Pharmacy Care Coaches Improve Outcomes in Patients With Diabetes

Melissa Almeida struggled for years to get her diabetes under control. After being diagnosed with type 2 diabetes at 16 years of age, Almeida grappled with frequent hypoglycemia as a result of her medication, and for years afterward attempted to manage her diabetes through diet alone.

Unable to maintain steady blood sugars with this approach, at 18 she lost her job at a photography shop because she was unable to maintain the energy she needed to work. It wasn’t until Almeida became pregnant at 22 that she began taking medication again.

But even with a newfound motivation to adhere to a rigorous diabetes care plan, as a full-time working mother—and eventual mother of 4—Almeida faced significant difficulty in dedicating adequate time to effectively manage her disease.

Recognizing all that she was juggling, Almeida’s endocrinologist, Dr. Richard Haas from UMass Memorial Health’s Diabetes Center of Excellence (DCOE), referred her to the Diabetes Care Coach program, an extension of UMass Memorial Health’s specialty pharmacy program and managed by Shields Health Solutions, a specialty pharmacy accelerator.

The Care Coach program offers a comprehensive set of pharmacy and counseling services to patients struggling to manage their diabetes and is available to DCOE patients with a sustained HbA1C result above 9.0%. Although a level of 6.5% or higher indicates diabetes, the target for most diabetes patients is an HbA1c below 7.0%.

Launched in 2021, the program provides high-touch specialty pharmacy services that manages prior authorizations and financial assistance for the patient, as well as nutrition and lifestyle counseling, medication management, diabetes technology assistance, motivational support, and referrals to local organizations to address challenges outside the purview of the clinic. The coaches serve as an integral part of the DCOE care team and help to ensure that a patient’s care plan and individualized goals are realized in full.

Hinal Sharma, PharmD, CSP, 1 of 2 Care Coaches assigned to the clinic, began working with Almeida in June 2021. Feeling overwhelmed in her attempts to self-manage her diabetes, Almeida had only been taking 1 of 3 prescribed medications and had lots of questions on these prescriptions.

As a clinical pharmacist, Sharma was able to answer these questions, explain the benefits of each medication, and establish a week-by-week plan for Almeida to gradually improve her adherence to the regimen. Sharma also worked with Almeida to make key changes to her diet, including adding more protein to carb heavy meals, kept Almeida motivated on days of high frustration, and arranged for her continuous glucose monitor to be delivered through the UMass Memorial Health specialty pharmacy. After 11 years of A1C levels above 9.0%, Almeida’s A1C is now down to 6.2%.

“The combination of specialty pharmacy support and regular guidance on how to effectively self-manage one’s diabetes has played a central role in the success of the program,” Haas said. “By offering both to patients, we’re removing silos of care that they no longer have to navigate.”

The complexity around adequately treating and managing diabetes can be a serious challenge for patients, but one the Care Coach program is designed to address. Most patients with diabetes manage 2 or more chronic conditions in addition to their diabetes.

On top of having to manage numerous medications, patients must continuously monitor their blood sugar, sustain a healthy diet and exercise regime, undergo annual foot and eye exams, and maintain positive mental health and strong motivation, among other obligations. Oftentimes, patients have to work with more than 1 pharmacy or durable medical equipment supplier to obtain all of their medications and supplies, with each of these demands posing increasing challenges to effective diabetes management.

By offering a dependable, 1-stop pharmacy resource for diabetes patients, in addition to a coach who can assist with a wide range of chronic disease management needs, the program has had a marked impact on patient outcomes. Patients who have been with the program for 6 months or more have experienced an average reduction in HbA1C of 2.4%. An average patient in the Care Coach program enters with an A1C score of 10.4%.

The program has also had a marked impact on medication adherence rates, another major challenge among patients with diabetes nationally. Since the start of the program, Care Coach patients on average have maintained a proportion of days covered medication adherence rate of 95%, far above national adherence estimates for patients with diabetes in the United States, which tend to hover around 65%.

The UMass Memorial Health diabetes team attributes this to the high frequency of coach-patient interactions, not to mention the financial assistance services the program provides to keep patient co-pays to an average of $5.

“Many of our diabetes patients face challenges on multiple fronts whether it be medication affordability, understanding and adhering to a healthy diet or adequately monitoring their blood sugar trends,” said Dr. Vrushali Shah, who clinically supervises the Care Coach program with Haas. “Having someone like a Care Coach who stays in regular contact with our patients and works alongside them to achieve week-over-week, incremental goals have helped patients feel empowered. This has truly been a game changer for our clinic.”

The high-frequency touchpoints the Care Coach program offers was exactly what Balram Santram needed after years of blood sugar levels in the 300s and 400s. Diagnosed with type 2 diabetes in his late 30s and prescribed several medications to treat it, Santram struggled to stay adherent to these medications and a healthy diet. Over time, he developed chronic pain in his legs as well as fatigue that impacted his ability to be an engaged family member, a priority for him as a grandfather of 2.

Santram entered the Care Coach program in July 2021 and with Sharma’s assistance, has been able to bring his A1C from 9.1% to 7.7% by switching him off medications that were creating adverse effects and reducing his intake of high-refinedcarb foods, such as pasta and candy, foods Balram still enjoys today, though in moderation.

Having Sharma there to help him navigate the challenges of diabetes self-management, including getting him lower co-pays for his medications, has been a game changer for Balram.

“This is the best I’ve ever done with this disease. I feel healthier, have more energy, can think more clearly, and am a more engaged husband, father and grandparent as a result,” he said.

While still in its pilot phase and already serving more than 170 patients, UMass Memorial Health and Shields hope to bring the Care Coach program to more UMass Memorial clinics and hospitals in the future with a goal of improving clinical outcomes, reducing cost of care, and enhancing patient and provider satisfaction.

“We believe this program addresses a real need in the diabetes space,” said Bill McElnea, vice president of Population Health at Shields Health Solutions. “Patients are demanding better access to care and simplification of care, and the Care Coach program has made significant inroads to accomplishing both.”