Diabetes outcomes before and during tele-health advancements surrounding COVID-19

Woodhouse, Ashley G.; Orvin, Chelsea; Rich, Caleb; Crosby, Joseph; Keedy, Chelsea A.

Background Pharmacists can optimize outcomes related to diabetes mellitus (T2DM) by taking advantage of telehealth opportunities despite the COVID-19 Public Health Emergency (COVID-19 PHE). Objective Identify and compare changes in T2DM outcomes prior to (August 2019 through February 2020) and during (March 2020 through October 2020) the COVID-19 PHE. Secondary objectives were to identify and compare pay-for-performance metrics and additional fee-for-service submitted in these patients. Methods This study examined changes in T2DM outcomes at one primary care office within a community health system. Pharmacists started regularly using Remote Patient Monitoring (RPM) services during the COVID-19 PHE to reduce in-person visits. Patients with an initial A1C greater than or equal to 8% were included. Data collected included comorbidities, change in A1C, and diabetes and statin medication therapy adherence. Percentage of Healthcare Effectiveness Data and Information Set (HEDIS) and Merit-Based Incentive Payment System (MIPS) measures met, and billing code frequencies were also assessed. Results In the pre COVID-19 PHE group (N=30), the average three and six month A1C reductions were 1.3% and 1.2%, respectively, while the reductions were 2.0% and 2.2% in the during COVID-19 PHE group (N=61). The percentage of patients appropriately initiated or maintained on statins was 96.2% in the pre COVID-19 PHE group versus 82.6% in the during COVID-19 PHE group. Related to HEDIS, statin adherence was 95.2% in the pre COVID-19 PHE group and 84.2% in the during COVID-19 PHE group while A1C control was 41.7% versus 54%, respectively. A1C control related to MIPS was 60% pre COVID-19 PHE versus 73.8% during the COVID-19 PHE. Diabetes medication adherence related to HEDIS and medication reconciliation related to MIPS was 100% for both groups. Conclusion Data demonstrates the opportunity for pharmacists to maintain and improve clinical outcomes related to T2DM despite the ongoing COVID-19 PHE through implementation of telephonic monitoring.