Sandhills Medical Foundation Credits Its Pharmacies with Helping Patients Manage Diabetes

Sandhills Medical Foundation (SMF) HRSA BPHC exit disclaimer is a HRSA-funded health center based in South Carolina, primarily serving patients who traditionally have limited access to health care. SMF operates four financially successful pharmacies that are integrated into its seven health center sites and participate in the 340B drug pricing program. SMF’s pharmacies make money, and this helps with financial stability. The health center also credits the pharmacies with helping improve patients’ diabetes control (HbA1C) over the course of two years (HbA1C poor control was 28% in 2015 and 19% in 2017). They are now among the Health Center Program’s highest performers in the area of diabetes control.

Integrated Care Team and Pharmacists

As a National Committee for Quality Assurance (NCQA)-recognized Patient-Centered Medical Home (PCMH), SMF’s integrated care teams include physicians, nurses, behavioral health counselors, as well as case managers who monitor gaps in care on a monthly basis to ensure best practices and data concurrence.

SMF considers its pharmacy team essential to its integrated care team for diabetes management. With onsite pharmacies, SMF’s pharmacy team has valuable interactions with patients and data about patients’ medications, prescriptions, and adherence. SMF estimates that it fills 60-70% of its patients’ diabetes medication prescriptions. Pharmacists also collect information about medication complications and side effects, and they track and notify the care team when patients do not pick up medications or when patients appear to be rationing their medications. With patients who experience challenges taking their medications, pharmacy staff work with providers to adjust type of medication and dosing to achieve best results. 

The pharmacy teams also examine and address financial and other barriers to medication access—for example, having a sliding scale for medications and mailing medicine to homebound patients. Patients’ ability to get their prescription medication onsite improves compliance and gives the care team opportunities to remove challenges patients face in obtaining affordable medications. This also reduces patients’ medication rationing or not prioritizing medications that may occur with use of other pharmacies.

Health Professions Education

SMF partners with a local college to rotate students through its pharmacies as a part of their doctoral degree. These students learn and participate in analyzing data and flagging patients who need medication therapy management services.

SMF’s integrated care team model has been emulated by other health centers and insurance companies. Case managers regularly visit and train other organizations in effective diabetes management.

Financial Incentives

All SMF staff are eligible to receive bonuses on a quarterly basis for providing quality care, based on performance on quality measures. Providers have six performance measures, two of which focus on diabetes: two A1C tests per patient per quarter and percent of patients with uncontrolled diabetes (A1C>9) below 22%. Providers receive quarterly bonuses for meeting goals on four or more performance measures and for participating in monthly peer learning calls lead by the medical director, where providers discuss issues and share promising practices. Other staff have similar measures to achieve in order to receive quarterly bonuses.

Charitable Fund

SMF has established charitable fund that supports patients, including those with diabetes, who cannot afford to receive specialized care. If a patient is struggling with financial barriers to manage their diabetes, the fund, established with excess pharmacy revenue, can pay for specialty referrals and necessary treatment. When a patient needs financial assistance, their case is reviewed by a multi-disciplinary committee, and a decision is made about whether to pay for care within 24 hours of the request.
As an added benefit, specialty providers outside of the health center are aware of the fund. They feel comfortable working with SMF patients, knowing that the patients will receive financial support for referrals and other treatments.

How to Implement

  • Recognize the value of pharmacy and a pharmacy team to patients and patient participation.
  • Open an onsite pharmacy, which can yield enough financial revenue to support other programs such as employee incentives or charitable funds. If staffed appropriately, a small rural town of 600 or less can support a Pharm-D and certified technician. A Pharm-D at each in-house pharmacy leads a team of one-to-two certified pharmacy technicians who can assist in data analysis and patient communication.
  • Integrate the pharmacy staff into the care team and PCMH model to complete the circle of the care team and allow for improved data analysis.
  • Partner with local institutions of higher learning to allow for development of future staff and to further extend the impact of pharmacy on patient care.
  • Leverage 340B savings to enhance patient care on an individualized care plan model to improve outcomes for all chronic modalities.
Date Last Reviewed:  April 2019

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For more information about this promising practice, contact:
Christopher W Dixon, Executive Director/ CEO