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Combining Home Testing and Personalized Care to Control Diabetes

People trying to manage their diabetes during the COVID-19 pandemic have faced a Catch-22.

They’re at higher risk of severe illness if they get COVID-19. But they risk other health problems if they skip routine lab tests needed to manage their diabetes because they’re trying to avoid exposure to the virus.

That dilemma led Health Care Service Corporation (HCSC) to launch a pilot program combining home hemoglobin A1C testing with one-on-one consultations to help at-risk members manage their diabetes and improve their health.

HCSC pharmacists and technicians gave dozens of members and their primary care providers personalized assessments, including a review of A1C results, health and lifestyle suggestions and potential savings on prescription drugs.

“This program shows members that there are people who care about them and are reaching out to help.”

Since the COVID-19 crisis started, HCSC has scaled up distribution of at-home testing kits to support members in controlling health conditions like diabetes and screening for colorectal cancer to help them stay healthy.

“There are so many barriers our members are facing,” says Hala Ibrahim, HCSC enterprise quality reporting director, adding that members appreciated receiving the extra care management. “The pharmacy team identified many opportunities to help members improve their outcomes during the pandemic.”

Free A1C test kits were mailed to about 2,000 members in Illinois, Montana, New Mexico, Oklahoma and Texas with gaps in their diabetes testing, which put them at greater risk of serious health complications. They had to identify a primary care provider to participate, and both the members and their chosen providers received the results.

The kits allow the members to draw a blood sample at home and send it to a lab for analysis. It measures the percentage of hemoglobin — a protein in red blood cells that carries oxygen — coated with sugar. The higher the A1C level is, the less controlled the blood sugar is, increasing risk of diabetes complications.

HCSC offered consultations to about 110 members who returned their kits, and more than 70 people accepted them. Based on the A1C results and pharmacy and medical claim histories, the team was able to discuss recommended immunizations, possible health concerns, lifestyle changes and savings on prescription drugs.

The reviews are intended to empower members by allowing them to ask questions and providing them with information to discuss with their doctors.

“Sometimes it’s hard for the member to even think about what questions to ask their doctor,” says HCSC clinical pharmacist Kasia Marek.

The primary care providers also were made aware of HCSC’s outreach and encouraged to follow up.

“That just helps reinforce the message and improve the member outcomes we’re looking for,” says Buki Fabusiwa, director of pharmacy health care management integration.

Including pharmacy in primary care

About 13% of U.S. adults have diabetes and an estimated 1.5 million new cases are diagnosed every year. Uncontrolled diabetes weakens the immune system and can lead to heart disease, stroke, kidney disease, nerve damage and amputations.

Research suggests people with diabetes benefit from having pharmacists involved in their primary care team as a source of education, medication expertise, monitoring and motivation.

At HCSC, pharmacists and pharmacy technicians, along with nurses and social workers, could bring their perspective and expertise to a holistic approach to care management.

“The pharmacy team is very equipped to speak to members about so many things,” Ibrahim says. “This program shows members that there are people who care about them and are reaching out to help.”

Improving outcomes with outreach

Although the American Diabetes Association recommends hemoglobin A1C tests every three to six months, Marek says some members in the pilot hadn’t had one in more than a year, putting them at risk for serious complications.

Most members who received pharmacy outreach said they were grateful for the convenience of home testing. HCSC clinical pharmacist Bukky Soyannwo helped a member get a new glucose meter so he could monitor his blood sugar. She provided guidance to another member who was struggling with side effects from medication.

"I was able to provide her with education and information on what she should watch out for and when to reach out to her doctor,” Soyannwo recalls, adding that she also offered tips to help the member get more exercise. “It’s just little changes in their lifestyle that can improve outcomes for their diabetes.”

Health Care Service Corporation, a Mutual Legal Reserve Company.