Diabetes outcomes before and during telehealth advancements surrounding COVID-19

Abstract

Background: Pharmacists can optimize outcomes related to type-2 diabetes (T2D) by taking advantage of telehealth opportunities despite the coronavirus 2019 (COVID-19) Public Health Emergency (PHE). Objective: Identify and compare changes in T2D outcomes before (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 T2D 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 glycosylated hemoglobin (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 were met, and billing code frequencies were also assessed. Results: In the pre–COVID-19 PHE group (N = 30), the average 3- and 6-month A1C reductions were 1.3% and 1.2%, respectively, and 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, and A1C control was 41.7% versus 54%, respectively. A1C control related to MIPS was 60% before 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 demonstrate the opportunity for pharmacists to maintain and improve clinical outcomes related to T2D despite the ongoing COVID-19 PHE through implementation of telephonic monitoring.