Pharmacies Fight Diabetes

Nearly 27 million American consumers have diabetes. Ninety percent are afflicted with type 2, the preventable form of the disease.

Thanks to a partnership with UnitedHealth Group, based in Minnetonka, Minn., a selection of retail pharmacists is working to help sufferers measurably lower blood glucose levels over a sustained period — reducing the risk of complications like heart disease, nerve disease, blindness and amputations — at no cost.

Called the Diabetes Prevention and Control Alliance, the partnership was launched in 2010 with the YMCA and Walgreens, Deerfield, Ill., to educate those covered by UnitedHealth Group employer insurance plans at a community level, covering both diabetes and obesity.

The alliance has since expanded to include Supervalu's Cub and Shop ’n Save pharmacies, Rite Aid, Albertsons LLC, Kroger, Winn-Dixie Stores and Safeway.

Once in the alliance, retailers participate in the Diabetes Control Program, through which pharmacists provide one-on-one consultations every three months.

“Patients have
been very receptive to receiving diabetes care at community pharmacies,” said Jason Reames, clinical banner leader for Cub and Shop ’n Save pharmacies, which have been in the alliance since April. “Our patients trust their pharmacist, so they are more likely to work with us to better manage their condition.”

UnitedHealth Group was planning on this type of consumer reaction when it modeled the program after The Asheville Project, a five-year pilot program in the city of Asheville, N.C., which demonstrated that pharmacists could help individuals take better control of their diabetes.

Proven Results

The five-year results included reduced levels of the blood sugar indicator HbA1c at all three-month follow-up visits — with more than 50% of patients demonstrating improvements at each visit.

This is an important number because every percentage point drop in HbA1c levels reduces the risk of diabetic complications by 40%, according to the CDC. The personal, community-based nature of each meeting is at the heart of these results.

“Pharmacists are highly skilled in diabetes disease management and are able to spend up to an hour with a member during the consultation,” said Tom Mills, director, Diabetes Control Program. “In many cases, the pharmacist is able to help members select healthy grocery items in the store to encourage a healthier diet.”

In one of these meetings a pharmacist might review the patient’s medication and diet, conduct blood glucose, cholesterol and blood pressure tests and provide immediate feedback on the results. The pharmacist also communicates results with the patient’s primary care physician, according to Mills.

Rite Aid joined the  Diabetes Prevention and Control Alliance in September 2011 with 27 pharmacies, and has found that its business has benefited from the personal relationship between pharmacists and patients, said spokesman Eric Harkreader.

“Pharmacists are on the frontline of health care and conveniently accessible to nearly everyone,” he said.

Cub and Shop ’n Save pharmacists have been  providing group diabetes education classes for over 15 years, and viewed this as a great opportunity to reach more patients, said Reames. “Our participating pharmacists complete a rigorous certificate training program prior to being able to provide any diabetes services; United-  Health Group also provides training to ensure program requirements are met.”

While it’s up to each retail organization to choose the certification it uses, approved programs are offered by the American Pharmacists Association, the American Association of Diabetes Educators, Joslin Diabetes Center and more.

From there, UnitedHealth Group markets the service to eligible members through direct mail and phone calls, said Mills. Additionally, members are invited to attend screening events at their employer, where they can receive an initial HbA1c test, and learn how to enroll.

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“For pharmacy partners, a variety of co-branded materials are available that can be provided to members at the pharmacy location to help them learn more about the DCP,” said Mills.

In a situation like this one, the insurance provider benefits too, said Robert  Passikoff, president of  consumer loyalty consultancy Brand Keys. And not just because prediabetes and type 2 diabetes threaten to affect more than half of all Americans by 2020 at an annual cost of $500 billion, according to a report from UnitedHealth Group’s Center for Health Reform & Modernization.

“Given the current political climate, it is a good idea for insurance providers to try to get closer to the consumer, who could one day choose a provider directly,” said Passikoff. Each partner in the program has the potential to gain a better reputation and a higher level of awareness with the patients, he added.

Outside of bringing new faces into the pharmacy, the program is increasing customer loyalty and satisfaction, retailers said.

“Many of those in the program did not use our pharmacy for their prescription service prior to participating in this program, but several have since started because of the great service they have experienced,” said Reames.

Programs such as this are contributing to increased satisfaction with brick-and-mortar pharmacies overall, and specifically, over mail-order pharmacies.

According to the 2012 U.S. Pharmacy Study from J.D. Power and Associates, satisfaction with mail-order pharmacies averages 792 on a 1,000-point scale, which is 22 points below the average score for brick-and-mortar pharmacies.  

The customers most  likely to use a service like this are the newly diagnosed, said Rick Millard, senior director of the health care practice at J.D. Power and Associates, as those who have been managing a chronic condition over a long period of time will have fewer questions. “My prediction is the impact of the pharmacists would be greatest and most appreciated when someone is newly diagnosed.”

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Since its inception in June 2010, the Diabetes Control Program has enrolled over 4,000 participants, said Mills. “The program is available to members on a continuum year after year as long as the member’s insurance remains active.” Once enrolled, no matter where the consumer is in their treatment, the service is available to them.

“Patients have found the program well worth their time, and the additional resources very helpful,” said Reames.

For the pharmacists, the feeling is mutual. Pharmacists who participate get greater job satisfaction through engaging with customers on a regular basis and in a more meaningful way.

“The pharmacists involved in this and other forms of medication therapy management generally tell us that they love putting their specialized training to work helping people to better manage their health conditions and get more from their medication regimens,” said Rite Aid’s Harkreader.

Feel Good Pharmacy

It’s an ideal for the pharmacy profession, he added, illustrating the company’s overall attitude toward its pharmacist and patient relationships.

Rite Aid’s relationship with the Diabetes Prevention and Control Alliance is an important first step to show patients with diabetes they aren’t alone, said Robert  Thompson, Rite Aid’s  executive vice president of pharmacy, in a statement.  

For Cub and Shop ’n Save, pharmacists have a passion for patient care  services, and it shows in the quality of their work, said Reames. “These services result in stronger patient  relationships and really drive that customer loyalty.”

Consumers feel that  having a relationship with their local pharmacists is the next best thing to having extended access to their primary care physician, said Passikoff. “This model of increased engagement  between retailer and customer is poised to continue, as consumers are apt to give money and attention to the retailer best meeting increasing expectations,” he added.

Parallel to this development has been the growth in retail clinics, said Millard.

The number of health clinics, which provide low-cost health care from nurse practitioners or  physician assistants, was at 1,355 at the beginning of 2012 and is set to climb to 1,500 by year-end, according to “The ConvUrgentCare Report on United States Walk-In Clinics,” released earlier this year by research consultancy Merchant Medicine. Walk-in clinics are poised for 10% growth in 2013.

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“Retail clinics are oriented toward providing more than immunizations,” said Millard. “They can conduct a lot of the same services that a primary care doctor can provide.” Whether it’s clinics or pharmacist consultations, consumers are craving that kind of access and attention, retailers said.

“National retail pharmacies — including supermarkets with pharmacy locations — are a well-known and trusted entity in local communities, making them a key partner in delivering intervention visits and lab work to our enrolled members,” said Mills.

The Diabetes Control Program has not released results, but Mills said the program is experiencing similar outcomes to those published by The Asheville Project, in which the number of patients with optimal HbA1c values increased at each follow-up, and more than 50% showed improvements in cholesterol levels on every measurement.

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