Advances in Care

Forecasters indicate that no end is in sight to rising diabetes rates — 29 million Americans and counting, plus 89 million prediabetics who are at risk of developing the disease. Even more worrisome, an estimated 8.1 million people live with diabetes but don’t know it.

Food and drug retailers have long recognized the importance of targeting the diabetic population from a public health standpoint as well as to tap such consumers’ value and loyalty.

Canadian diagnostic company Miraculins Inc., which is in the process of testing its Scout DS diabetes-screening kiosk in its home country, notes independent research that puts the average spend of diabetes patients at $6,000 per year for treating the disease, of which $3,000 may be spent at the pharmacy. That figure doesn’t include purchases in a grocery/pharmacy setting.

While diabetes numbers keep rising, the health care system remains in flux, and advances in therapy and mobile technology stand to impact how retailers go to market with services and offerings for diabetic shoppers.

Will Bevins, director of pharmacy operations for Abingdon, Va.-based K-VA-T Food Stores, has observed a trend toward personalized therapies and notes the importance of the pharmacist in the diabetes management equation.

“Advances in therapy have provided patients and prescribers many new and unique treatment options. These new advances target different and novel ways to treat the patient. With many of these new medication classes, prescribers may be able to individualize treatment plans based on the patient’s needs and symptomology,” Bevins says.

“The pharmacist is in a unique position to evaluate the patient’s overall medication profile and identify any gaps in therapy and work with the prescriber to close these gaps,” he adds.

The Affordable Care Act, which has ushered in about 16.4 million insured, stipulates that diabetics can’t be denied insurance coverage and requires health insurers to cover some basic needs, including free preventive care, diabetes screenings for adults with high blood pressure and for pregnant women, and medical nutrition therapy.

However, with more people insured, the supply can’t meet the demand, since there are, as mentioned earlier, around 29 million diabetics and only about 5,000 endocrinologists in the country.

Acute Care to Clinical

New venues and models for health care are in development, and the retail landscape has become a proving ground. Last year, retailers Walmart and Target, for example, began moving from acute care clinics to primary care services

The Bentonville, Ark.-based mass merchandiser opened a handful of Walmart Care Clinics, which it owns and operates. This is in contrast to the 100 or so Clinics at Walmart that are leased and operated by third parties.

Broad-range services offered at Walmart Care Clinics include chronic condition management for those with uncomplicated diabetes, notes Walmart’s Ben Wanamaker, senior manager strategy and operations. The cost of entry is low: $40 per visit, with Walmart employees and their dependents paying just $4.

The mega-retailer also offers an exclusive line of affordable Reli-On diabetic products, including test strips for just $9, regardless of whether customers have health insurance. Further, shoppers can find in-depth information on diabetes, treatment options and healthy living tips at relion.com.

“The biggest challenge facing our diabetic customers is the rising cost of health care,” notes a Walmart representative. “We will continue to remain committed to providing affordable products to help them manage their disease and reach optimal health.”

Meanwhile, Minneapolis-based Target, through a partnership with Kaiser Permanente, opened four California clinics offering primary care services delivered by Kaiser staff. Telemedicine is being used to connect patients to Kaiser staff doctors.

And earlier this year, in a interview with Bloomberg Business News, John Mackey, co-founder and co-CEO of Austin, Texas-based Whole Foods Market, floated the idea of a Whole Foods medical clinic, first for employees, and then possibly for consumers.

“The big question is, how long will it be before Whole Foods wants to cater to patients with chronic conditions [like diabetes]?,” asks Dave Wendland, VP at Waukesha, Wis.-based Hamacher Resource Group. “If they collaborated with a strong pharmaceutical partner, the [Whole Foods] patient base that expects fresh may gravitate to that kind of environment.”

Wendland sees a growing demand for different health care access points, and retail health clinics make perfect sense.

“I’ve seen a stepped-up number of health clinics being integrated into grocery,” he says. “If you look at the DNA, it isn’t just about acute care. [Grocers] are beginning to focus on chronic care and management, and the biggest food retailer player in the world isn’t bashful about saying, ‘We can replace primary care physicians.’”

Jim Wisner, president of Libertyville, Ill.-based Wisner Marketing Group, who has worked in the area of retail wellness for more than a decade, says those with a clinic/pharmacy model have an advantage when it comes to managing chronic conditions like diabetes.

“With a medical care model, consumers are completely linked in, and, better yet, if you can impact their lives, that is the best of everything,” he observes.

Wisner believes many grocery chains are doing a good job on the diabetes front and will continue to hone their services and offerings.

“Medication adherence and cost of medications are two of the biggest challenges with tackling diabetes moving forward,” says Maria Brous, a spokeswoman for Lakeland, Fla.-based Publix Super Markets, which operates 925 pharmacies in a chain of 1,000-plus stores.

Five years ago, the grocer began a multifaceted diabetes management system. The first phase offered diabetic patients a free medication, Metformin; online resources; and the benefit of a knowledgeable pharmacist.

Customers could also sign up to receive a monthly e-newsletter containing diabetes-related articles, a featured recipe of the month, and special offers from Publix and Publix Pharmacy. The program additionally included a voucher for a free Publix branded glucose meter.

Last year, Publix expanded a Sync Your Refills program established to assist customers with synchronization of their medications to be refilled on the same day of the month. The program is designed to help with medication adherence.

Staff Training

With 93 Food City locations and 78 pharmacies in Food City stores, K-VA-T has invested in training programs for pharmacists to become diabetic coaches and provide overall medication therapy management.

For company associates and their family members, K-VA-T offers through its Healthy Initiatives department health coaching to those enrolled in its Diabetes Management Program.

The program provides the incentive of a reduced co-pay on diabetic supplies and medications that lower blood sugar for associates/family members who comply with its requirements, one of which is meeting with a pharmacist health coach, who provides education, support and counseling.

The Healthy Initiatives department also partners with Kingsport, Tenn.-based Wellmont Health Systems Diabetes Treatment Center to offer free in-store tours. These small group tours focus on shopping and consuming foods that will help those with diabetes better manage the disease. Further, K-VA-T reaches out to other organizations and businesses to offer free diabetes educational sessions and support groups.

“We strongly feel that diabetes management must begin with the patient as the central person caring for their diabetes, but that a team approach, including their family members/support persons, is critical to a better quality of life and outcomes,” Bevins says.

Besides new therapeutics, technology is changing the way retailers will deliver services and how patients manage their diabetes. Telemedicine, being used by Target and some large drug chains, is just one example.

Miraculin’s Scout DS, which was tested earlier this year in several Lovell Drug stores in Ontario, is able to determine whether the user has type 2 diabetes. The kiosk reads, via a light source, AGEs (advanced glyscosylated end-products), among other biomarkers) in the skin and, based on age, provides normal, borderline or elevated results on those tested.

Christopher Moreau, president and CEO of Winnipeg, Manitoba-based Miraculin, says the kiosk provides a 90-second no-blood, no-fasting screening test for type 2 diabetes that’s 80 percent sensitive.

“It is ideal in a food-pharmacy environment to identify those who may be prediabetic or diabetic,” Moreau says. The company will seek FDA approval to market the kiosk in the United States.

“With many of these new medication classes, prescribers may be able to individualize treatment plans based on the patient’s needs and symptomology.”
—Will Bevins, K-VA-T Food Stores

“Medication adherence and cost of medications are two of the biggest challenges with tackling diabetes moving forward.”
—Maria Brous, Publix Super Markets