Pharmacy Today
June 15, 2009
Diabetes Ten City Challenge demonstrates positive clinical, economic outcomes
Final program results published in JAPhA show success of pharmacist interventions
Joe Sheffer
The Diabetes Ten City Challenge (DTCC) - an employer-funded, collaborative health management program using community-based pharmacist coaching, evidenced-based diabetes care guidelines, and self-management strategies - demonstrated positive clinical and economic outcomes, according to results published in the May/June 2009 Journal of the American Pharmacists Association (JAPhA). For 573 patients with diabetes who had baseline and year 1 medical and pharmacy claims and two or more documented visits with pharmacists, statistically significant improvements were observed for mean glycosylated hemoglobin (A1C; decrease from 7.5% to 7.1%, P = 0.002), mean low-density lipoprotein cholesterol (decrease from 98 to 94 mg/dL, P < 0.001), and mean systolic blood (decrease from 133 to 130 mm Hg, P < 0.001) over a mean of 14.8 months of participation in DTCC. Other Health Plan Employer Data and Information Set (HEDIS) diabetes process-of-care indicators, such as influenza vaccination rate (from 32% to 65%), eye examination rate (57% to 81%), and foot examination rate (34% to 74%), improved for patients between the initial and final evaluation periods. Average total health care costs per patient per year were reduced by $1,079 (7.2%) compared with projected costs.
Pharmacist 'coaches' at center of model's success
DTCC - an implementation of the Patient Self-Management Program for diabetes - is modeled after several successful APhA Foundation programs and other projects that tested the pharmacist "coach" model for managing chronic diseases such as asthma, cardiovascular disease, high cholesterol, and osteoporosis. Earlier this year, the APhA Foundation announced a partnership with Mirixa Corporation, the nation's largest pharmacy-based patient care network, to offer the DTCC collaborative care model to employers nationwide for diabetes and other chronic diseases through Health-MapRx. Supported by GlaxoSmithKline, DTCC worked via the establishment of a voluntary health benefit for employees, dependents, and retirees with diabetes by self-insured employers. A total of 30 employers in 10 cities waived copayments for diabetes medications and supplies if participants met regularly with a pharmacist coach, who helped patients manage A1C, blood pressure, and cholesterol and recommended exercise, nutrition, and other lifestyle changes as needed. After each patient visit, pharmacists communicated with physicians and, if necessary, referred patients to other health care providers for additional care or education.
"The Diabetes Ten City Challenge demonstrated the power of partnership and the impact of putting patients at the center of their own care," said Toni Fera, BPharm, PharmD, Director of Patient Self-Management Programs for Health-Map RX
Driving fundamental change in U.S. health care
According to study authors Fera, Benjamin M. Bluml, BPharm, and William M. Ellis, BPharm, MS, of the APhA Foundation, DTCC and the process of care used provide a promising model that blends important elements of a "reformed" health care delivery process by integrating accessibility, patient-centered focus, and value achieved by helping patients make clinical improvement while managing costs. The APhA Foundation has observed several factors driving successful program implementation, including employers that are willing to invest in incentives for patients and providers to improve health and lower costs. Successful networks have a robust infrastructure to handle administrative functions, operational processes, and clinical coaching; an effective system of performance-driven accountability; a wide-ranging geographic reach of its pharmacists; and an ability to lead in client service. The authors also expect advances in health information technology to aid in the expansion of the model used in DTCC. According to the American Diabetes Association, 23.6 million individuals in the United States have diabetes, 5.7 million of whom are unaware that they have the disease. The direct cost of diabetes totaled $174 billion in 2007, translating to $1 of every $5 spent on health care being attributed to the disease. "Chronic disease is responsible for 7 of 10 American deaths and 75 percent of the nation's $2.2 trillion health care bill," said Ellis, who is CEO of the APhA Foundation. "The collaboration between the APhA Foundation and Mirixa through HealthMapRx provides an opportunity to transform health care delivery in local communities and drive fundamental change in the U.S. health care system. Our goal is to make this model as widely available as possible and encourage employers to invest in helping their employees manage all chronic conditions."