Improve Prevention of Cardiovascular Disease in Diabetes with Pharmacist Involvement
All of the participants in a roundtable discussion on reducing cardiovascular mortality in patients with diabetes agreed—pharmacists are essential members of the patient care team. And they emphatically included community pharmacists. That statement has even greater impact considering the participants were physicians, experts in endocrinology, who represented the diverse fields of health policy, managed care, outpatient and inpatient settings. As a community pharmacist, you can help diabetic patients prevent cardiovascular disease and boost your pharmacy’s quality ratings by taking the lead and joining the care team.
Pharmacist Involvement in an Outpatient Care Team
In addition to discussing the role of pharmacists, the participants in the roundtable, which was hosted by the American Journal of Managed Care Peer Exchange, touched upon some of the key drivers of team-based health care:1
- Increasing prevalence – The sheer number of diabetic patients overwhelms the health care system – 9 percent of adults have diabetes and 37 percent have prediabetes.2
- Medicare is moving toward integrated health care with shared savings programs and accountable care organizations.
- Managed care organizations are seeking to reduce hospital readmissions by connecting patients with integrated community services.
Adults with diabetes are two to four times more likely to have heart disease or a stroke compared to adults without diabetes.3 The expertise of a specialist is vital for their long-term health as the impact of diabetic medications on heart disease must be carefully considered for each patient. Here are just two examples of treatment issues based on recent studies:
- EMPA-REG Trial: Empagliflozin reduced cardiovascular-related deaths, nonfatal myocardial infarction and nonfatal stroke by 14 percent in patients who had type 2 diabetes and a high risk of cardiovascular disease. It also resulted in 35 percent fewer hospitalizations for heart failure.4 While this is a game-changer in diabetes care, the researchers don’t know how their results will extrapolate to patients who don’t fit the same clinical profile as their subjects. Its mechanism of action is likely hemodynamic rather than metabolic and agents in the same class don’t necessarily have the same results. In other words, expert guidance is essential.
- Liraglutide: This GLP-1 drug lowers the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction and nonfatal stroke among patients with type 2 diabetes.5 However, another GLP-1 drug, lixisenatide, doesn’t have the same cardiovascular benefits. Since lixisenatide costs less than liraglutide, evaluating the costs and benefits for each patient and obtaining approval from insurance providers will require a pharmacist on the team.
Impact on Patient Compliance and Pharmacy Quality Measures
Numerous studies verify that adherence to a medication regimen improves when pharmacists are directly involved in caring for patients with type 2 diabetes. One study found that HbA1c values went down, while medication adherence increased with pharmacist intervention.6 A systematic review and meta-analysis of randomized controlled trials published in Diabetes Care found that patients had a significant reduction in blood pressure, LDL cholesterol and body mass index when pharmacists were involved in patient care, whether alone or as part of a health care team.7
In this era of value-based patient care, your business also stands to benefit when you participate in patient care teams. The Five-Star Quality Rating system established by the Centers for Medicare and Medicaid Services (CMS) rates health plans on quality and performance. Many of the quality measures they report revolve around medication-related issues, like patient compliance and medication management.
CMS publishes their star ratings, which means a low rating is likely to affect beneficiary enrollment. As a result, health plan administrators are highly motivated to boost their ratings. If necessary, they can revise their preferred networks to include only pharmacies with high star ratings in areas such as antidiabetic pharmacotherapy and medication adherence. An article in the Journal of the American Pharmacists Association advises that health plans and community pharmacies need to build partnerships to ensure the quality of care demanded by evolving public and private payment models.”8
How to Structure Pharmacist Involvement
So you know that deciding to take an active role in patient care improves patient outcomes, helps avoid readmission to hospitals, and can affect your business. The big question is: How will you be reimbursed for time spent with patients and communicating with physicians? Since this is an evolving field, some of the answers have yet to be developed, but there are a few options.
- Certification as a diabetes educator: Pharmacists can choose from a variety of accredited programs to obtain certification in diabetes education. The National Community Pharmacists Association offers a Diabetes Accreditation Standards Practical Applications program, which makes you eligible to provide diabetes self-management education/training (DSME/T) and receive payment for that service from CMS.
- Collaborative drug therapy management (CDTM): CDTM is a formal partnership between pharmacists and physicians that allows pharmacists to manage patients’ drug therapy. This type of health care team is authorized and regulated by each state’s pharmacy practice act or through regulations developed by state boards of pharmacy. Depending on your state’s laws, you may be able to implement and modify drug therapy for diabetic patients, order and evaluate laboratory tests related to medications, check vital signs, and perform physical assessments. Pharmacists may receive compensation by working as part of a physicians’ group practice, filing for payment under the physician’s provider number, or establish provider status with health plans and bill directly.9
- Develop new reimbursement models: Since value-based payment is such a new world for pharmacists, you may be able to work directly with your insurance providers to develop a system that more accurately reflects your patient care efforts than their current method for collecting data and authorizing reimbursements.
- Bill Medicare Part D for medication management services (MTM): If you’re not already doing it, set a fee schedule for services and use MTM CPT codes to bill for services to patients covered by Medicare Part D.
Pharmacists Should Step Up to Collaborate with Physicians
Patients with type 2 diabetes are increasingly being treated by primary care providers (PCPs) who may not be up-to-date with the latest protocols for preventing cardiovascular disease in diabetes. When you reach out to PCPs to create a team, the patient gains an expert who knows the research, can educate patients about self-care, and monitor for drug-drug interactions. As you choose to become more involved, you’ll extend the lifespan of diabetic patients, while forging a profitable path in the evolving value-based health care system.
The experts at Pharmaceutica North America keep up with the latest research and look forward to collaborating with pharmacists to improve patient care. Contact us today to talk about our prescription medications, bulk active pharmaceutical ingredients, and OTC supplements.
- “The Pharmacist as a Member of the Managed Care Team,” June 2016, http://www.ajmc.com/peer-exchange/reducing-cardiovascular-mortality-in-patients-with-type-2-diabetes-mellitus/the-pharmacist-as-a-member-of-the-managed-care-team/text-version ↩
- “Estimates of Diabetes and Its Burden in the United States,” 2014, https://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf ↩
- “Cardiovascular Disease and Diabetes,” August 2015, http://www.heart.org/HEARTORG/Conditions/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp/#.V6MviPkrLIU ↩
- “SGLT2 Inhibitors and Cardiovascular Risk: Lessons Learned From the EMPA-REG Outcome Study,” May 2016, http://care.diabetesjournals.org/content/39/5/717 ↩
- “Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes,” July 2016, http://www.nejm.org/doi/full/10.1056/NEJMoa1603827 ↩
- “Impact of a Pharmacist Led Diabetes Mellitus Intervention on HbA1c, Medication Adherence and Quality of Life: A Randomised Controlled Study,” January 2016, http://www.sciencedirect.com/science/article/pii/S1319016415000614 ↩
- “Pharmacist Interventions to Improve Cardiovascular Disease Risk Factors in Diabetes,” December 2012, http://care.diabetesjournals.org/content/35/12/2706 ↩
- “Medicare Star Ratings: Stakeholder Proceedings on Community Pharmacy and Managed Care Partnerships in Quality,” May 2014, http://www.ncbi.nlm.nih.gov/pubmed/24770440 ↩
- “Practice Advisory on Collaborative Drug Therapy Management,” February 2012, http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=14710 ↩