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Diabetic Patients in Value-Based Care: Creating the Win for Patients and Physicians

By: Dr. Cynthia Nwaubani, BCGP, CMTM

National Diabetes Month presents the opportunity to examine the process of improving diabetic health outcomes and boosting quality metrics. As a clinical pharmacist and medication expert, I understand the complexities of diabetes and believe it is critical to examine changes through the continuum of care as the national healthcare paradigm has shifted and the market has welcomed innovations. Changes in CMS (the Centers for Medicare and Medicaid Services) reimbursement models have allowed chronic care management (CCM) to be re-engineered; however, the cumbersome process involved in a shift of this magnitude has dictated the pace of change thus far.

As you may know, both tracks of the Medicare Access and CHIP Reauthorization Act’s  (MACRA) Quality Payment Programs, MIPS (Merit-Based Incentive Payment System) and APMs (Alternative Payment Models), tie Medicare reimbursements to patient health outcomes. Physicians are charged financial penalties or awarded financial incentives for reporting on six chosen quality metrics.

The diabetic population, which includes more than 30M Americans, and the prediabetic population, which includes 84M Americans, will comprise a significant portion of the patient population whose health outcomes will be tracked through quality metrics. Meeting quality metrics relies on between-visit care, which has historically added to physician workloads and detracted from practice bottom lines. Compounding the issue of outcome accountability and physician burden is the human tendency to delay physician visits until they reach critical status, creating administrative and physician burden derived from same-day visits.

The Institute for Healthcare Improvement’s (IHI) Triple Aim (which some have expanded to the Quadruple Aim and included physician satisfaction) emphasizes improved patient care and better population health while reducing per capita costs. During the past several years, CMS has made significant changes to reimbursement of chronic care management services to improve population health, hold physicians accountable, and control spiraling healthcare costs based on the Triple Aim. Many physicians I have spoken with agree: in theory, pharmacist-led CCM services are a promising solution to challenges in population health management. But, in practice, how do these services help physicians manage diabetic patient health, meet quality measures and avoid burnout?

Here’s how:

Clinical pharmacists are uniquely qualified to make high-level decisions regarding patient care, including management of the health complexities of diabetic patients. As medication experts, pharmacists can reconcile medication lists from various specialists between primary care visits. Clinical pharmacists serve as a patient resource for questions and concerns around-the-clock, including weekends and holidays, ensuring patients have the appropriate referrals and resources to care for all diabetic issues and complications. Clinical pharmacists are equipped to identify root cause and adjust patient therapy as needed. PharmD Live’s proprietary software relies on an advanced clinical rules engine and artificial intelligence to assist in identifying and managing care and medication side effects.

PharmD Live, a telehealth company committed to improving patient outcome and helping physicians earn quality bonus payments and avoid financial penalties, serves as a seamless extension of physician practices. To fortify your value-based care strategy, schedule a capabilities presentation with Ellery Plowman.