Diabetes care within schools is not great
Many schools are underfunded and cannot afford school nurses or use staffing services that result in a high turnover of school nurses, lack of coverage, and lack of training. This is a particular problem for children with diabetes, both T1D, and T2D, who are in their early years of diagnosis and don’t understand how to manage their condition.
‘Kids with diabetes have 2-4 severe hypoglycemic events a year but schools are unprepared to handle these events both in terms of medications and staff training.’ — Anh Nguyen, MD, MBA, and Co-founder Zingen Health
The worst A1C levels are between the ages of 6-25 signaling that early years of diagnosis, when the child’s diabetes education is in its infancy, also results in poor diabetes management. Early access to diabetes education and coordinated care in schools should improve their entire life. Data source: T1D Exchange
‘The problem is that diabetes is undermanaged and there is a critical access gap with diabetes care because diabetes education is not emphasized inside traditional healthcare provider systems.
Schools provide a significant opportunity for diabetes education because kids spend one-third of their day in school. We view diabetes education of children as an investment in their lifelong health.’ — Mike Hayes, MBA, Co-founder Zingen Health
Care Funding Breakthrough
Zingen Health’s innovation is creating a school-based virtual practice manager that enables healthcare professionals, primarily certified diabetes educators, to provide billable services within schools.
This does not add cost to the overall healthcare system.
‘We are cost shifting reimbursement for diabetes education from traditional primary care settings to the schools where we can help each child improve their self-management. We will create a management plan for each student, including all their medications. This plan will be available within the school and will meet 504 compliance requirements.
We believe this early education will lower the overall cost curve for diabetes care by empowering children to take better care of themselves, reducing hypoglycemic events involving school children, and ensuring that schools have the medications and training to respond when needed.
There is no copay for public insurance such as Medicaid. We anticipate the copay for private insurance will be equivalent to a primary care visit.’ — Anh Nguyen, MD, MBA, and Co-founder Zingen Health
Voluntary and Private
The Zingen Health platform provides training to school staff around the diabetes management plan but is not expected to replace any existing services.
The student and family would consent to have education and care provided by Zingen Health. Zingen Health does not work for the school nor is it a strategic arm of the schools.
The objective is to provide students with diabetes education and care inside the school, particularly for students who would otherwise have difficulty obtaining access. A model for this is already demonstrated in school-based health clinics (SBHCs).
The intent is that every student participates and that no student is excluded. Zingen Health will particularly focus on underserved communities where health disparities and health inequities are clearly evident.
The education and care provided to each student are done under standard healthcare privacy rules. Except for the data necessary to complete the 504 plan nothing else would be shared with the school.
Zingen Health has great advisors. Both the American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA) are helping. ADA’s Safe at Schools program is being used as a model for care within schools.
The Rehabilitation Act was implemented in 1973. The main purpose of the Act was to create and extend civil rights to people with disabilities and ensure that proper care and resources are provided for “any disability”.
The Rehabilitation Act has several sections. Section 504 relates to children and adults with disabilities in education, employment, and various other settings. Each Federal agency can establish its own set of section 504 regulations that apply to its own programs. This includes agencies that provide Federal financial assistance. Each agency is responsible for enforcing its own regulations.
‘Section 504 states that “no qualified individual with a disability in the United States shall be excluded from, denied the benefits of, or be subjected to discrimination under” any program or activity that either receives Federal financial assistance or is conducted by any Executive agency or the United States Postal Service. Section 504 may also be enforced through private lawsuits. It is not necessary to file a complaint with a Federal agency or to receive a “right-to-sue” letter before going to court.’
Most schools are not in compliance with section 504. As an indication of this, The American Diabetes Association is joining families to sue the NYC Public Schools for failure to provide sufficient diabetes care for students. (ADA)
Zingen Health Details
Zingen Health — https://www.zingenhealth.com/ — is a Public Benefits Corporation based in Chicago. It is getting resources, guidance, and support from the University of Chicago Polsky Center and Booth School of Business.
The scope of Zingen Health services includes:
- A visiting, on-site, verified diabetes educator who is directly linked to each student
- Regular 1:1 student education and care management, including an updated care plan for each student
- Regular school staff training on the diabetes management plan
- Updates to prescriptions for drugs and devices delivered directly to the school, including medications to handle emergency situations, hypo or hyper, such as glucagon and rapid-acting insulin.
Chicago Public Schools (CPS) has about 700 schools in total. A Master Services Agreement is being finalized between CPS and Zingen Health. Beginning in the Fall of 2019, Zingen Health anticipates that it will run a Program Evaluation with 346 schools (the number of schools that enroll children with diabetes). Champions for this project are from the Office of Student Health & Wellness (OSHW) and the Office of Diverse Learning Support and Services (ODLSS). Both of these teams are within Chicago Public Schools and have helped shape the program and ultimately they will approve the Program Evaluation. Zingen Health is partnering with the American Association of Diabetes Educators (AADE) for the CPS Program Evaluation. This AADE partnership demonstrated to CPS that Zingen Health had the proper backing to make this a successful Program.
Model for rest of United States
Within schools nationwide, there are three children with T1D for each person with T2D. T2D, however, is growing quickly amongst children and young adults. It is estimated that there are 200,000 school age children and adolescents nationwide with T1D or T2D.
The 504 program Zingen Health will initiate in Chicago in the Fall of 2019 is a prototype for a program they hope to roll out nationwide.
There are 13,800 school districts in the USA. Zingen Health plans to focus on the major metropolitan areas because it takes some effort to integrate with each school district’s IT infrastructure and their existing 504 plan system.