Health care quality reporting is evolving, and diabetes care and education specialists have an important role to play. In this episode of Diabetes Care Conversations, host Davida Kruger talks with Marie Frazzitta, DNP, APRN, FNP-C, PMHNP-BC, CDCES, MBA, about the shift toward value-based care and digital quality reporting and what these changes mean for diabetes care. Learn how emerging quality measures are incorporating GMI and CGM utilization, how real-time diabetes data can support improved outcomes, and where DCESs can add value through patient engagement, technology implementation, clinical workflows, and collaboration with quality teams. The conversation also explores barriers related to technology, sustained CGM use, and equitable access, as well as how DCESs can position themselves as strategic partners in the changing health care quality landscape.
Health care quality reporting is evolving, and diabetes care and education specialists have an important role to play. In this episode of Diabetes Care Conversations, host Davida Kruger talks with Marie Frazzitta, DNP, APRN, FNP-C, PMHNP-BC, CDCES, MBA, about the shift toward value-based care and digital quality reporting and what these changes mean for diabetes care.
Learn how emerging quality measures are incorporating GMI and CGM utilization, how real-time diabetes data can support improved outcomes, and where DCESs can add value through patient engagement, technology implementation, clinical workflows, and collaboration with quality teams. The conversation also explores barriers related to technology, sustained CGM use, and equitable access, as well as how DCESs can position themselves as strategic partners in the changing health care quality landscape.
Davida Kruger
Welcome to Diabetes Care Conversations, the podcast from the Association of Diabetes Care and Education Specialists. I'm your host, Davida Kruger. Joining me today is Marie Frazzitta, a family and psychiatric nurse practitioner and certified diabetes care and education specialist. We'll discuss changes in health quality reporting amidst an evolving health care landscape and what this means for diabetes care and education specialists in practice today. Marie,
Welcome to Diabetes Care Conversations. Before we dive in, can you tell us more about yourself and your investment in quality reporting?
Marie Frazzitta
Yes, absolutely. Thank you, Davida. And I appreciate the opportunity to be here today. I'm excited to be here to talk about such an important topic. So, over the past 25 years of my career, I've had the unique opportunity to work in the three major pillars of health care. First, in a health care system, where I worked in clinical practice and then got very involved in administration and program development. Then I went into working for a health plan in a senior leadership role, running care management, population health, employee wellness programs, and really aligning with quality metrics and outcomes. And then my last experience has been working with a diabetes digital technology company. I'm really passionate about this type of work because the more we really combine clinical care quality and the business aspect of health care, we are really improving outcomes and aligning financial incentives, which in today's health care arena, right, is really important.
Davida
Well, first of all, I'm so impressed that you've had all of these pillars and how you have been able to bring them together. And I love that you have both a DNP and an MBA that is so impressive and really allows you to speak from a level that's beyond what most people can do. So thank you. Can you tell us about the changing quality landscape in health care?
Marie
Absolutely. Well, the big picture is that our current health care system is really unsustainable. We pay so much per capita for health care. The costs are just skyrocketing. In 2024, we paid five point three trillion dollars, which was a seven point two percent increase from the year prior. So it's just really, really unsustainable. And what is very concerning about that is that not only are we paying so much in health care, our outcomes are not where they need to be. So if we think about specifically diabetes, about 50% of people living with diabetes are not meeting the standard of care of seven percent A1C. And when we look at people living with type one diabetes, only 23% are really meeting the standard of care.
So we need to do a better job at improving outcomes for people living with diabetes. And then thirdly, the administrative burden. I mean, you and I are both in clinical practice and we know how arduous, right, the administrative burden is. So because of this, the health care industry is really shifting from like a fee for service model where they reward volume to a value-based model where it's going to be rewarded financially if you can improve outcomes. So that is like one of the biggest transformations that we're seeing now in health care.
Davida
You know, it really does boggle my mind because you and I both, like you said, are in clinical practice in health care and it makes me crazy to see how many people have A1Cs greater than eight percent, greater than nine percent, and that just continues despite the fact that we have all this technology, all these great medications. So I'm thrilled to hear that we're making that transformation.
Are there any frameworks or workflows that the DCES can rely on to guide them as we enter this next phase of care?
Marie
Yes, absolutely. I mean, really the beginning catalyst of this all really started in 2008 when the Institute for Health care Improvement kind of rolled out what they called the triple aim. And those three pillars really were improving population health, enhancing the patient experience, and reducing costs of care. That has since expanded now to the quintuple aim, where they added now.
Provider satisfaction because we know people in health care are getting burnt out, right? People are leaving clinical roles in in large quantities and advancing health equity.
Davida
Yeah. Outlining that certainly helps us find places where we can hang our hats. And your point about burnout, you know, the best of the best say, you know, enough. Hopefully this will help as well. What's driving these changes in health quality reporting?
Marie
One of the biggest changes that are happening is that we're going from a very manual way of collecting data and utilizing claims data that really capture delivery that had happened retrospectively to a more real-time approach and really utilizing technology. I recall being an auditor back for NCQA for the diabetes recognition program and having to manually, you know, go through charts. And it was extremely arduous. You know, health care is one of the late adapters to really embracing technology. When you look at other industries like the retail industry or the banking industry, they embraced technology. They were one of the earlier adopters. And now what's happening is health care has finally come to age, right, where we're going to be using digital reporting to get real-time data. For you know, driving and improving outcomes.
Davida
I think that's magnificent because clearly we're working with that data. We have it every single day. Now we just need to utilize it, put it into practice, and help have a positive, better outcome for people with diabetes. I love that direction. Thank you.
So what does the shift in quality measures mean for the DCES in practice? So can we transfer a little bit and say, and now how do we ask or see the DCES's role?
Marie
Absolutely. And I think that being a diabetes care and education specialist is really going to add so much value to this because we are really clinicians who understand the human side of diabetes and how technology really works and how we can support patients. And I think it's a massive opportunity for us to elevate our role and be part of this transformation.
Davida
Absolutely. And they're in the prime seat, ready, willing, and able. We just need to give them the information. And that's always been. It's you know, when people say, have you used a DCES? And they're you know, we're ready, willing and able to help. Can you talk a little bit about how the DCES can continue to elevate in this context and what will that mean for the specialty practicality?
Marie
Absolutely. So the DCES already excels at the core drivers to really improve quality performance, right? We're experts in patient engagement, in technology implementation, behavior change, and chronic disease management. And as we become more and more familiar with digital reporting and leveraging diabetes technology, we can play an even more influential role across the health care system.
And I think this really means, right, for us to kind of move from traditional education to become more essential strategic partners in this whole transformation.
Davida
Wow, okay. I think that's fair and reasonable to expect that we're gonna be able to make that transition again, you know, ready, willing, and able. We've got the background and the education.
So what has changed with the Glycemic Status Assessment Measure? How would you describe that information?
Marie
Sure, absolutely. So this to me is really where the rubber hits the road. The glycemic status assessment, also known as the GSD, is the most widely used quality metric, right? It's used in HEDIS, it's used in Medicare STARS, and it's used in value-based contracting. And it's important to note that it's a triple weight measure, and that means that it has a major impact.
On health care's overall ratings and financial performance. So it's really an extremely important measure. And the whole intention of the measure is to really look at how are we supporting people living with diabetes in achieving improved glycemic outcomes? So the big change really happened in 2024. So historically, the HBA1C was the metric that was used to report for the GSD. So in 2024, NCQA, the National Committee on Quality Assurance that owns the development of HEDIS metrics, incorporated the GMI, the glucose management indicator, as a reporting metric for the GSD. So you can report now either an A1C or a GMI.
And what's happening in the future is that in 2027, an additional metric is going to be rolled out, which I actually was really excited about, where you're going to be reporting on the utilization of CGM for people living with type one and those living with type two who are on insulin. So there'll be a second metric now, a process metric, if you will, you know, looking at the utilization of CGM.
Davida
So in 2024, let me just get this right. In 2024, NCQA said, okay, we can now use GMI as well as A1C, which I think is magnificent since we know that the GMI is readily available for those people who are doing CGM. And then when we look ahead in 2027, we'll be able to track all of this using CGM, which is real time data in people with type one and type two. Wow.
That's a lot. And how magnificent to take the CGM that we really want everyone to have. And really that will help, I think, engage our primary care colleagues to want to use CGM to be able to then use the GMI. I love it. I love it. That's great information.
Marie
And we'll have real time actionable data. We don't have to wait three months to see how someone is improving. If someone's having medication adherence issues or coaching them on meal planning, right, we can see within two weeks how their glycemic control is improving.
Davida
Love that. And then that's what we've been asking for. So kudos for being able to incorporate all that. So can you talk to us a little bit about how you envision translating this information into clinical practice?
Marie
So I think a big step is really building those clinical workflows. I think it's really important. And I think this is an area where diabetes care and education specialists can really help support is helping create those clinical workflows where the data can seamlessly go into the electronic health record, right? We can't rely on, you know, patients bringing in their devices and uploading it while they're in clinic or that one clinician that knows how to upload a device, right? It has to be done where it's a one-time integration within the platform where that data can come continuously. So I think that is a really important component that we need to kind of focus on and again where I think diabetes care and education specialists can really help support.
Davida
You know what else I think is interesting too is the companies that bring us CGM are recognizing this as well. And they're developing platforms in some of the EHRs that once I write the prescription, it will automatically upload moving forward. So the data will be there. And we're so excited about that because then we won't have to cut and paste.
Marie
Absolutely. And I think there has been a lot of focus on that integration piece. And I think it's just going to continue to develop.
Davida
Awesome. So what barriers exist to success and how can these challenges be overcome? I mean, I think that's really important as we're getting ready for all of this, to get rid of as many barriers as we possibly can.
Marie
Absolutely. When I think about barriers, I think of three different types of barriers. One is the patient, second is the technology, and the third, which is very important, is equity, right? First is patient adherence, right? The device is only going to be as useful as frequently as the patient is adhering to it and is using it. And this is an area where I really think diabetes care and education specialist can really add value, you know, with really helping patients understand the value of CGM, know how to act on the data so that they are engaged in utilizing the technology and will continue to use it, you know, long term. Because when you look at attrition data, it's a little bit higher than we want it to be. The second is technology, and we talked about that already, right? The operations of the integration to get the data seamlessly within discrete fields continuously so that we can capture it for reporting. And the third is really health equity. Advocating for access to CGM. Right now, when you think of this, who's covered mostly, or you think about this metric, this metric applies to all people living with diabetes. When you look at the denominator, it's all people living with diabetes. And now not all health plans cover someone just with the diagnosis of diabetes. Sometimes they have to be on insulin in order to get a CGM covered. So I think there's opportunity for us to really advocate for advanced coverage for all people living with diabetes.
Davida
I love that and you may or may not know but my tagline is, CGM should be a right, not a privilege. And we really need to work towards that. And I think that's exactly what you're saying. And I support that 100%. And we all need to be aware of that and work towards it.
Marie
For this metric to really be successful, everyone needs to have access. I agree with that. It's not a privilege to have this type of technology to improve outcomes.
Davida
And standards of care would support that as well, that everybody with diabetes needs CGM. So I love that. Thank you.
Where does the DCES hold the greatest value as these trends are taking shape? We know they're wonderful and they bring so much value, but can you help me just verbalize where you think we would be best help?
Marie
And again, I'm gonna emphasize I think where DCES can really bring value is through the adherence, right? We can learn a lot from our blood glucose monitoring data, right? We learned, you know, the adult learner does what they see value in. And the more people understand how to act on the data and to utilize it in their everyday life and not just something that they report out to their clinician, they will see the benefits of wearing it because they'll see value in it. And I think that's where diabetes care and education specialist can really add, you know, additional value too.
Davida
Well, this has been amazing. Some of your final thoughts and calls to action for our listeners. How can DCES prepare for where health quality trends are headed?
Marie
Sure. So I think historically diabetes education has been viewed strictly as like clinical support services. And I think this is a real opportunity for diabetes education programs to really become a strategic partner and to really work with the quality leadership. You know, my call to action would be to go knock on the quality team's door. Always, always looking for ways and suggestions to improve outcomes and find out what's top of mind for them. Where are their pain points? And let them know, you know, our skill sets and how we can really align with them to improve quality.
Davida
I love that. I think that is an amazing call to action for all of our listeners. Your information was just superb. Thank you so much. And thank you for our listeners to the episode of Diabetes Care Conversations and engaging with ADCES. Remember, being an ADCES member gets you access to many resources, education, and networking opportunities. Learn about the many benefits of ADCES membership at adces.org/join. The information in this podcast is for informational purposes only and may not be appropriate or applicable for your individual circumstances. This podcast does not provide medical or professional advice and is not a substitute for consultation with a health care professional. Please consult your health care professional for any medical questions.