Use of Medicare’s diabetes self-management training benefit
Abstract
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.
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Only 5-7% of individuals eligible for diabetes self-management education and support through Medicare or a private insurance plan actually receive it.
“Despite the benefits of DSMES, reports indicate that only 5-7% of individuals eligible for DSMES through Medicare or a private insurance plan actually receive it (80,81).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [80]
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- Authors
- Strawbridge, L. M., Lloyd, J. T., Meadow, A., Riley, G. F., & Howell, B. L.
- Affiliations
- Centers for Medicare and Medicaid Services (US)
- Venue
- Health Education & Behavior
- Publisher
- SAGE Publications
- Published
- 2015-01-23
- Volume
- 42
- Issue
- 4
- Pages
- 530-538
- ISSN
- 1090-1981 (ISSN-L)
- 1552-6127
- OpenAlex
- W2008032536
- Cited by
- 152
- References
- 28
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 11 · 2023: 19 · 2022: 19 · 2021: 14 · 2020: 20 · 2019: 17 · 2018: 9 · 2017: 13 · 2016: 6 · 2015: 1
- FWCI
- 8.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Education & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetes self-management education, Medicare, program utilization, newly diagnosed diabetes, health disparities, provider availability, Medicare-Medicaid dual eligibility, comorbidities, sex differences, racial disparities
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Diabetes Mellitus, Female, Medicare, Health Status, Humans, Male, Middle Aged, Patient Education as Topic, Self Care, Sex Factors, United States, Racial Groups
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