montague. I'm a registered nurse and a practice transformation specialist here at Quality Insights. I work on the diabetes initiative to, improve health equity. And I work alongside with Chris Yocom from PMSI. Chris, take it away. Good morning. Nice to be here.

My name is Chris Yocom. I work with Pottstown Medical Specialist, the Diabetes Education Department. I primarily run the diabetes prevention program, but we also are having diabetes education and support. So I'm the community outreach coordinator for that as well. Thank you both for being with me today.

In this episode, we're going to dive into an important topic that touches lives across Pennsylvania and the nation alike, diabetes self management. Specifically, we're here to explore a fantastic resource that Chris mentioned a little bit, which is the known as DSMES, or Diabetes Self Management Education and Support.

So Rabina and I are thrilled to be joined by Christopher Yocom, who has been working with PMSI as a Diabetes Prevention Program Manager for a little over 10 years. So he's here today to share some insights into their DSMES program and the impact that it's having on Pennsylvania communities. So again, welcome to the podcast, Chris.

It's exciting to have you with us to share your journey and success in creating a DSMES program.

Thanks again. Um, just wanted to say that, you know, it is a team approach that we use for our DSMES programs and our DPP.  We have. pretty much specialties within our specialty group.  There's five of us.  We are led by face cycle. She is our diabetes education nurse. So she runs the department as well.

We also have Abby Nestle. She is our medical nutrition therapist.  And she helps with advanced nutrition cases that I myself might need a little assistance on because I am more in the range of exercise physiology, developing exercise programs for people that need corrective exercise specialties and along with general nutrition.

So we really take a team approach to that. We also have two lifestyle coaches in addition to Abby and myself, Shreya Patel and, Debbie's only, which unfortunately we're losing Debbie to retirement, but a well deserved retirement, because she is basically the founder of our education department.

So without her,  none of us would be here and our program would not be where it is today for sure. It sounds like you have a really strong team and when it comes to a new initiative or carrying one on, it certainly. It takes a village. Absolutely. Not 1 person. Well, I have to correct myself. 1 person did start this program, but, she laid the groundwork for us to follow.

 And she, Debbie, who I'm referring to definitely put the groundwork in the time in for us to, have the success that we have today.

Thank you for introducing your team, Chris

So, with that, for our listeners, I'm hoping that you could kind of discuss some of the common challenges with diabetes and paint a little bit of a picture about what participants could expect if they enrolled in your DSMES program. Sure, absolutely. Our DSMES program Programs basically, we work off the 7 core principles is the association of diabetes care and education specialists.

That's our program is accredited by they have basically 7 core philosophies principles that we help people manage that have diabetes because diabetes is a. It's a whirlwind disease. Uh, they could have anything from, you know, just their blood sugar monitoring to multiple medications that they're not sure when to take, where to take, you know, where to inject, things like that.

So we give them these principles to kind of outline success with diabetes management. We go over healthy coping skills because once you're diagnosed as a diabetic, it's a big life change. So people are just kind of, Oh my gosh, what do I do now? Is my life over, you know, because I'm diabetic. So we kind of teach them that, Hey, you know, your, your life is not over.

You can manage this. You can, you can cope with this disease. So that's one skill that they will learn in our program is healthy coping. Um, along with that, uh, we also. you know, go over nutrition because nutrition is the basis for good diabetes management.  Our favorite saying in the education department is you can always out eat your medications.

 And that's where Abby comes in. She's our medical nutrition therapist. She's a registered dietitian.  So she goes over That section of the program with them, to, just kind of bring them up to speed on nutrition because, everybody knows what they need to eat. It's just how do you incorporate that into  your daily lifestyle?

 My specialty exercise physiology is part of the core 7.  It's activity, you know, how to increase their activity, how to manage your blood sugar through activity.  And what the benefits of activity can just do for you overall,  in terms of managing your diabetes. And a lot of times we get people, past injuries, you know, they might be a little bit overweight.

So their joints, their back, hurt. And that's where my corrective exercise specialty background comes in, where I can design programs for them that they're able to do so they don't get defeated and they don't feel like, Oh, I can't exercise. I'll just,  watch TV. So I work closely with them to ensure that they can do exercises that are Beneficial and also fun for them because that's a big key of the role too is make it fun.

So they want to do it  faith she's our education specialist, nurse So she's the one that would break down their medication usage when to take it How to take it how to self dose storage disposal all that stuff because some of these medic diabetes medications are pretty time specific you need to take them on a regular basis.

 You need to storage them properly. So a lot of times people forget that and they might leave their insulin syringe in their car when it's 90 degrees out. And that's not going to be a good thing. Along with that, we also go over risk reduction, what to do if you become sick, ill, injured in the hospital for a while.

And then we also help them, develop a an action plan for problem solving. So we based the DSMES on the seven core principles. And that's basically what each session goes over with that person to help them, better educate themselves on how to deal with their diabetes diagnosis.

That sounds like an incredible and all encompassing program that supplies participants with so many critical skills to help them manage their diabetes more effectively. And it makes sense why there are so many people on your team because you're covering a range of so many topics. Yeah, it's definitely a team effort for sure.

One of the things that you mentioned was medication and, along with nutrition and exercise. When it comes to medication,  this is kind of a hot topic today, is diabetes, medication, and GLP 1s. Do you guys discuss this in your program or have any information that you'd like to share with listeners on this topic?

We do discuss GLP ones. It's relatively new for us to incorporate it into our program. But it's always like you said, it's a hot topic and everybody brings it up. Everybody wants to know about the GLP ones. Our philosophy is that we are not against medication at all by any means. But we want you to put the groundwork in first before we, either agree to recommend it to your primary care physician.

Or, say, Hey, I think this would work for you. And by primary groundwork, I mean, we want you to develop the necessary skills in nutrition and activity to help the GLP 1. GLP 1s are fantastic medications. And so far they have proven themselves to be everything from diabetes management and control to, helping with sleep apnea is the latest that we've heard.

So they're really front and center almost every day. But there is some groundwork with them because you metabolically change when you start the GLP 1s. Your stomach digestion process changes. So the way you eat has to change too, and a lot of people don't realize that. So, we do want you to go through the education process first, before either recommend or start you on the GLP 1, but it is something that we are incorporating into our programs.

And it sounds like the nutrition and exercise pieces of your program would pair very nicely into that conversation and education. Yeah, it does, because you have to lay the groundwork for the GLP 1. As much as we'd like to say this is the latest, greatest, miracle drug, and it's the  magic injection, we've all been looking for,  it's really based on how you take care of yourself outside of giving yourself the medication.

It's, it, as much as we like to say, it's not the end all be all of diabetes management. But it's a good, it's a good start. Okay. So, with your program covering all of these important topics, how long could someone expect to be in this program? The DSMES program we have set into four sessions. so it's not very long, like the actual program itself is for sometimes we can go five sessions depending on the needs of the class.

 But if we have a group class, it's four sessions. They're about maybe an hour, hour, 20 minutes long. Each of us take one class and it's a specialty session. So in the group setting. It's for consecutive weeks. In the office setting, if you were to come in and visit us in the office, it could be, as long as you need it to be.

Basically, we don't really put a time frame on our education process. Unfortunately, sometimes we have to follow what their insurance covers for them, but,  if you need to come in and discuss something because you've had a medication change, you need your,  your blood sugars are a little, out of whack, there is no limit.

So we will never tell someone, Hey, you know, you've hit your session number 5 with Chris. You can't come in and see him again. We don't do that. We're here as long as they need us. Incredible resource. With that, sometimes even if you have a program that is so beneficial to the people that it's intended for, it can still be tricky to get them to enroll.

So, what strategies have you guys used to engage patients and kind of reduce any hesitancy that they might be facing in regards to joining your DSMES program? That is a good question. That's probably one of the trickiest things. He said one of the trickiest things we've had is getting people to enroll in the classes because they don't really know what it is.

So a lot of groundwork, a lot of, brochures, advertisement, talking to the people say, hey,  Why don't you just come in and have a consultation with myself or Abby or faith and we'll talk to you about the program. Get to meet them, get to know them. Just have information sessions.

Technology is a great way to get, reach out there and do it. We have our facebook page that, People can refer to.  But basically just  being approachable, I think,  is the biggest thing that I've found that helps to get them into the classes. We don't want to be seen as your, and I don't mean any disrespect to our other providers, but we don't want to be seen as our typical medical provider.

We are here, More as an educator role. We want you to be comfortable when you come to see us, so we don't want that stigma of, we're going to come in and tell you, you have to do this. You have to do that. You have to do this. And that's what you have to do. Now. We want to develop a relationship.

One on one so you feel comfortable coming to us and saying, Hey,  I missed my medication a couple of days in a row and my blood sugar is really out of whack. Can you help me get it back? So I think just being personable, getting the word out. So people understand that this is an education process and not a, I'm going to tell you what you have to do process, really helps to get them to come in to the education center.

Well, it sounds like. having you on our podcast today could also help get that word out.  Oh, absolutely. Yeah.  Boots on the ground and what they say, that's the common thing, network, get to know people, get to know your physicians, get to know people that can refer you, patients that  need the assistance.

And on the topic of providing specific assistance to patients, in the history of your program, how have social factors like access to care or economic challenges affected the participation of your DSMES program, and how does your program work to address those barriers? Social aspect, I think, has really changed in the last couple of years, just because people are  becoming more familiar with social media.

And, it's not only, the outreach is a lot greater, using those techniques, especially since,  the COVID pandemic, we do tons of online sessions now, where before that, we, you'd say somebody,  online,  And you're like, what's that? We don't want to do that.  So that makes it a lot easier for people that have that capability  for us to reach them.

And even for those that don't have the online capability, a lot of our physicians offices, they have free wifi. So  if wifi is an issue or connections are an issue,  they can go to one of our offices and,  Log in that way. But there is, there's so much kind of technology out there that has helped our area is pretty fortunate.

We have a lot of resources available to people that might not have the capabilities to,  reach our social media or social present online. so there's a lot of resources out there, that they can tap into to, for us to help reach them. It sounds like for the most part, technology has played a huge role in your program, at least over the last five years since the pandemic.

Yeah, absolutely.  It's huge. I mean, it probably wouldn't be where it's at without, the increase in technology. I think there are a number of people across the world who have a similar story and how the pandemic kind of morphed the program's relationship with technology and catapulted it forward in unexpected ways.

Yeah, yeah, for sure. So we've discussed patient engagement and buy in.  I'm hoping to learn a little bit more about provider and care team buy in and how that influences your program. That's a huge influence. Our providers are our biggest referral source. Fortunately, our practices is a pretty good sized practice.

We have five family physicians and three specialty groups. Eso their referrals to us are invaluable. They see them usually before we do, they get the lab results before we do. So if they see something and they say, hey,  your a one sees up a little bit,  let's get you hooked up with one of our educators.

So we can bring that down a little bit.  The buy in for our providers took some work. It wasn't an instant success story, even within our own organization. division. , it  took some schmoozing, took some, educating them on exactly what we do.

 Because, we're not all centrally located. So our practices are spread out all the way from Boyertown. to Collegeville.  So there's a pretty wide range in there. So a lot of times people would say, Oh, it's the Department of Education and what do they do? So it was a lot of just going to our own providers and saying, Hey, this is what we do.

This is what we offer. If you have a patient that meets these criteria, send them our way. So it took some time and  that's where the groundwork was laid to  get our own providers on board with the what we could offer. And also, bragging about yourself a little bit to help a lot so we can say, Hey,  remember, you know, patient X.

 Their A1C was 12. 2.  In six months, we got them down to 7. 3,  just by them coming to our education, sessions and everything like that. So, a lot of self bragging,  you got to  tout your own success stories to your physicians so they can see that what you do works.

And then once we get them on board. Then it's a lot easier to go out into the community and say, Hey, we have, Dr. Smith. It's not an actual doctor, but Dr. Smith supports our program. Can we have 1 of your programs at the local, community center?  And then it's a lot easier to kind of get backing, when your physicians are behind it, and then you go out to the community and you have evidence based results that you can show them, and say, Hey, we know you have  a high, Diabetic community in this area, would you like to host a program and  it's a medically supervised program, you know, blah, blah, blah, kind of tell you and then go from there.

So, yeah, physician backing is huge and just getting them to know what you offer is a big part of that. And it sounds like there's a very direct relationship between provider buy in and participant buy in because both Involve communication and being approachable and education and just having those conversations, but it sounds like the conversations with participants really builds off of the conversations with providers and vice versa.

Yeah, our providers, like you said, they're the frontline for us as much as we'd like to, get those results first. The providers see the patients usually, before we do or even kind of know about the patient because they see the lab results, they see the patient, they talk to them about medications.

The nice thing about our department is we can spend more time with the person than our providers can. Our providers aren't really tight schedule just because the volume of patients they see, our average appointment time is about a half hour.

Some a little bit more so we can really  dive into,  what The bottom root causes for their health, their needs. Well, sustaining a program like DSMES, it takes more than support from providers and participants. So how are you guys approaching securing funding for your efforts moving forward and ensuring that this is something that you can continue to provide?

Funding  is a touchy source, but we work with some really good partners. Quality insights has helped us immensely with securing funding health promotions council. Has helped us a lot with their block grant programs. And then also just, our billing department  is good. But billing for the DSMES is, is tricky.  That's kind of why we've reached out more to health promotions council and are now part of their umbrella hub with our diabetes prevention program. And we're also working with them to get into an umbrella hub. I guess you could call it with their DSMES once that's up and running.

And that's specialty  is billing, finding funding for these programs because we don't, we will never ask people for out of pocket money.  That's one thing that we pride ourselves on our DPP program or diabetes prevention program. If their insurance doesn't cover the entire thing, we don't overbill for, cause we want them to have the program.

So we, we basically, take what we can. But we've never, and again, being part of a large organization, a strong organization like Toxtown Medical Specialists,  helps us with that. The startup costs minimal,  ongoing support is pretty minimal too. And then, basically it's the type of program once it's up and going,  if you get in with,  a company or an organization like Health Promotions Council.

They can really help you, Quality Insights,  can also help you find funding for programs. And then just,  it's, basically your billing department. , how good are they, and how much support can you give them, to get the claims accepted and the process But like I said, some of the social determinants we've decided that we don't overbill for any of these programs.

 Fortunately  we're good to go with that. Thanks for sharing that insight. And in a way, our conversation has made it full circle back to the idea of it takes a village and these things cannot be accomplished by one person or just a small group. It really, it takes a full care team. It does.

And  it starts basically from the top. Because you need to have  your organization support because there's a lot of processes with D. S. M. E. S. and diabetes prevention accreditation is not the easiest thing. But once you have an accredited program, it opens up. for you that you would not believe.

But also you have to have the support of your organization, the sort support of your providers. You have to have a good team in place, which fortunately we do.  I couldn't ask for a better team to work with. Everybody from Amanda, who greets you at the front desk to our medical, director, Dr.

Brocious is on board and they treat us with priority,  because they know that we are an important division of Pottstown medical specialists. And a lot of times we're the face of the company.  We're the ones going out to the health fairs. We're the ones,  out in the community, we're the ones representing Pottstown medical specialists.

So not only do you want to have good providers that know what they're talking about and good educators. You also have to have that willingness to be a community presence, and everybody on our team has that willingness to share their information with the community. So  that's what I'm most proud of  our team,  is their willingness to get out into the community  and, express your passion for diabetes management and prevention.

On the topic of your team, you have mentioned a few times your diabetes prevention program and we've mostly been talking about DSMES. So is there anything that you'd like to share about the DPP? Oh, my gosh, this could be another one all by itself. But yeah, our diabetes prevention program has grown exponentially since I first started.

And again, it goes back to someone that had a passion for that type of program, which was was Debbie. She got our foundation started. She laid the groundwork for the diabetes prevention. She handpicked her coaches in the beginning. And fortunately, I was I was one. So I feel kind of honored to be,  in the beginnings of it, and watch it grow and help the growth.

So our diabetes prevention program is based off the, CDC's National Diabetes Prevention Program. It is the National Diabetes Prevention Program. So those are, it's a year long course,  16 weeks are weekly sessions. The majority of them right now are online, but we are slowly breaking back into, in person classes.

And it just teaches people, Prevention is worth a pound of an ounce of cure or whatever they say with that.  But  it lays the groundwork for lifestyle change,  better nutrition habits, more activity, all in hopes to, get that blood sugar number down out of that pre diabetic range or kind of freeze it where it's at and push off,  their future as a diabetic.

We want to lay the groundwork in the beginning when they get that pre diabetes diagnosis, say okay, these are some small little changes you have to make. There's nothing huge. Yeah,  it's a lifestyle change, but it's not like you're doing a complete  180 flip with your lifestyle. Small little things that can help you, manage your pre diabetes conditions.

So you don't,  work yourself into,  the diabetic zone where we would, have to move you into  our DSMES classes. So  it's a great program and it's grown we used to have cohorts maybe, once every couple of months and now with demand, we're having them pretty much monthly.

Well, it sounds like when it comes to diabetes management or prevention, nutrition and exercise are two of the biggest pieces in managing these conditions. Mm hmm. Yeah. I mean, nutrition and exercise lays the groundwork. If you And this is my exercise specialty coming out. But if you're not willing to put in the work to become a little more active, to change your eating habits just a little bit, I'm not talking, drastically.

But if you're not willing to put in the work, then we might as well just start you on the diabetes medication right away. And that's going to be a process that you might not enjoy because,  it's one more medication to add to your,  your daily routine. It's one more thing you have to monitor.

It's, , one more stressor in your life that you have to worry about. But if you just put in a little bit of work in the beginning,  you can make those changes where the medication might not be in your immediate future. And that's the one thing that we stress,  comes from, small dietary nutritional changes and an increase in activity.

Thank you, Chris. This has been an invaluable conversation and it's been very helpful to learn about PMSI's journey and success with your DSMES program. Before we wrap up, is there any one message that you would like to leave for providers, care teams, and patients alike who might be considering diabetes self management education and support?

Yeah, my biggest message to everybody is just be proactive. Diabetes is the kind of, disease where the more proactive you are, the better your long range outcome will be.  Don't just sit back and let it run its course. You can fight against this disease.  It's the kind of thing that, the more you take control of it, the better your long range outcome will be.

 Just don't sit back and say, Oh, I was, my mom was diabetic. My dad was diabetic. I'm diabetic. You know, it's just the way it is. It doesn't have to be the way it is.  You can manage your diabetes care through,  organizations that have educational providers. And don't be afraid to, if your organization doesn't have an education team, a diabetes education management team, don't be afraid to ask for a referral.

 If you're in the area.  Our DPP program is nationwide. So if you are in New York. I've had a person in Hawaii, part of my, one of my cohorts. So if you're in, you know, anywhere you can be part of our DPP program.  And we also take outside referrals for diabetes, self management.

So don't be afraid to ask questions. Don't be afraid to be proactive and don't let it take over your life. I mean, there are things that you can do to,  halt that process.  And a lot of times it's just. Tiny little things that people are so surprised of they go, that wasn't that bad and it helped me a lot in the long run That's incredibly empowering advice.

My hope is that this podcast finds the right people so that they can Understand everything that you just said I hope so, too  our team is passionate about diabetes prevention and diabetes care and management And if you know anybody listening to this podcast, give me a call if you need to help You We'll be sure to include some of your contact information when we post it so they can.

Awesome. And with that, thank you, Chris, for taking the time to have this conversation with me today, for sharing your insights, and for all of the work that you're doing to improve diabetes care in Pennsylvania. With that, that concludes our episode for today. I would like to give another big thank you to our guest Christopher Yocom for sharing his experiences.

And to our listeners, we hope this discussion inspires and informs you about some of the possibilities of enhancing your diabetes management. Please share this podcast with your friends and colleagues and join us again next time for more engaging discussions on healthcare innovation. Until we meet again, take care.

Thank you.