Earning from Learning

If you want to be successful in business, you’ve got to grab an opportunity when it comes your way. Great Lakes Home Healthcare Services in Erie, Pa., did just that when it acquired the diabetes education department from its hospital affiliate two years ago.

By tying together patient education with diabetes equipment and supplies, the company realized it could improve service to patients, establish a reputation in the community and broaden its referral base.

While management understood that diabetes classes and other education services are not a usual fit for an HME, the acquisition rounded out the company’s diabetes business, explains Kathy Dubowski, GLHHS president. “It made sense to put it all together. It kept diabetes education viable in the community and allowed us to take the education component — particularly the education related to insulin pumps — and expand into the region.”

Strengthening the Service Line

As an affiliate of Hamot Health Foundation, an Erie-based health care system, GLHHS provides HME, home infusion and respiratory therapies, orthotics and prosthetics and private duty nursing services. Over the past few years, the company has begun several new programs — including the formation of a nutrition support team — to enhance existing services and further grow specialized business.

As far back as 1996, GLHHS had developed an HME niche through the sale and service of diabetic supplies. But with new technology designed for diabetics being released at a rapid pace, the provider found its patients had an increasing number of questions and concerns. To address them, the company added customer service representatives with special training in diabetes technology to existing “traditional” staff in its retail showroom. The new CSRs became responsible for the full line of diabetes-related products.

While this was not really a major innovation, says Dubowski, “what makes GLHHS unique is that during a time when many DME companies were abandoning the diabetes product line altogether due to low reimbursements, GLHHS elected to strengthen this service line even further.”

In 2003, the opportunity to acquire the diabetes education department came up. The hospital affiliate was seriously considering eliminating the department — a potential problem for GLHHS, which routinely relied on it for diabetes-related referrals. Comprised of seven nurse- and dietitian-certified diabetes educators, the department was a mainstay for diabetes education in the area and had a strong community presence.

GLHHS knew a good deal when they saw one.

“We knew from the beginning that providing education and technology under one roof would ensure our patients retained a much needed resource and also sell products,” Dubowski says, adding that if GLHHS had not taken over the program, it might have disappeared altogether.

“It would have been a horrible thing for the community to lose this resource,” she continues. “If someone’s not educated in diabetes, that’s Step One for someone to fail with his or her disease.”

By the end of the year, the Great Lakes Diabetes Institute was created, integrating diabetes education into the company’s product service line — blending two very different services with the common goal of serving patients, according to Diane Harbaugh, Institute manager.

One of the main goals with the education component was to increase the referral base for diabetes equipment and supplies. The staff at the Institute became experts in insulin pump products, working with patients from intake and insurance authorization to ordering and education — and sales showed a significant increase from prior years.

Another goal was to expand the service line regionally. The company was the only major HME in the region to offer insulin pumps, blood glucose monitors and supplies, so expansion was relatively easy. “The tricky part was that we didn’t want to step on the toes of other regional diabetes educators by offering education services,” Harbaugh explains, “because we still relied on them for referrals of insulin pumps and other supplies.”

Instead, the Institute now contracts with established diabetes educators in outlying areas to do insulin pump training. The company doesn’t have to add staff, and “in these rural areas, people who may not have gotten an insulin pump because they didn’t want to travel can receive training,” Harbaugh says.

Getting with the Program

The Institute also provides a wide range of educational programs, including a support group for children.

“Sometimes kids are treated like small adults [with diabetes], which is not true,” Harbaugh says.

One of the ways the Institute caters to young patients is by coordinating a summer camp for children ages 8 to 16 with — and without — diabetes. The YMCA sub-camp, which is owned by an Erie endocrinology practice and supported by the Erie County Diabetes Association, provides dietitians, physicians and nurses.

“The premise is that life is a blending of people with and without diabetes,” Harbaugh explains. “We promote an understanding of diabetes among kids their own age. Kids who don’t have diabetes learn that kids [with diabetes] are just as healthy.”

Traditional support groups and classes for adults with diabetes are offered during and after regular work hours. “We’re seeing a growing number of working people in their 30s who have diabetes, and who we have to accommodate by providing evening and weekend classes,” Harbaugh says.

The Institute also sponsors an annual Diabetes Expo. Last year, the third for the free event, 1,500 visitors showed up to receive information about “anything to do with diabetes, whether education on products or foot care, [and to hear] local physicians talk about some aspect of diabetes,” Harbaugh says.

New nurse hires from a local hospital also can receive contact hours through the Pennsylvania State Nurses Association for attending the all-day expo.

Fitting the Patient, not the Payer

Equally as beneficial as providing patient education, according to Dubowski and Harbaugh, is the Institute’s ability to test, recommend and provide new products to customers with diabetes.

“We can turn the clinical perspective into a focus on a device or piece of DME,” Harbaugh explains. “Some suppliers may look at if or how well a product is reimbursed, or how well the product is marketed and promoted by the manufacturer, rather than considering if it is something that would benefit this population of people, regardless of age or type of diabetes.”

Because they research all available products, Harbaugh’s staff not only can educate patients on the products prescribed by their physicians but also can educate physicians on the products available for their patients.

“We do the [product] research so the patient doesn’t have to. We provide technicians or clinicians to explain the technology or, if we can’t, we find someone who can,” Dubowski adds.

One popular new product is a manual pump device for erectile dysfunction, a common side effect of diabetes in men. Because many diabetic men are medically unable to take the popular pharmaceuticals developed to treat erectile dysfunction, the pump presents a viable alternative. However, the sensitive nature of the condition has long made these products virtually invisible in the medical equipment community.

“One of the questions the clinicians ask is, ‘Do you have sexual problems?’ because that’s a significant issue,” Harbaugh says. “Many times, no one asks this question … and by the time a patient is referred to a urologist, he has probably had the problem for a long time.”

Another popular product — assessed, recommended and demonstrated by the Institute’s clinicians — is a non-invasive nighttime aid that tests for low blood glucose levels by monitoring body temperature and perspiration, the hallmarks of hypoglycemia.

As a clinician, Harbaugh says, “I can say I want to carry this product. The challenge is that it is not covered by insurance — there’s always a lag time between product availability and [insurance] coverage. But people are willing to pay for a device that can alert them to low blood sugar before they require more aggressive treatment, such as an ambulance or glucose kit.”

Of course, increased sales in diabetes products can generate sales of related items in the company’s traditional DME lines. “Diabetes sales in the traditional showroom lead customers into coming in to see other products; it’s a natural expansion in that regard,” Dubowski says. “Customers can see and look and touch and feel and pick the products up, as well as talk to clinicians about the equipment.”

“We pride ourselves on having excellence in education and technology,” Harbaugh says, adding that through the Institute, patients with diabetes as well as medical professionals now have one resource in the community they can count on for help in managing the disease.

With education, patients and their families can make decisions on what may best fit their lifestyle, and the Institute has become a trusted source of information, Harbaugh continues. “One of our most challenging and creative insulin pump cases involved the placement of a pump on a 19-month old child,” Harbaugh recalls. “After gaining the trust of those parents, the rest seems easy,” she says.

November Is National Diabetes Month

There are 20.8 million people in the United States, or 7 percent of the population, who have diabetes. While an estimated 14.6 million have been diagnosed, unfortunately, 6.2 million people (or nearly one-third) are unaware that they have the disease.

In 2005 alone, an estimated 1.5 million people aged 20 years or older will be newly diagnosed with diabetes.

For more information, including prevention, research, advocacy, community programs and local events, visit the American Diabetes Association at www.diabetes.org.