Project IMPACT: Diabetes Prevention · Unique delivery model using teams of lifestyle coaches Model emphasizes meeting participants where they are •Identify participant preferences

Project IMPACT: Diabetes Prevention

KIAWAH ISLAND, SC ● THURSDAY, JANUARY 24, 2019

BENJAMIN BLUML, RPHS E N I O R V I C E P R E S I D E N T, R E S E A R C H A N D I N N O VAT I O NA M E R I C A N P H A R M A C I S T S A S S O C I AT I O N F O U N D AT I O N

24-Jan-19 COPYRIGHT © 2019, APHA FOUNDATION. 1

Improve health by inspiring philanthropy, research and innovation that advances

pharmacists’ patient care services

Innovative Practice Model Designs with Consistently Improved Outcomes

Adherence Alzheimer’s

Diabetes Depression Hyperlipidemia

Hypertension Osteoporosis

Our Research and Innovation Axioms

Do the right things well.

Structure. Process. Outcomes.

Align the Incentives, Improve the Outcomes, Control the Costs.

“The best way to predict the future is to invent it.” – Alan Kay

Convene

Pilot

Scaled Demonstration

Idea

IMProvingAmerica’sCommunitiesTogether

National Implementation

… “Incubating Care Innovation”


Net Annual Savings in Chronic Disease The Asheville Project: $1,622 - $3,356 Patient Self-Management Program: $918 Diabetes Ten City Challenge: $1,079 Project ImPACT: Depression: $983

Creating the Basis for a Preferred Future


Pharmacy Practice Activity Classification

Step

Task Activity

Class

Domain

“Interdisciplinary care is the best way to invent a preferred future in healthcare.”

Immunizations

Advancing Service Deliveryin Pharmacy Practice


Health PromotionHealth Risk Assessment

Immunizations

Disease Prevention

Wellness Programs

Health ManagementAsthmaCardiovascular Disease (Dyslipidemia, Hypertension)

Coagulation DisordersCongestive Heart FailureDepressionDiabetesOsteoporosis

…all with MTM

Selection Criteria:- High prevalence- High risk- High cost- Problem prone

A Preferred Future in Diabetes Prevention


Diabetes: A Public Health Challenge30 million Americans have diabetes

84 million Americans have prediabetes

9 out of 10 adults with prediabetes don’t know they have it


Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA; US Department of Health and Human Services, Centers for Disease Control and Prevention, 2014; Available at: https://www.cdc.gov/diabetes/data/statistics/2014StatisticsReport.html

https://www.cdc.gov/diabetes/data/statistics/2014StatisticsReport.html

National Diabetes Prevention Program (National DPP)Congress authorized the CDC to establish the National DPP◦ A public-private initiative to offer evidence-based cost effective interventions in communities

across the United States to prevent type 2 diabetes

Program Goal ◦ Help participants make lasting behavior changes such as eating healthier, increasing physical

activity, and improving problem-solving skills

Program Elements◦ Yearlong lifestyle change program that offers participants:◦ A trained lifestyle coach◦ CDC-approved curriculum◦ Core phase: Weekly sessions during months 1-6 ◦ Maintenance phase: monthly sessions during months 7-12

◦ Group support over the course of a year


Impact of National DPPResearch led by the National Institutes of Health showed that people with prediabetes who take part in a structured lifestyle change program can cut their risk of developing type 2 diabetes by 58%1

Over the course of 15 months, Medicare-eligible individuals who participated in the Y-DPP avoided $2,650 in healthcare costs2


1 Diabetes Prevention Program. National Diabetes Information Clearinghouse. U.S. Department of Health and Human Services. National Institutes of Health. Available at: https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp/Documents/DPP_508.pdf2 Department of Health and Human Services Centers for Medicare and Medicaid Services. Office of the Actuary. https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/Diabetes-Prevention-Certification-2016-03-14.pdf

https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp/Documents/DPP_508.pdf

https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/Diabetes-Prevention-Certification-2016-03-14.pdf

CDC RFA DP17-1705OPPORTUNITY TO SCALE THE NATIONAL DPP IN UNDERSERVED AREAS TO PRIORITY POPULATIONS


CDC DP17-17051 of 10 CDC Cooperative Agreements5-State, 5-year Initiative, 7,500+ Patients

Partnership between APhA Foundation and KrogerCombination DPP including In-Person, Distance Learning, and Online


Project Principles◦ Community pharmacies are highly accessible locations that can be utilized to expand both

diabetes prevention and health management services◦ An optimal way to facilitate delivery of DPP services is through an enhanced role for highly

accessible support staff in community practices (e.g., pharmacy technicians in community pharmacies)

◦ Expanding evidence-based diabetes health management services by pharmacists, supported by public and private employers, in parallel with prevention program coaching by certified pharmacy technicians is beneficial for population health

◦ Optimized service delivery methods include in-person (1-on-1 or group), distance learning (telehealth), and online services as evidenced in an increasing number of published reports and best practices

◦ We are preparing for successful pharmacist provider status legislative change by designing an implementation effort that evaluates methods for delivering services in medically underserved and healthcare provider shortage areas


Project ImplementationWhat is happening at a site level:

◦ Practices Serve Patient Population(s) with High Levels of Need◦ DPP Services Delivered from Highly Accessible Community Practices◦ Hybrid DPP including Face-to-Face, Distance Learning, and Online Modalities◦ Minimum Dataset Submission of DPP Metrics Quarterly◦ Parallel Offering of Diabetes Management Services Beyond Grant


Priority Populations • Medicare beneficiaries• Men

• African-Americans• Asian-Americans• Hispanics

• American Indians/Alaska Natives• Pacific Islanders

• People with visual impairments• Patient with physical disabilities


DPP Program DeliveryDPP delivery in Project IMPACT: Diabetes Prevention offers a combination yearlong lifestyle change program The combination program will be delivered by trained lifestyle coaches through multiple modalities:

• In-Person Face-to-Face (Individual or Group)• Distance Learning (Telehealth)• Online (Digital Application)


Innovative Project FeaturesOpportunity to change the landscape of how DPP is delivered in communities across the country◦ Pharmacies provide access point in local communities

Unique delivery model using teams of lifestyle coaches Model emphasizes meeting participants where they are• Identify participant preferences for modalities at enrollment visit• Assesses participant knowledge at the beginning of the program

Model supports participant success throughout the program• Provide flexibility for participants to move between modalities throughout the

program based on needs


Affiliate Sites – The Kroger Co.• Will serve as the DPP delivery sites

• In-person modality will be provided in 5 geographic locations◦Alabama (Morgan/Madison/Limestone Counties)◦ Kansas (Butler County)◦ Kentucky (Hardin County)◦Ohio (Clark County)◦ Tennessee (Blount County)

• Distance learning modality will be provided by Kroger telehealth services


Background

COMMITMENT TO DIABETES PREVENTION AND MANAGEMENT


For Kroger Patients with Diabetes Diabetes Management (Coaching)

Diabetes Self-Management Education (ADA and AADE Recognition)

Medical Nutrition Therapy

Beating Diabetes

CGM (Dexcom) Trainers

Insulin Pump Trainers


DIABETESCARE

The Kroger Health and Wellness Ecosystem

Pharmacy and Clinical Services

The Little Clinic Health Services

Food as Nutrition and Medicine

OTC Medication, Vitamins and Supplements

Dietetic Services

We keep food at the center…but also tell the story that connects the dots between Pharmacy, The Little Clinic, HBC and nutrition so Kroger is increasingly seen as a health and wellness destination.



Kroger Diabetes Care

2009• ADA DSME

Recognition

2014• Expanded to DPP delivery as AADE sub-

grantee• 5/1/14 Effective Date

2014-2016• Program

Development and Delivery

2016• KPP

Pilot

2017• CDC Pharmacy Stakeholder Group

• CDC Full Recognition• APhA/Kroger

Partnership CDC 1705 Grant

2018+• Program

improvement and

optimization


Key Aspects of Kroger DPPCertified Lifestyle Coaches◦ Certified Diabetes Educator (CDE)◦ Registered Dietitian (RD)◦ Pharmacist (PharmD)◦ Licensed Diabetes Educators (LDEs and MLDEs)

Location◦ Easily Accessible◦ Access to grocery store◦ Pharmacy◦ Dietitians◦ Little Clinic Partnership


Overcoming Delivery BarriersUse of personnel with lower hourly rate◦ Residents◦ Student Pharmacists/Pharmacy Interns◦ Certified Technicians◦ Nutrition Technicians

Advanced HCPs (PharmDs, NPs, RDs) to Oversee the Program◦ Referral for medication management◦ Referral for complex issues or development of T2DM

Collaboration with other members of the healthcare teamPartnerships with third party administratorsInvolvement in DPP networksCombine face-to-face and virtual delivery options


Kroger Team Support• Kroger Corporate Leaders who support program implementation • Community Champions who lead local implementation of the lifestyle change program• Team of Lifestyle Coaches who deliver the lifestyle change program sessions and support DPP participants


Community Champions

Roles and Responsibilities

Motivate and empower local team

Mentor lifestyle coaches

Facilitate DPP implementation for in-person modality

Identify and remove potential barriers

Manage program logistics

Ensure program accountability


Lifestyle Coaches • A team of lifestyle coaches selected at each DPP delivery site• The team of lifestyle coaches led by the community champion • Team composition varies depending on the resources available• The team of lifestyle coaches may include, but not be limited to:◦ Pharmacists◦ Pharmacy technicians◦ Nutrition technicians◦ Dieticians◦ Nurse practitioners


CDC-ApprovedLifestyle Change Program Key components of the program include:◦Utilization of CDC-approved curriculum and resources ◦Participant interaction with trained lifestyle coaches who lead

the program◦Participant connection with a support group of people with

similar goals and challenges


CDC-ApprovedPrevent T2 CurriculumDuring the core phase over the first 6 months of the program, participants will attend weekly sessions to learn about: ◦ Eating healthy ◦ Adding physical activity ◦ Dealing with stress◦ Coping with challenges ◦ Staying on track

During the maintenance phase over the second 6 months, participants will attend monthly sessions to enhance the skills they have learned and emphasize key ideas such as: ◦ Tracking food and physical activity◦ Setting goals◦ Staying motivated◦ Overcoming barriers


CDC RecognitionTo gain CDC recognition, an organization must show that it can meet CDC standards and effectively deliver a proven diabetes prevention lifestyle change programStandards for CDC recognition include:◦ Use of a CDC-approved curriculum for the lifestyle change program◦ Capacity and commitment to deliver the program over at least 1 year◦ Provide at least 16 sessions during the first 6 months ◦ Provide at least 6 sessions during the last 6 months

◦ Utilization of trained lifestyle coaches ◦ Designation of individual to serve as the diabetes prevention program coordinator◦ Ability to submit data on participants’ progress (i.e., attendance, weight loss, and

physical activity)◦ Requirement that at least 35% of participants be diagnosed with prediabetes through

blood testing (or have a history of gestational diabetes)


Questions/DialogueBENJAMIN M. BLUML, RPH [email protected]

SENIOR VICE PRESIDENT, RESEARCH AND INNOVATION


mailto:[email protected]