Missing the point

Missing the point

“People in the diabetes program get one-on-one support and coaching by phone and at CVS pharmacies and MinuteClinics, generally staffed by physician assistants and nurse practitioners, for no out-of-pocket cost. They also receive a glucometer that measures and shares blood glucose levels digitally to CVS, which can then help head off complications or intervene when issues arise.”

This paragraph comes from an article posted on the Fox Business site entitled CVS Moves Deeper Into Doctors’ Turf.

Now we have no idea which way cool whiz bang cloud enabled glucose meter CVS is using but does it really matter. As we have noted many times you can’t swing a dead cat these days without hitting one of these way cool whiz bang devices. The bigger story here is something we have also discussed at great length, that is how everyone wants a piece of the diabetes management pie. Heck just the other day we noted that pharmacies are moving into turf once occupied by CDE’s. As we noted there just aren’t enough CDE’s to handle the increasing patient load.

The real question, the more important question is will this program by CVS yield anything of substance or will this just be one more failed attempt at improving patient outcomes. We hate to be skeptical and we do applaud CVS efforts but experience tells us that this program like so many others will have minimal impact. Here’s why;

The biggest issue we have always had with any of these programs is they fail to meet the patient on their terms. They assume patients want to be coached, that they are motivated to improve their outcomes. That they will become engaged with their diabetes management and CHANGE THEIR BEHAVIOR.

We know were beginning to sound like a broken record but achieving better outcomes does not motivate a patient to change their behavior. Behavior change will only happen when the patient has skin in the game, when they receive something tangible for achieving better outcomes. Let’s face facts a patient cannot see, touch or feel better outcomes. But they sure feel it when they pay health insurance premiums or reach into their pockets to cover drug co-payments.

What missing from nearly every one of these programs is they are trying to change behavior when instead they should be changing the diabetes management experience. They fail to understand for the masses diabetes is just one more thing they must deal with. That these people DO NOT live their lives FOR their diabetes they live their lives WITH diabetes. A chronic disease they do not want, really don’t understand and requires work to manage. Additionally, even if they do the work it takes time to see results and then once they achieve good results it takes just as much work to stay there.

Now all this heavy lifting would be worth it if the patient had some skin in the game. Again, we hate to be redundant but if the patient’s health insurance premiums were lowered or if their co-payments were lowered or eliminated for achieving better outcomes things would be different. These are things that the patient can see, touch and feel. These are the things that make all the heavy lifting worthwhile. These are the things that change the experience.

Perhaps a good example of this for someone who is not diabetic is to think of someone wearing an Apple Watch. One of the neat features of the Apple Watch is that it proactively sends messages telling the person to stand up or breathe. While this neat at first it does become somewhat annoying. Well the same applies to all the messages or calls a patient with diabetes gets. But it’s worse for these patients as most are using oral medications and even if their numbers are completely out of whack there is nothing they can do about it. The reality is all this communication is like the boy who cried wolf.

Let’s take this a step further and say the patient is very diligent, that they measure their glucose regularly (something most won’t do), they change their diet (something that normally does not last long), they begin to exercise (again something that normally doesn’t last long either) and they still aren’t under good control. What’s the next step? A new medication, increase the dose of existing medications? No, the next step is a visit to the doctor which while necessary also costs money and takes time.

Ok let’s say the patient takes this step, let’s say they spend the money and take the time. Let’s further assume that the physician does make some adjustments, what’s the next step? Will the patient see an immediate change? Or will it take even more time and more analysis to see if these adjustments work? Let’s say they do, what’s the payoff for the patient? Is this enough to keep the patient engaged with their diabetes management or will they get frustrated that after all this work they got nothing tangible in return?

We say this often but better outcomes for patients takes time and time is not a renewable resource. It is not as if they can do well for a few days, then take a few days for good behavior. No diabetes management is 24x7x365 job and like any job comes with its fair share of ups and downs. To believe that these patients will put in all this effort just to achieve a lower HbA1c is just ludicrous. Now if these patients had some skin in the game, if this lower HbA1c saved them time or money the story, the experience of managing their diabetes would change dramatically.

The problem is none of the programs are designed to help patients are built on that premise. They all believe that making help or coaching easily accessible that patients will take advantage, that they will listen, that they will change their behavior. That this behavior change will be permanent. That patients really want a lower HbA1c.

Yep you’ve heard it before but we’ll say it again because it applies to patients too, this is all about money, who spends it, who makes it and who saves it. If patients ending up spending less for their diabetes management, or saved money with better diabetes management or were rewarded financially for better management things would be different.

As Momma Kliff used to say; “You have a much better chance of achieving something good when everyone has some skin in the game.” The problem with nearly these programs is the patient is the only one who does not have skin in the game. The pharmacy makes money, the drug companies make money, the device company makes money but what about the patient. Yep once again the patient gets nothing.