The Centers for Disease Control recently issued a press release titled, “More than 29 million Americans have diabetes; 1 in 4 doesn’t know.” Diabetes is one of the fastest growing diseases in America and, according to the CDC, more than 29 million people have the disease, a figure that has increased by nearly 12% in less than four years. Additionally, another 86 million people have pre-diabetes, according to the CDC.
Ann Albright, Ph.D., R.D., director of the CDC’s division of diabetes translation, says, “Diabetes is costly both in human and economic terms. It’s urgent that we take swift action to effectively treat and prevent this serious disease.” And, according to the CDC, in 2012, diabetes and its related complications accounted for $245 billion in total medical costs and lost work and wages — a 40% increase from 2007.
These are a lot of statistics and large numbers to demonstrate a point you likely already know: the diabetic is a critically important patient for pharmacies to serve. Yet, with increased Medicare audits, stringent compliance requirements and reduced reimbursements, is servicing these patients really worth it?
Many believe the answer is yes and encourage pharmacies to proactively develop a strategy for chronic disease patients, especially the critical diabetic population. The challenges of billing Medicare claims, especially Durable Medical Equipment claims — glucose test strips, diabetic shoes and socks — can certainly be a concern. However, pharmacies should take a more holistic view, going beyond the revenue from supplies and prescriptions and consider the broader importance of diabetics.
In a recent white paper entitled, “Medicare Diabetic Supplies: Should Pharmacies Stay in the Game?” Tim Weippert, executive vice president of Thrifty White Pharmacy, said: “For us, it was a pretty easy decision, although sometimes painful due to reduced reimbursement. No one is going to make a lot of money, and that’s all some people thought about. You can’t look at it just at the product level. It would be easy to walk away. There is more to it than that – the patients are important.”
Thrifty White Pharmacy caters to diabetics with convenient healthcare services such as immunizations, medical screenings and health coaching. But it has also framed the discussion around the bigger picture: performance and quality improvement.
Despite the regulatory oversight and reduced reimbursement for supplies, diabetic patients are a critical population for pharmacies. As a trusted healthcare advisor, a local pharmacist has the opportunity to encourage adherence, provide dietary coaching and assist with disease management. While this is first and foremost an important contributor to patient health, effective strategies position a pharmacy well in the support of health plans and employer groups looking for partners to improve patient outcomes. Proactive wellness strategies for the diabetic patient just could open the door wider for pharmacies to demonstrate the positive impact they can have on patient wellness.
Kevin Dore is a director at Emdeon, a leading provider of healthcare revenue and payment cycle management and clinical information exchange solutions in the US healthcare system. He has more than ten years of experience in healthcare technology. Prior to working in healthcare technology, Kevin worked for several technology companies, including Arthur Andersen and IBM Global Services.