Seeking an alternative for patient education, diabetes coaching company, Fit4D, has created Pathways, a B2B solution used to help people with diabetes become empowered by answering specific questions, and getting them to adhere to their management and lower their A1cs. One of the program’s developers, Joanne Rinker, MS, RD, CDE explains how this can be applied and scaled upwards to help a greater number of people.  

By: John Parkinson, Clinical Content Coordinator,

To understand the development of Fit4D’s Pathways program is to take a glimpse of some separate but ongoing trends related to healthcare. 

Everywhere you look, companies are interested in their employees’ health. One of the areas within the healthcare spectrum companies are beginning to explore is chronic disease. Employers realize there are constant, static ongoing costs for diseases like diabetes with medicines and supplies, as well as potentially avoidable long-term costs associated with comorbidities.

They realize that they can cut costs, help their employees’ morale if they are healthier, and increase productivity too.  

Separately, but related to this trend, has been the development of diabetes coaching as an alternative to traditional diabetes education. Diabetes coaching company Fit4D was founded with the idea of helping individuals become healthier by counseling them on their diabetes management and aiding them in achieving their athletic goals. 

Along the way, Fit4D developed relationships with pharmaceutical companies and healthcare insurers and heard from them about the need for more diabetes management education and that they wanted to further leverage their relationship with their customers. 

Understanding these ongoing healthcare trends, Fit4D created Pathways. It’s a turnkey, online program that guides users through a portal by first asking them questions and then offering solutions based upon peoples` answers. The program also provides individualized service for those who are looking to connect with a diabetes coach through Fit4D.

Shepherding the program is one of its developers, Fit4D’s Joanne Rinker (pictured above). In addition to helping write this unique program, Rinker won the 2013 AADE Diabetes Educator of the Year Award in August at their annual conference in Indianapolis, Ind. Rinker is enthusiastic about Pathways as it gets to the heart of the needs of individuals with diabetes with the added benefit that the program can be delivered to larger groups of people, saving resources in the process. spoke with Rinker about how Pathways works, the program’s goals, and how it can be tailored to help individuals overcome their diabetes challenges. How did you become involved with Fit4D?

Rinker: After I had been working for about five years, I had my first child. I scaled back to part-time at my last job, and I decided to look for a contractor position. I found Fit4D and I really liked the concept of people being able to access a diabetes educator on a patient’s schedule, versus a patient having to figure out a schedule that suited the healthcare practitioner. People work 9 to 5, and that is usually the same schedule for when the doctor’s office is open, so patients have to figure out when they can take time away from work, which can be a hassle. With Fit4D, we say let’s figure out a time to talk that fits your schedule. We can set up a time to talk by phone, through e-mail, or we can even do webinars or Skype. Can you define the differences between a diabetes coach versus a diabetes educator?

Rinker: As a Fit4D coach, the role is different because there is an opportunity for more ongoing interaction. A patient may tell me they want to focus on one particular aspect of their management. If so, we can try working on the one specific thing, and then discuss blood sugars afterwards. Patients can e-mail me throughout the week and we can see how they are doing. We can then tweak things before we talk again the next week. 

A diabetes educator, on the other hand, has to teach the whole disease first. You are teaching people about monitoring, exercise, diet, and medication. And you are somewhat limited in the process when patients are “coming in for diabetes education.” You are covering all of the content areas rather than the area that the patient wants to focus on most. You are limited by what is billable and what is allowed by your insurance company. Of course most diabetes educators, including myself, will tell you that just because you can’t bill for it, doesn’t mean you aren’t going to cover it with your patients. Often, patients need a lot more time than the 10 billable hours. The beauty of diabetes coaching is that there is a lot more time for continued interaction. You helped develop the Pathways initiative. Can you provide an overview of what it is?

Rinker: Pathways is about finding out what is troubling people about their diabetes. The beauty of Pathways is that it allows us to help a patient with the information they need when they need it. It’s amazing how patients will have a specific question in mind that they really need an answer to. Maybe it’s confusion about the numerous medications that they take. Maybe they have been told they need to exercise and don’t like to or don’t have time to do it.

Since everyone with diabetes is on a different journey, Pathways has hundreds of different paths to accommodate different needs, profiles, etc. The Pathways program leads them, based on their responses, to the information they need.

If their biggest concern is what to eat, then that is where we help them first. We set them up with a meal plan, carb counting, and make up their plates at breakfast, lunch, and dinner.

Once they feel more comfortable with that element, we can then move onto the next thing they need help with. It’s guiding them to the information they need, when they need it. Rather than the generic making sure everybody knows about medications, monitoring, meal planning and exercise. For people who are already informed about their medications, they don’t need to sit through a lecture about this aspect of diabetes management. Is Pathways a supplement to the ongoing diabetes coaching offered by Fit4D? 

Rinker: We are not replacing coaching. This is a program that we offer on a business to business level. If there is a company that makes a meter, for example, and they want to couple their meter with education, they could provide Pathways as a ways to improve their customers’ outcomes.

The difference with Pathways is that people can be guided to different webinars or educational tools versus a regular coaching session. When you say business to business, are you looking at companies that have a diabetes connection or can they be any company?

Rinker: It can be anyone. However, companies that create meters or pharmaceutical companies who manufacture diabetes medicines are looking to develop ways for patient adherence and management and that is who we have been working with thus far.

Insurance companies are another good fit, as they are looking at costs and how patients are spending their monies.

It is not only about cutting costs, but helping patients adhere to their medicines and improving their outcomes. It is a combination of those things. It is amazing how much of an improvement a patient will make when he or she is getting specific questions answered and the topics and information they are being given is what they want to know. How does a person with diabetes or interested companies sign up for Pathways?

Rinker: People can first start with their meter company or their pharmaceutical company. Check out their website and see if they have the Pathways service. Additionally, companies can go to our website and see a demo of Pathways. 
We can show them the outcomes and the benefits of using the program. We use a customer relationship management (CRM) system that we can run reports from for companies to see results. They can see the ins and outs and see the portal and what a patient would see. They can also view sample webinars.

If a company is interested, there is a way through the website to contact us, and we can set something up to talk further with them. Do the Pathways personnel coordinate care with primary care providers?

Rinker: While we are learning a lot about them and their diabetes, there are a couple of things we cannot do. We cannot make changes to their medication and we cannot give them referrals to other providers. It is something their primary care provider (PCP) would need to do. We do not have that direct contact care with them. We can, however, recognize when there is a need and encourage them to call their PCP or schedule an appointment. if someone does need a medication adjustment or a follow-up to a social worker for a mental health referral, how do you handle those situations?

Rinker: You would encourage them to contact their provider and explain your reasons for it. Maybe they are a good candidate for insulin and it might be a matter of making them comfortable with that thought.

You might say something along the lines of, `although you are making efforts, your diabetes may have progressed. You do need to see your primary care provider; be open to his suggestions.’ 

Help them to understand that insulin is not equated to failure—because a lot of diabetes patients think that—but maybe their diabetes has progressed to that point.

Make them understand we are lucky to have insulin. While they may have a fear of needles or they are uncomfortable giving themselves shots, explain to them that technology has come a long way and we now have insulin pens with very small needles to decrease pain. Again, we would encourage them to talk to their PCP but also let them know that we are there for them.
How do you handle support?  Does a patient get one coach or is it a team approach where a patient works with a few different coaches?

Rinker: If the person’s question is unique or the person needs some one-on-one guidance, they can send an e-mail or request a phone call. If they want a phone call, they would include the day and time they want the Fit4D diabetes coach to call them. The person would get an e-mail back telling them who their coach is—if that hasn’t been established already—and a confirmation of the date and time they would call. So, if I’m a Pathways client, I would go to the Pathways portal, log in my information, and go through the Pathways portal. How do patients identify problems with self management?

Rinker: Because they know themselves the best, we try to pinpoint what we can help them with. We want to try to pinpoint what is their specific struggle. Is it too much stress? is it diet? What is bugging them the most? Or, what are they weakest at? This is where we start. Of course that doesn’t mean we don’t cover other areas.

Sometimes when you handle one thing, you may have other topics that still need to be addressed. Once we can help them get through a problem you can see the difference in how they feel and respond. They can have this Ah Ha moment and that can really help their blood sugars. What are the big picture goals for Pathways?

Rinker: The biggest goals we have for Pathways are patient adherence, lowering their A1cs to prevent complications, and to have them live with diabetes with a high quality-of-life.

To learn more about Pathways, interested readers can go here.