How Diabetes Care Can Impact Star Ratings
Help boost Star Ratings while earning a reputation for excellence in caring for diabetes patients
After doubling between 1990 and 2008, the prevalence and incidence of diabetes has apparently leveled off, according to a recent study in the Journal of the American Medical Association.1 Does this mean that diabetes is no longer a big deal and should no longer be a priority for community pharmacies? Not at all.
Serving diabetic customers is more important than ever. More than 9% of Americans have diabetes, and diabetes rates continue to increase among certain groups, such as African Americans, Latinos, and those with a high school education or less.2 As a result, caring for patients with diabetes costs the U.S. health system an estimated $245 billion annually in direct and indirect medical costs. To better control costs, health plans are looking for pharmacies that excel at serving patients with diabetes.
Also, among the measures that CMS is using to assign Star Ratings to health plans, two are directly related to diabetes medications. (See “How Health Plans and PBMs Evaluate Pharmacy Performance.”) Specifically, health plans need to ensure that:
- Patients who have diabetes and high blood pressure receive a medication that includes a renin angiotensin system antagonist.
- Patients who are prescribed an oral diabetic agent refill their prescriptions enough to cover 80% or more of the time they are to take the medication.
Diabetes Facts and Action Items
The following facts and action items explain how pharmacies can position themselves to excel at serving patients with diabetes.
Help Identify Patients
Fact: In addition to the 21 million Americans who knew they had diabetes in 2012, an additional 8.1 million had the disease but went undiagnosed.3
- Provide health screenings. Include blood glucose and HbA1C tests when your pharmacy offers free community health screenings.
Reach Out to At-Risk Populations
Fact: The prevalence of diabetes varies widely by age, race/ethnicity and more. For example, while only about 4% of Americans ages 25–44 have diabetes, that figure jumps to more than 25% for those ages 65 and older.
- Target marketing. Reach out to groups with a high prevalence of diabetes, but be aware of important differences. For example, the overall prevalence of diagnosed and undiagnosed diabetes in Hispanics/Latinos is 16.9%.4 But by age 70, more than 50% of Hispanic/Latino women and more than 40% of men have diabetes. The likelihood that a Hispanic/Latino will have diabetes increases with the person’s time living in the U.S. and decreases with education and income.
Lead Patients to Adherence
Fact: Taking medications as prescribed can save diabetic patients money and improve their health. Rates of adherence to oral medications and insulin range from about 60% to 85%. Increasing adherence from 50% to 100% has reduced hospitalizations by 23.3% and emergency department visits by 46.3%. The result is a net cost savings of $1.14 for every $1 spent on medication.5 Plus, for every percentage point reduction in glycated hemoglobin, there is a 40% reduction in complications such as kidney disease, eye disease and neuropathies.
- Counsel patients. Talk with patients about whether they are taking their diabetes medications as directed and identify barriers to doing so. Help them understand the possible consequences of not taking their diabetes medications, even if they feel fine.One study dubbed the Pennsylvania Project found that brief interventions by pharmacists increased adherence for oral diabetes medication by nearly 5% and reduced patients’ healthcare costs by $341 per patient.6 “If they have a better understanding of why they should be taking their medication, that will help motivate them to take their medications on time. We spend a little extra time to figure out why they’re having a problem, and then we try to address it with them,” said Christine Jacobson, owner of Wasatch Pharmacy Care in Ogden, Utah, which counsels patients on medication adherence.
- Offer a medication synchronization program, which can help improve patient adherence and pharmacy revenue. (See “Improve Your Refill Rates and Revenue with Medication Synchronization.”) Refill reminders and compliance packaging also can improve adherence.
Fact: Health plans that are creating preferred pharmacy networks value pharmacies that prove they provide quality service for patients with diabetes, which can improve plans’ Star Ratings.
- Track pharmacy performance. EQuIPP™ (Electronic Quality Improvement Platform for Plans and Pharmacies) allows pharmacy owners to see how well they are performing on those Star Ratings measures and shows they are performing at the level that can earn a health plan a five-star rating. (See “4 Takeaways from Health Mart’s Town Halls on Pharmacy Quality Measures.”)
- Intervene for improvement. Create systems to flag prescriptions that affect those measures and it will help improve your pharmacy’s performance.
- Collaborate with providers. In Hawaii, 5 Minute Pharmacy worked with physicians to develop a form letter that the pharmacy sends to providers when it identifies a diabetic patient who should be on hypertensives. The pharmacy will fax, mail or hand-deliver the letter and educate the physician to help get patients on the right therapies. “That will help the physician’s score, our score, and also the patient,” said owner Derek Tengan.
Provide a Range of Products and Services
Fact: Patients with diabetes spend more than $1,000 a year on medication and other supplies. (See “The Full Value of a Diabetes Patient.”)
- Offer education and training, not only in your pharmacy but in the community. “We offer on a monthly basis — at the city hall, at senior centers and in our stores — a diabetic support group education class,” said Lisa Umfleet, owner of Parkland Health Mart Pharmacy in Desloge, Missouri. As a result, two hospitals contacted the pharmacy asking them to offer the classes there, too.
- Become well known as a diabetes expert and physicians and others will refer patients to your pharmacy. (See “Why Becoming a Diabetes Expert Makes Good Business Sense.”)
- Clearly identify and promote diabetes-related products. Create a special end cap or section where patients can easily find related OTC products that can help them manage their diabetes, and make sure to include educational materials.
Jeff Sherr, owner of Apple Discount Drugs in Salisbury, Maryland, has been diabetic since he was 20 years old. As a result, he is passionate about training his pharmacists and technicians about the disease so they understand its importance and can be comfortable speaking with patients about diabetes. The pharmacy also has an accredited diabetes center, where they offer educational sessions.
“We realize they [diabetes patients] are probably the largest spenders in the pharmacy setting. So, if we can keep them well and keep them out of the hospital, we’ll have those patients for a longer and longer period of time,” Sherr said.
With the huge numbers of diabetic patients, the growing incidence of diabetes in some population segments, and the importance of diabetes in Star Ratings, the opportunity has never been greater to distinguish your pharmacy as the go-to diabetes expert in your community.