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Volume 163, Issue 11
Great patient care and new business opportunities don’t have to be mutually exclusive.
According to the CDC’s 2017 National Diabetes Statistics Report, 30.3 million individuals in the U.S. have diabetes, and 7.2 million people living with the disease are undiagnosed. This showcases the need for diabetes management programs and continuous patient education and monitoring.
According to a study published in Diabetes Spectrum, pharmacist-led interventions in a rural primary care clinic were associated with the majority of patients experiencing an A1C reduction of at least 1%, which has the potential to reduce the risk of complications and decrease diabetes associated costs. Pharmacists’ have a unique skillset as drug experts and play an integral role as part of the healthcare team-not only improving patient outcomes, but also expanding business opportunities.
Exploring Business Opportunities
Pharmacists can play an integral role in establishing diabetes management services in the community and health system settings. According to a study published in American Health & Drug Benefits, 96% of the providers approved of the collaborative practice agreement for pharmacist-led diabetes services.
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Additionally, pharmacists’ satisfaction with the new protocol was high. The majority (89%) of patients were referred by providers who received a personalized provider report card, which identified patients who met the criteria (A1C > 9%) for pharmacist referral under the protocol. Pharmacists can use these personalized provider report cards to establish a relationship with physicians and expand diabetes management services. This may lead to expanded patient care opportunities and enhanced communication with prescribers.
The CMS offers reimbursement for Medicare beneficiaries for diabetes self-management training (DSMT), provided that individuals have been recently diagnosed with diabetes or are at risk for complications. Pharmacies first need accreditation to provide DSMT. The National Community Pharmacists Association (NCPA) has teamed up with the American Association of Diabetes Educators to provide an educational program known as “Diabetes Accreditation Standards-Practical Applications” (DASPA), which provides the necessary requirements for accreditation to be recognized as a certified program provider. Approved program instructors may include pharmacists, registered nurses, and registered dietitians, which demonstrates the importance of interprofessional patient care programs. The DSMT programs should include education on self-monitoring blood glucose (SMBG), diet and exercise counseling, an insulin treatment plan, and motivation to use skills for diabetes self-management.
Bhavana Mutha, RPh, BCMAS, a clinical consultant in Woodstock, GA, with over 14 years of practice experience in different retail centers says “personal support and guided education to manage and control different aspects of diabetes can lead to a very balanced approach in disease management.” Mutha also says she believes in the importance of keeping up with the profession and expanding her horizons, so she is pursuing additional training and certification for diabetes.
Pharmacists are being recognized by Medicare Part B for their role in managing patients with diabetes, even in perhaps unconventional ways. Part B covers furnishing and fitting of custom-molded shoes and inserts, and pharmacists are recognized as other qualified individuals besides podiatrists that are able to provide those options for patients. However, individual states may require additional requirements for pharmacists to prescribe therapeutic shoes, so they should double check with their state laws.
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Medication therapy management is a great way for pharmacists to become a one-stop-shop for management of comorbidities and receive reimbursement for their services. These services can be provided face-to-face or via phone and may consist of identifying potential drug interactions, dose optimization, therapeutic outcomes, and medication adherence. Immunizations are extremely important for individuals with diabetes as they are at higher risk for vaccine-preventable diseases, and pharmacists can play an important role in this process through education and administration.
Pharmacists can also participate in the program From Prevention to Pump Training for opportunities and ideas for diabetes services like wellness coaching and insulin pump training. Various programs exist for the certification of pump training and offer reimbursement for different services provided to patients.
The CDC’s Rx for the National Diabetes Prevention Program helps pharmacists get involved in prevention by identifying and reaching out to patients at risk for developing type 2 diabetes. This resource provides pharmacy case studies and how pharmacists can play an integral role through raising awareness; screening, testing, and referring; and delivering the program.
Ultimately, managing medications is about building trust and makes a much deeper impact on the patient than dispensing a medication without counseling. Mutha says patients who have diabetes will in turn be grateful for the medication management and counseling points for their health. Even if there is not always a profit, the pharmacist-patient relationship is continually enhanced to promote disease state management, which will in turn advance the business side.
Many deaths seen in the news have resulted from various factors affecting access to insulin, (i.e. cost), and have caused patients to turn to rationing or going without the important drug therapy. Pharmacists can play an important role in addressing these timely issues to ensure patients have access to these life-saving medications. “Personally, I have undertaken such cases and made life changing impacts in many ways by providing education, counseling, and teaching patients the A1C targets, glycemic index, lifestyle modifications, body mass index, symptoms of hypo and hyperglycemia, and guidance to personalize cost effective solutions for diabetes,” says Mutha.
Technology and Diabetes Management
Telehealth may offer unique opportunities for pharmacists to make a huge impact on patient care. “Considering the imbalance in the profession with a growing number of pharmacists and job saturation, telehealth could be a niche way to fill the gaps in care and make an impact on population health with diabetes and comorbidities,” says Mutha.
Mutha adds that “the current trend of telehealth care could play a vital role in helping the community with diabetes management.” Pharmacists as drug therapy experts can play a vital role in disease state management remotely as technology is continuously expanding. The CPT codes 99453, 99454, and 99457 may be used by pharmacists in the future for reimbursements through remote patient monitoring or telehealth.
What does this mean? “With availability of continuous glucose monitoring (CGM) systems, Bluetooth-guided meters, and remote patient monitoring or monitoring under collaborative practice agreements, diabetes management can be taken to a whole new level due to the ease of data accessibility and enhanced communication,” says Mutha.
The ADA recently added a new section on diabetes technology to the Standards of Medical Care in Diabetes. These recommendations discuss SMBG, CGMs, and automated delivery systems. Pharmacists can counsel patients about these technologies to make monitoring blood glucose easier in their daily lives. Most patients using intensive insulin regimens (multiple daily injections or insulin pump therapy) should check glucose levels using SMBG or CGM before meals and snacks, at bedtime, occasionally postprandially, before exercise, when they suspect low blood glucose, after treating low blood glucose until the levels are normal, and before critical tasks like driving.
According to a study published in the Journal of the American Pharmacists Association, diabetes care provided by a clinical pharmacy specialist via clinical video telehealth was as effective for type 2 diabetes management compared to face-to-face management by a pharmacist. Patients with type 2 diabetes who were managed between April 2013 and October 2014 were included in the retrospective study, and the primary outcome was the average A1C reduction at three and six months.