Diabetes care program for West Virginia state employees: Insights for pharmacists nationwide

Face-to-Face empowers patients while providing low-barrier means for community pharmacists to provide clinical services

While just under 10% of U.S. adults have diabetes, 13% of West Virginians do. This places the state last in diabetes rankings. West Virginia pharmacists help to address the prevalence of diabetes among state employees. A program called Face-to-Face empowers patients to manage their diabetes with a pharmacist while providing a low-barrier means for community pharmacists to provide clinical services. 


Now in its 10th year, Face-to-Face has new policies to improve patient outcomes. The program offers insights to community pharmacists nationwide who wish to expand clinical services. 


What is Face-to-Face?


State employees who have diabetes and are insured by the Public Employees Insurance Agency (PEIA) are eligible for Face-to-Face. Participants keep regular appointments with a community pharmacist or other nonphysician provider and meet specified glycosylated hemoglobin (A1C) goals, and PEIA waives their copays for diabetes-related medication and supplies. Pharmacists are reimbursed for the visits at rates commensurate with the amount of time spent.


“PEIA felt that by educating members on their disease state and how to better control it, the member would benefit with improved quality of life,” said Felice Joseph, BSPharm, Pharmacy Director for PEIA. “PEIA and West Virginia taxpayers would also benefit by potentially reducing medical and pharmacy costs associated with complications from diabetes.”


During the first year, patients must keep quarterly appointments with their pharmacist. After a year, they are only required to see their pharmacist once a year.


“I feel like a lot can happen if I go without seeing my patients for a year, so I try to see them at least every 6 months,” said Shannon Gooden, BSPharm, LDE, a district clinical pharmacy coordinator for Kroger Pharmacy.


Starting this year, patients are required to achieve an A1C of 8% within 2 years of joining the program in order to remain enrolled, unless the physician provides a medical reason the patient did not reach the goal. 


“Implementing an A1C threshold is a very exciting direction to move into,” said Krista Capehart, PharmD, MSPharm, AE-C, who is director of West Virginia University’s Wigner Institute for Advanced Pharmacy Practice, Education, and Research. “It not only incentivizes the patient, but also the pharmacist, and it gives the physician incentive for everybody to work together as a team.” Capehart is President of the West Virginia Pharmacists Association. 


Also new: patients who are unenrolled in the program because they fall short of requirements can enroll again in 12 months. Until this year, Face-to-Face was a once-per-lifetime benefit.


Tips for launching a program


Among the clinical services that West Virginia pharmacists offer, Face-to-Face poses the lowest barriers.


“The primary requirement is that pharmacists complete the APhA diabetes certificate program,” Capehart said, referring to the APhA Pharmacist and Patient-Centered Diabetes Care Certificate Training Program. “The billing structure and the patient base are already there. They don’t have to develop their own program. So it’s not as intimidating.”


For pharmacists in other states who would like to launch a program with a built-in patient base and payment structure, Capehart suggested looking to local and statewide self-insured employers. “They are often looking for creative ways to save health care dollars and improve patient outcomes. And they may have more flexibility to be creative with incentives to entice employees to participate and increase the likelihood for the program to be successful.”


Waived copays are not the only possible incentive. Similar programs have lowered insurance premiums as an incentive, Capehart said. She suggests that pharmacists think creatively about the incentives that would be attractive to patients and payers. 


When considering expanding clinical services, think outside your pharmacy. “While offering a service at an individual location is good, working with others—pharmacists, pharmacies, and other disciplines—can increase patient participation and provide a larger amount of data to aggregate for increasing evidence to convince other payers,” Capehart says. She suggested looking to contacts in your state and regional pharmacy associations to get started.


‘Thinking outside the box’


In the APhA diabetes certificate training program that Capehart conducts, she sees pharmacists who envision Face-to-Face as a platform for innovation. “We have a lot of thinking outside the box—pharmacists who see all the things they can do with this program. It’s nice to see pharmacists willing to venture into new realms.”


At Kroger, for example, pharmacists like Gooden take advantage of the supermarket setting. “We go right out into the store with them and try to help them with healthy food choices,” Gooden said.


“They are making a difference in patient outcomes,” Capehart said, “and I know there are a lot of physicians in the state that depend on those pharmacists that truly make a difference.”