State Releases Diabetes Report

Approximately 700,000 people in Missouri have diabetes which is 13.2 percent of the adult population, according to the “2019 Missouri Diabetes Report” submitted to the General Assembly. The report contains information on diabetes-related efforts underway in the State’s HealthNet Division and the Missouri Department of Health and Senior Services (DHSS)

Current programs underway to help people with diabetes at DHSS include:

  • Center for Innovation for a Healthier Missouri (CHIM) plus five public health and medical care organizations are focusing on designing, testing, and evaluating innovative approaches towards reducing health disparities and the burden it produces for chronic disease organizations. With grant funding, the Center will work to prevent and manage diabetes and heart disease and stroke


  • The Community e-Connect Program supported by a State Innovation Model grant provides bi-directional e-referrals. Missouri’s initial project is planned with the Truman Medical Center in collaboration with Cerner, and the YMCA of greater Kansas City


  • The use of EHRs and a population health management tool called Data Repository plus the use of a Visualization System is able to track performance measures in registries and then plan patient visits around performance.


  • The Community Health Center- Pharmacist Integration (CHC-PI) program identifies and develops processes and systems to help pharmacists become part of the clinical healthcare team. Ten CHCs participated in the phase 1 pilot consist of centers in urban and in rural areas


  • Patient Centered Medical Homes are available so primary care can emphasize care coordination and communication


  • The School Health Program provides professional development for school nurses and staff to help students have the resources and support needed to manage their chronic health condition


Missouri’s Primary Care Health Home (PCHH) makes it possible for primary care providers to participate in the PCHH program. The population eligible for the PCHH Program includes people with two or more chronic conditions or one chronic condition and at risk for a second condition. In addition, the eligibility criteria has recently been updated to include pediatric asthma, obesity, along with anxiety, depression, and substance use disorders.

Currently there are 35 PCHH provider organizations along with 135 clinic sites providing health home services to more than 24,000 individuals but additional organizations and clinic sites are being added to PCHH. The program has demonstrated reductions in emergency department use along with hospital admissions where cost savings have been achieved.

Go to to search for the diabetes report. The report is titled “Missouri Diabetes Report” dated January 1, 2019 (RSMo) 191.990).

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