Megan Wesling, PharmD and fellow pharmacists and epidemiologists evaluate the impact of chronic care management (CCM) on diabetes-related outcomes in interprofessional care of a medically complex patient cohort. In this single-center, retrospective, pre-/post-intervention chart review study, adult Medicare Part B beneficiaries with type 2 diabetes (T2D) were enrolled in the CCM program from February to August 2020. The study team evaluated the subjects via non-parametric tests to compare clinical measures, Healthcare Effectiveness Data and Information Set (HEDIS) measures, and clinical staff time-on-task one year before and one year after the enrollment dates. Generating a return on investment (ROI) analysis offered a perspective into financial outcomes and program viability. The goal of this endeavor? While the benefits of CCM, as measured by clinical and financial sustainability are often touted, the actual study evidence as manifest in the literature remains limited. In this case the study team focuses on evaluating diabetes-related outcomes of an interprofessional CCM program and calculating the return on investment (ROI) of the implemented program. For reference an interprofessional CCM is a collaborative approach to patient care that involves healthcare professionals from different disciplines working together to improve patient outcomes. CCM programs provide care management and coordination services to patients with two or more chronic conditions. What did the authors find?

Wesling, PharmD, BCPS, BCACP, CDCES, Interim Chair and Associate Professor, Department of Pharmacotherapy at the University of North Texas, Health Science Center at Fort Worth and colleagues included 42 participants based on their study inclusion criteria. The statistically significant pre-/post-measures included reduction in glycosylated hemoglobin (A1C) (7.5% vs. 6.8%, p-value = 0.003) and the body mass index (BMI) (34.8 vs. 34.0 kg/m², p-value < 0.001), and increased clinical staff involvement for pharmacist interventions (9 vs. 36, p-value < 0.001), plus social worker interventions (1 vs. 24, p-value < 0.001).

Also, other observations centered on reductions in blood pressure and increases in patients achieving multiple HEDIS measures. According to Wesling and colleagues:

“ROI demonstrated that every $1 invested in the CCM program returned $1.29 to the clinic, $3.04 when accounting for A1C reduction.”

 Summary

CrossTx can report yet another well-designed academic study showcasing the positive returns of the CCM program. In this case demonstrating that an interprofessional CCM program caring for “medically complex patients with T2D improved patient outcomes, specifically A1c and BMI values, and demonstrated financial sustainability with a positive ROI.”

Wesling and colleagues find that when mobilizing “a collaborative, interprofessional team approach, the CCM program facilitates progress towards achievement of the Institute for Healthcare Improvement’s triple aim and supports consideration in the investment in diverse clinical staff.”

What further validation is needed?

According to respected academic research collaborative additional research should be designed in part to overcome some of the limitations inherent in the present study.

For example, the long term impact and scalability of CCM interventions as applied across an array of healthcare settings and diverse patient populations, health equity and feasibility in transition from fee for service to value based care models needs ongoing investigation.

Authors in this study include Ashlyn Aguiniga Pharm.D, Didi Ebert DO, MPH, MS, Emmanuel Rodriguez MBA, Angel Nguyenly BBA, and, Megan Wesling Pharm.D

Call to Action: Follow the link to the source in Journal of the American College of Clinical Pharmacy published September 2024.