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Project IMPACT: Diabetes program targets hard-to-reach patient populations
Project IMPACT: Diabetes, a five-year study conducted by the American Pharmacists Assn. (Washington, DC) and funded by the Bristol Myers Squibb Foundation, has reported promising interim results that point to overall healthcare savings when coordinated, team-based care is provided to patients. That, in itself, is not a surprising advance, notes Ben Bluml, RPh, SVP for Research and Innovation at the APhA Foundation, but this study purposely aimed at underserved populations disproportionately affected by diabetes—including uninsured, homeless patients who received care at free clinics and Federally Qualified Health Centers.
“This study builds on the Diabetes 10-City Challenge and, before that, the Ashville Project, which were experiments in treating diabetes patients who were members of employer health plans and other forms of insurance,” notes Bluml. “The challenge for Project Impact: Diabetes is to see whether the same beneficial outcomes could be achieved by reaching out to these underserved populations.”
The project, which began in 2010, started with a solicitation to community health organizations who could bring in patients from underserved populations. Each of the 25 communities organized teams that included, among others, health centers, healthcare providers, diabetes educators and others that, together, could provide both medical attention as wellness services such as meals, transportation, exercise and education. The “cornerstone” of the service is a local pharmacist, who works with patients who have taken a APhA Foundation-developed “Patient Self-Management Credential” that assesses the ongoing awareness level of the patient in his or her self-care. This assessment, in turn, enables the pharmacist, who maintains ongoing contact with the patient, to evaluate and communicate needed improvements in wellness.
The results to date: A1C reduction from 9.0 to 8.3 (The recommended American Diabetes Assn. goal is to keep this below 7.0); a 7.3% reduction in LDL cholesterol; and a 1.9% reduction in systolic blood pressure. These are “statistically significant” healthcare improvements, according to Bluml.
Given the “outside the system” status of patients, it is impossible to do a cost-benefit analysis of the overall economic impact of the intervention, says Bluml—but that was known in how the project was set up. However, given that the program ran more or less as previous APhA Foundation-led programs have, expenditures for medicines rise 1.4-1.8 times that of patients not receiving the intervention (better adherence to regimens, and essentially more comprehensive care account for the higher drug cost), and first-year overall savings in healthcare costs are in the black by around $1,000-1,600 per patient, per year. “There are added costs for the pharmacist intervention and the team-based care coordination, but results like these show payers that if you change how services are delivered, you empower patients to improve their own health, and you create savings in overall healthcare costs,” says Bluml. “This model has compelling results for accountable care organizations looking at how to manage healthcare costs better.”