Collaborative Diabetes Model Saves Health Costs

A collaborative diabetes clinic that includes pharmacists is reducing health-care costs by more than $5,000 for type 2 diabetes patients, according to a new study.

The Diabetes Intensive Medical Management (DIMM) clinic, managed as a collaboration between a pharmacist and an endocrinologist with the help of pharmacy students, is a project of the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California, San Diego. They run the clinic for complex type 2 diabetes patients at the Veterans Affairs San Diego Healthcare System.

Jan Hirsch, PhD"This is a good example of ‘team-based care’-an approach that’s becoming more common in health-care systems today," said Jan Hirsch, PhD, Professor and Chair of the Division of Clinical Pharmacy at Skaggs and Clinical Pharmacist Specialist at the VA facility.

Candis Morello, PharmD

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Hirsch and Candis Morello, PharmD, Professor of Clinical Pharmacy and Associate Dean for Student Affairs at Skaggs, led the project and co-authored the study, which was published in the March, 2017 issue of the Journal of Managed Care & Specialty Pharmacy.

Diabetes cost the United States an estimated $245 billion in 2012, through both direct medical costs and reduced productivity. To help reduce these costs, the researchers compared 99 DIMM clinic patients to 56 type 2 diabetes patients who saw their primary care providers an average of two times over six months.

Both groups were patients at the VA San Diego Healthcare System, were primarily non-Hispanic males, and were an average of 62 years old. The collaborative care team provided personalized medication therapy management and patient-specific diabetes education in one-hour visits. DIMM patients typically attend the clinic three times over six months.

Up next: The results of the study and what researchers learned from it

Hirsch and Morello had previously reported that DIMM clinic patients significantly improved their glycemic control by reducing their A_1C by an average of 2.4 percentage points after six months. In contrast, type 2 diabetes patients who saw only their primary care providers during that time reduced their A_1C concentrations by 0.8 percentage points.

The DIMM clinic patients did not gain weight and did not experience low blood glucose incidents.

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As a result, the researchers found that $5,287 would be saved per DIMM clinic patient over three years, compared to those who visited only their primary care provider. From the clinic perspective, the cost for each additional patient who reached the treatment goal was relatively low: between $115 and $164 over six months. These savings add up to a return on investment of $9.01 for every $1 invested in the DIMM clinic, the study found.

From a health insurer perspective, the quality adjusted life years gained by the DIMM clinic patients were greater, and estimated medical costs were lower over 2-, 5-, and 10-year periods than in the primary care provider group.

“No matter how we looked at the data, the cost for the DIMM clinic group was always lower, while their predicted quality adjusted life years were always higher,” Hirsch said.

The cost savings came about because of better clinical outcomes for DIMM clinic patients, particularly their average glucose concentrations (measured as A_1C).

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This collaborative “tune up” clinic model may be so successful in part, Morello said, because many of the patients have several other health issues that need to be discussed at regular primary care provider office visits. That leaves little time to talk about managing diabetes and associated complications, as well as discussing medications, healthy eating, exercise, and managing blood glucose concentrations.

The DIMM clinic is able to dedicate time specifically to talk about these issues, freeing up primary care provider time for other health concerns. “In addition to medication management, we’re also teaching lifelong skills for diabetes management that patients can continue doing long after they’ve completed six months with the clinic,” Morello said.

This pharmacist-led DIMM clinic may be just the beginning of many health-care changes over the next decade, Hirsch said. In 2014, California joined a growing number of states that allow pharmacists to initiate and monitor a patient’s drug therapy, rather than simply fill a prescription.

“Pharmacists are no longer simply pill dispensers-they’re becoming a new type of primary health-care provider,” Hirsch said. “And, as we found in this study, this new approach may help us improve health care on many fronts.”