Costs Associated with Implementation of Two Models of Diabetic Shared Medical Appointments

JEANETTE WAXMONSKY, PhD
University of Colorado

Shared medical appointments (SMAs) for patients with diabetes are an evidence-based and potentially efficient approach to provide self-management education and support in a group setting. For sustainability planning, we evaluated personnel time and other costs for delivering diabetes SMAs in primary care.

Twenty two practices were randomized and trained to deliver standardized or patient-driven models of diabetes SMAs in a comparative effectiveness study. Both models included six two-hour sessions using the Targeted Training in Illness Management curriculum for groups of approximately 5-15 patients. Standardized SMAs were delivered by a health educator with accompanying prescribing provider visits. Patient-driven SMAs further incorporated behavioral health providers, peer mentors, and patient-led topic prioritization (expected to yield better value albeit with higher costs).

Practices were surveyed regarding personnel time for SMA delivery and support and additional resources needed (e.g., travel, materials, overhead) for start-up (prior to first cohort), and initial delivery phases (after completing first cohort).

Starting-up standardized and patient-driven SMA models required similar amount of personnel time on average (46 vs. 45 hrs.). Delivering patient-driven SMAs on average required more personnel hours (75 hours) than standardized SMAs (50 hours). Other costs for patient-driven SMAs on average were higher for both start-up ($957 vs. $1,717) and initial delivery ($137 vs. $177). Overall, hours and other costs varied greatly by practice, as indicated by wide ranges reported in both hours spent (min = 12 hrs., max = 135 hrs.) and other costs (min = $0, max = $802).

Reported costs of delivering diabetes SMAs varied considerably among practices, both in personnel time and other expenditures. As expected, delivering a model with a larger team involved more hours during implementation than an approach with fewer personnel, plus modest increases in other costs. Practices seeking to implement diabetes SMAs should consider what elements of SMAs are most important to their patients and the resources required relative to reimbursement for each model.