How Buena Vista Drug fills a community need for diabetes education

Diabetes education helps improve patients’ health and boosts a pharmacy’s bottom line

In brief:

• Many patients need education about managing their diabetes
• But in many communities, resources to provide diabetes education are lacking
• Providing diabetes education is an attractive opportunity for pharmacies that can improve patient outcomes and generate increased revenue

Fill the diabetes care gap

About a year after Lucas Smith became owner of Buena Vista Drug in Buena Vista, Colorado — a town with fewer than 3,000 residents, in a county with only about 20,000 people — his pharmacy became the first in the state accredited by the American Association of Diabetes Educators.

He saw an opportunity to fill the diabetes education niche in Buena Vista. “It’s a prevalent disease, but there are no resources available for education,” Smith said.

Smith also saw the financial opportunity. “It’s a clinical service that pharmacies can bill insurance and Medicare for and be reimbursed,” he noted.

Medicare pays for diabetes self-management training (DSMT):

• 10 hours the first year
• 2 hours of follow-up every additional year

(See Medicare Reimbursement Guidelines for DSMT.)

Buena Vista used the Strand Rx platform to earn accreditation in just over three months. “They help you with the whole process,” Smith said, from curriculum to documents you can customize. With its accreditation, Buena Vista Drug added diabetes education under the Medicare PTAN (Provider Transaction Access Number) it already had for vaccines, Smith explained.

Work with providers

Before starting the Diabetes Self-Management Education and Support (DSMES) program at Buena Vista Drug, Smith talked with local providers and the public health department. “They were all excited because they knew patients needed it, but they didn’t have time to provide it,” he said.

Now, when a patient expresses interest in DSMES, the pharmacy contacts the patient’s provider for the required referral. Throughout DSMES, the pharmacy shares with the provider the patient’s:

• Care plan
• Goals
• Progress

The pharmacy also notifies providers if one of their patients isn’t following through with DSMES.

Make it part of the workflow

Buena Vista’s staff asks patients with diabetes if they want to learn how to improve their health. When a patient says “Yes,” the pharmacy obtains a referral and provides:

• 1 hour of 1-on-1 education to identify needs and set goals.
• 4 group sessions of 2.25 hours each, covering topics such as complications of diabetes and how to set and meet lifestyle goals. In the first year, groups ranged from two to eight patients.

Factors making the program work include:

• Staffing. Smith brought on a semi-retired nurse practitioner who is a certified diabetes educator, and fourth-year pharmacy interns also deliver education. These interns have relevant knowledge and gain experience working with patients. Techs handle tasks such as taking vital signs and gathering data from patients.
• Scheduling. Buena Vista initially offered education programs after the pharmacy closed, at 6 p.m. With the nurse practitioner, it can also offer sessions during the day.
• Check-ins. “We check in with participating patients whenever they come into the pharmacy,” Smith said. When there is no group session, the nurse practitioner or pharmacy staff calls each patient to ask about their progress toward their goals, leaving notes in the pharmacy system.

Buena Vista also has 400 patients on its med sync program. Techs calling those patients also enrolled in DSMES ask how they are progressing and ask patients with diabetes if they want to schedule an A1C test or consultation when picking up their medications.

Go beyond education

Buena Vista Drug, winner of the 2019 Health Mart Clinical Innovation Award, offers more for patients with high glucose levels:

• Testing. Along with point-of-care testing for cholesterol, blood pressure, flu and strep, the pharmacy offers A1C testing for patients with diabetes. Patients usually pay the $35 fee out of pocket. This is similar to a co-pay for a doctor’s office visit and $5 less than a local clinic charges. “We’ve never had people not get it because of the price,” Smith said.
• Prevention Buena Vista is becoming certified under the National Diabetes Prevention Program to help people make lifestyle changes that can prevent or delay onset of diabetes.
• Supplements. The Pioneer software the pharmacy uses has built-in triggers to notify staff if a patient’s medication may lead to nutrient depletion. This helps the pharmacist check whether a patient on metformin may benefit from B12 supplements.

Enrollment in DSMES is growing. Smith now hopes to reach patients in towns surrounding Buena Vista. He also hasn’t given up on patients who didn’t accept a first invitation to enroll or who dropped out partway through the program. The pharmacy will try again in six months, when a person’s motivation may have increased.

“To be successful you’ve got to be all in. You’ve got to plan for it,” Smith said of offering diabetes education. “You can’t do it halfheartedly and expect to make it successful.”

The information provided here is for reference use only and does not constitute the rendering of clinical, legal or other professional advice by McKesson. Results will depend on the factors of a pharmacy’s business. Readers should consult appropriate professionals for advice and assistance prior to making important decisions regarding their business.