Upping the ante on diabetes care

November 18, 2016 | Pamela Youngberg Dickson

On November 2, Medicare released its final rule solidifying its focus on chronic care management and behavioral health, including a plan to expand the Diabetes Prevention Program model test in 2018. Medicare estimates it will spend $42 billion on fee-for-service, non-dual-eligible beneficiaries with diabetes, and the program encourages the establishment of community-based intervention to prevent and manage the disease in an effort to bring those costs down.

Diabetes is a high driver of health care costs and is one of the most prevalent chronic conditions seen in our independent pharmacies. It’s also one of the five disease states that plans are most focused upon this year and for the foreseeable future. Here’s why focusing on diabetes care is important:

  • It’s low-hanging fruit. Star Ratings, based on 2014 claims data, identify a threshold for PDC (proportion of days covered), and beating those adherence numbers is an actionable goal for pharmacies. Here are some specific steps to take to improve adherence. Plus, it’s money in the bank. The pay-for-performance or pay-for-outcomes movement is without legs without a measurement component. Adherence is measurable—and according to NCPA, participation in adherence programs may result in the reduction of DIR fees.
  • It’s a seat at the table. Diabetes care represents a clear intersection of interests between providers and pharmacists. Taking a coordinated approach toward diabetes care could be an influential step toward gaining provider status. January 2017 marks the full implementation of Washington State’s groundbreaking law, under which pharmacists will be included in provider networks, and benefits will not be denied for services performed by a pharmacist. Several smaller pilot programs are looking into the role of the pharmacist in team-based diabetes care.
  • It’s better care. Pharmacists see a diabetic patient much more often than the patient sees his or her primary care provider. That familiarity provides pharmacists a unique opportunity to improve patient outcomes with a more personalized approach to counselling on lifestyle efforts, like diet and exercise, and other health and safety topics, like foot health and mobility.

Software such as  PrescribeWellness enables pharmacists to easily identify those patients who need help most—and who would most move the needle relative to Star Ratings. Read about Medicare’s diabetes program here or review the fact sheet


Pamela Youngberg Dickson

Before she came to Smart-Fill, Pamela developed marketing strategy and content for a range of technology start-ups and large-cap enterprises. Outside the office, she's into gardening, renaissance history, the Big Ten, and exploring the great outdoors.