Collaborative Diabetes Model Saves Health Costs
How a diabetes clinic that includes a collaboration between an endocrinologist and a pharmacist can produce thousands of dollars in health-care savings.
Hirsch and Morello had previously reported that DIMM clinic patients significantly improved their glycemic control by reducing their A1C 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 A1C concentrations by 0.8 percentage points.
The DIMM clinic patients did not gain weight and did not experience low blood glucose incidents.
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 A1C).
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.”