Effectiveness of a pharmacist diabetes coaching program: A propensity-matched retrospective analysis

TL;DR

A pharmacist-led diabetes coaching program improved glycemic control and reduced hospital days and costs for patients with poorly controlled diabetes.

Contribution

This study provides evidence that a pharmacist-driven telehealth diabetes coaching program can improve clinical and cost outcomes.

Findings

Diabetes coaching participants had a greater mean A1c reduction compared to non-participants.

The program reduced hospital days and total medical expenditures per patient in the ACO subgroup.

The program was cost-neutral and beneficial for economically vulnerable patients through the 340B program.

Abstract

Limited evidence exists on the clinical and cost impact of diabetes coaching programs integrated into care teams. The Diabetes Care Coach (DCC) program is a pharmacist-driven telehealth coaching program for patients with poorly controlled diabetes. Coaches provide frequent telehealth support to improve glycemic control through medication management, nutrition and lifestyle counseling, leveraging diabetes technologies, initiating mental health referrals, and addressing health-related social needs. The objective of this study was to evaluate the effectiveness of the UMass Memorial Health (UMMH) DCC program.

A retrospective matched cohort study was conducted with data collected from the UMMH electronic health record and the UMass Memorial Medicare Accountable Care Organization (ACO) claims database from January 2020 to December 2023. The DCC program was implemented at the UMMH diabetes clinic, a specialty care clinic in Worcester, MA, supported by the UMass Specialty Pharmacy program, which is managed by Shields Health Solutions. Participants included patients with persistent severe hyperglycemia (hemoglobin A1c [A1c] ≥ 9) receiving care at the diabetes clinic. Intervention participants (n = 239) enrolled in the DCC program were matched with comparison participants (n = 815) not enrolled in the program during the study period. Intervention and comparison participants who were also enrolled in ACO were considered for cost analyses. Between-group differences in glycemic control (A1c change), health care utilization (emergency department visits and days hospitalized), and cost (total medical expenditures, TME) were evaluated. Intervention participants experienced a greater mean A1c reduction of –0.4 percentage points (95% CI, –1.1 to 0.3) compared with comparison participants. Within the ACO subgroup, intervention participants also had a greater mean reduction in annual TME of $2,649 per patient (95% CI, –$14,425 to $9,127) and a reduction in hospital days per patient per year of –5.2 (95% CI, –9.8 to –0.6) relative to comparison participants.

The DCC program was associated with directional improvements in clinical, health care utilization, and cost outcomes and was cost-neutral due to savings and associated revenue. With approximately one-third of participants having Medicaid insurance, the sustainability of such programs increases through leveraging the 340B program to enhance care for economically vulnerable patients.

Figures