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Medical Management Clinic for Type 2 Diabetes Cost-Effective from Clinic, Health System, and Payer Perspectives

March 01, 2017

A clinic to provide medication therapy management and patient-specific education for complex patients with type 2 diabetes resulted in improved patient outcomes and cost-savings for both payers and providers, a new study reports.

As direct medical costs for diabetes continue to rise across the United States—totaling approximately $245 billion annually—health care providers now face increasing pressure to lower costs while maintaining patient outcomes. Researchers from the Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego developed a diabetes intensive medical management (DIMM) clinic with the goal of acheiving this aim. Results of the program were reported in the Journal of Managed Care and Specialty Pharmacy (2017;23[3]:318-326).

Managed by a pharmacist and an endocrinologist, the clinic provides personalized medication therapy management and patient-specific diabetes education in 1-hour visits. On average, patients typically visited the clinic three times over a 6-month period. "This is a good example of 'team-based care'—an approach that's becoming more common in health care systems today," Jan Hirsch, PhD, professor and chair of the Division of Clinical Pharmacy in the Skaggs School of Pharmacy, and lead study author, said in a press release.

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The researchers examined the cost-effectiveness of the DIMM clinic from three perspectives (clinic, health system, and payer) and over three timeframes (6 months, 3 years, and 10 years). Costs and outcomes for patients with type 2 diabetes who visited the DIMM clinic (99 patients) were compared with those for patients saw their primary care providers (PCPs) two times over a 6-month period (56 patients).

From the perspective of the clinic, the cost per additional patient treatment goal acheived for patients who attended the DIMM clinic was relatively low. The clinic reported costs between $115 and $164 per patient over 6 months. For the health systems perspective, researchers found that $5287 would be saved per DIMM clinic patient over 3 years compared with patients who visited their PCPs. Notably, these savings total a return on investment of $9.01 for every $1 invested in the DIMM clinic.

From the payer perspective, quality-adjusted life years (QALYs) gained by the DIMM clinic patients were greater, and the estimated medical costs were lower over 2, 5, and 10 years as compared with patients who saw their PCPs.

The researchers suggested that the cost savings were due to improved clinical outcomes for the DIMM clinic patients. In particular, A1C levels of DIMM clinic patients were reduced by an average of 2.4 percentage points after 6 months. Comparatively, patients with type 2 diabetes who saw only their PCP during the 6-month period reduced their A1C concentrations by just 0.8 percentage points. Further findings showed that DIMM clinic patients did not gain weight or experience low blood sugar incidents during the trial period.

“No matter how we looked at the data, the cost for the DIMM clinic group was always lower, while their predicted QALYs were always higher," Dr Hirsch said.

According to the researchers, a pharmacist-led DIMM clinic may be the beginning of many health care changes over the next decade.

“Pharmacists are no longer simply pill dispensers—they're becoming a new type of primary health care provider,” Dr Hirsch concluded. “And, as we found in this study, this new approach may help us improve health care on many fronts.”

Julie Gould (Mazurkiewicz)

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