Project IMPACT: Diabetes
The process of care deployed in Project IMPACT: Diabetes was a refinement of that used in the Patient Self-Management Program for Diabetes and the Diabetes Ten City Challenge. These past projects brought together interdisciplinary care teams, innovative payers, and aligned incentives to create a diabetes care model that improved health outcomes, enhanced the quality of care, and reduced costs. In Project IMPACT: Diabetes, the communities are very diverse and care for patient populations that face significant barriers to managing their diabetes, which required a flexible approach to implementing the care model across the US.
Pharmacists' Patient Care Services
The key requirement within Project IMPACT: Diabetes is that all communities include pharmacists on their diabetes care teams. Collectively, more than 80 pharmacists are participating in Project IMPACT: Diabetes. These pharmacists meet one-on-one with patients to provide targeted education based on the Patient Self-Management Credential, medication-related coaching, and goal achievement plans that fits into their lives. Pharmacists talk to patients about what diabetes is, how medicines help address the problem, diet changes, exercise plans, and the many barriers that may keep that patient from being an effective self-manager of their health. Pharmacists hold their patients accountable for good self-management behavior by showing each person how much they care, investing time into frequent visits, and truly listening to the challenges each person is facing.
Interdisciplinary Health Care Teams
Pharmacists do not work alone when helping patients become better self-managers – integration into the healthcare team is essential. Each community brings together a unique group of stakeholders based upon what services are needed and provided within that community. Pharmacists collaborate with these stakeholders to design care plans, select and adjust medications, and bring resources to patients..Collaborating healthcare team members within communities include:
- Family practitioners
- Physician assistants
- Certified diabetes educators
- Social workers
- Patient advocates or promatoras
Innovative Payers and Sustainability
Communities were encouraged to integrate the pharmacists’ services in a way that would make them sustainable even after the project ended. Some communities developed partnerships with self-insured employers that provided payment for the pharmacist to provide care. Groups that care for uninsured or underinsured patients often sought buy-in from the administration at their clinic, which allowed for the pharmacist to dedicate time to patients with diabetes. In each of the scenarios, positive outcomes justify the resources invested in pharmacists’ services, often leading to the continuation or expansion of the care model.
As described in Our Approach, “aligned incentives” means that all stakeholders are motivated to implement the model because of what they will receive in return. For healthcare providers and clinic administrators, interdisciplinary care teams provide efficiency in the system and result in healthier patients. For pharmacists, the ability to provide direct patient care and receive payment for those services supply strong incentives to implement the model. Payers experience reduced total cost of care when they implement models. The incentives that motivate patients change based on culture, health beliefs, access to quality care, socioeconomic status, and many other factors.
Within Project IMPACT: Diabetes, communities were not required to provide patient incentives but they were encouraged to consider what tactics would best motivate patients to visit with the pharmacist and stay engaged in self-management behaviors. Many self-insured employer communities waived copayments associated with diabetes medications and supplies, and some provided additional incentives for goal achievement. In FQHCs, free clinics, and other communities serving the un- or under-insured, incentives were provided in the form of bus tickets, free meals during educational sessions, enhanced social services, and grocery store gift cards. Some communities found that many patients saw the access to quality diabetes care as the incentive and were eager to maintain their relationship with the pharmacist who cared for and spent time helping them.
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