Expert: ‘Huge Opportunity for Pharmacy Reimbursement’ in Diabetes Self-Management Education Services

Pharmacy teams can affect margins and patient outcomes by expanding diabetes care and prevention services, explained Amina Abubakar, PharmD, AAHIVP, CEO and owner of Avant Pharmacy & Wellness Center, during a presentation at the National Community Pharmacists Association 2022 Annual Convention. Further, diabetes self-management education (DSME) services can successfully fit into a pharmacy’s workflow with appropriate planning, according to Abubakar.

“Pharmacists have to start thinking of patients coming to our pharmacies for a particular visit,” Abubakar said.

When providing DSME services through the pharmacy, Abubakar noted that there is more than one option regarding the delivery format and focus. Specifically, the services can be set up to provide the training in both individual patient visits or in group visits. Also, although offering DSME services through the pharmacy requires accreditation, the services do not need to be located inside the pharmacy if space or access is an issue.

“You can accredit your pharmacy, but you can also accredit other sites that you can offer this education at,” Abubakar said. “Some people say that their pharmacy doesn't have any space to have diabetes education. So if there's a community place that you have availability to go and do that, then you can accredit that site [by going through the] 2 accrediting organizations, the ADA and ADCES.”

Abubakar explained that to achieve accreditation, the pharmacy has to take a patient through the standards, including providing support for the services. Further, the pharmacy team that's involved in offering the delivery and design of the DSME program should make sure to focus the training on being patient-centered in nature.

“So you're treating each patient with their goals, and then you need to measure and demonstrate the outcomes,” Abubakar said. “But the instructor does not have to be a [certified diabetic educator instructor] and does not have to have board certification.”

Additionally, Abubakar noted that the pharmacy does not have to be DSME-accredited to start offering these services.

“The opportunity for this is Medicare pays for about 10 hours during the first year that the patient is eligible, and then 2 hours after that medical commercial and Medicaid plans do cover, you just have to find out for your area,” Abubakar said. “You may have to credential directly with either BlueCross BlueShield, or your local [managed care organizations] in order to find exactly what they pay for.”

Fortunately, Medicare is a bit easier as it is the same across the United States, Abubakar explained. Specifically, the best time to work with patients is right after their initial diagnosis.

This can be facilitated through a referral program from physicians or other medical providers who treat patients. For these providers, if they have a patient with a new diagnosis of diabetes, they can refer individuals who are having complications during their annual assessment or during transitions of care when a patient was hospitalized because of a diabetes complication.

“That's a good target. So if you market in your area and ask for patients who are transitioning from the hospital to the home or from a facility to the home, and they have diabetes needs, that would be a good candidate for the program,” Abubakar said.

Abubakar highlighted data showing that only 4% of Medicare patients have received DSME services, which becomes more evident due to a lack of accredited programs for these services in communities around the country. Further, only 6.8% of patients with private insurance who have been diagnosed with type 2 diabetes have participated in these programs as well.

“So there's a huge opportunity for pharmacy reimbursement,” Abubakar said.

Further, Abubakar noted that if a pharmacist is allocating their time to participate in DSME services, it is beneficial to plan for no-shows and overbook appointments for group visits.

“The trick is always to schedule more patients in a group because no shows do happen,” Abubakar said. “Always overbook, even in medical practices. Overbooking is the name of the game because patients are notorious for not showing up.”

After the visits, Abubakar explained that it’s valuable to have a member of the pharmacy team tasked with connecting back to the referring physician to report on what occurred. Specifically, Abubakar noted that technicians can be useful in this role.

“What pharmacists do well is take care of the patients. What pharmacists do poorly is looping the providers back about what they did,” Abubakar said. “So everything you do—send a referral back saying that the patient was there for a visit, this is what we talked about, and this is what’s going on. It gives confidence to the providers, and they are more likely to refer more patients to your program.”

Another method for increasing patient engagement in these programs is offering food during DSME trainings. Abubakar explained that when her pharmacy started providing this services, they observed a lack of patient buy-in. To increase engagement, her pharmacy team looked for new methods of increasing patient interest.

“So we started doing one Saturday a month, and we partnered with a local food prep person. She would bring food and recipes—people love food. So people showed up on those Saturdays,” Abubakar said.

For additional engagement incentives, Abubakar explained that her team also set up games based around eating during these trainings. Specifically, they would offer healthy and unhealthy foods and would ask participants to put on blindfolds and do taste tests to see whether they could tell if the food was healthy or unhealthy based on how it tasted.

“You can gamify your program if you want higher participation,” Abubakar said. “Because we collaborate with physicians, it made sense for us to plan this for a Saturday when the physician would bring 20 patients, and they could yield 20 office visits with each patient. So they're coming because they will see their physician, and then we get to bill 20 patients for the education, and we can do all that in about a 2-hour window. So there are many ways you can maximize this depending on your opportunity.”

Reference

Abubakar A. Taking Action in Diabetes Care and Prevention. Kansas City, MO: National Community Pharmacists Association 2022 Annual Convention; October 2, 2022.