Title: Taking Control of Your Health Using benefit design and collaborative practices to improve the health
1Taking Control of Your HealthUsing benefit
design and collaborative practices to improve the
health, while lowering costs, for diabetic
patients
Generous support for this project is being
provided by
2Why should employers address diabetes?
- For many employers, diabetes is the most costly
chronic disease in the workforce - Diabetes has negative effects on heart disease,
hypertension, stroke, nervous system damage,
adult blindness, ESRD and lower limb amputations - Major indirect costs
- 8.3 sick-leave days annually
- 1.7 sick-leave days for employees without
diabetes - 47 billion in productivity forgone due to
disability, absence, and premature mortality - It is one of the few conditions that you can see
reduced costs and improved health in less than 12
months.
3Patients own this disease
- For many patients, they control whether they get
worse or better - Most problems caused by patients allowing
conditions to get worse - Not knowing how to reduce risks
- Not filling or staying on medications, due to
high co-pays - Not eating correctly
- Not being screened or counseled regularly, due to
minimal physician time at visits - Proper treatment, education and motivation of
patients could dramatically improve health
outcomes in short amount of time
4A project using value-based benefit design
collaborative care
- Objectives
- Decrease cost barriers to care
- Lowering or waiving medication and medical supply
costs for the most costly health services to
encourage their use. - Improve access to and coordination of care
- Utilizing specially trained pharmacists as
extension of physicians practice and disease
management programs, to increase the likelihood
of compliance to treatment, recommended
screenings, patient self-management and improved
health outcomes. - Slow growth rates
- Reduce unnecessary hospital emergency room
visits, surgeries and physician visits, as
employees manage own condition and their health
status improves. - Model can be applied to diabetes, asthma, cancer,
and depression.
5What is the ROI for Employers?
6Total Health Care Costs1
- 1Cranor CW, Bunting BA, Christensen DB. The
Asheville Project Long-term clinical and
economic outcomes of a community pharmacy
diabetes care program. J Am Pharm Assoc.
200343173-84.
7Asheville Average Annual Diabetic Sick-Leave
Usage
8Asheville Project ROI
- Diabetes decreased total health care costs avg.
2000/pt/yr. - Diabetes missed work hours cut 50
- ROI (calculated by employer) of 41
- No diabetes patient has gone on dialysis in 8
years of program (1227 patient-years) - Approximately 10 of employees enrolled in a
program (diabetes/asthma/htn/cholesterol) - Missions total health plan costs rose 0.1 from
2004-2005 - Over 6 million in health care cost savings over
8 years
9Chicago is Part of Diabetes 10 City Challenge
- Ten City Challenge is a nation project of the
American Pharmacists Association and
GlaxoSmithKline (GSK) - Taking Control of Your Health is the Chicago
site, coordinated by MBGH, funded by Novo Nordisk
and Novartis, in cooperation with the Illinois
Pharmacists Assoc. - Objectives
- Align incentives to promote motivated,
self-managed patients, leading to improved health
outcomes for people with diabetes - Demonstrate that benefit design can impact
behavior - Demonstrate that employer investment in pharmacy
services and reduced co-pays improves diabetes
control and cuts overall costs for chronic
disease workers and retirees
10Diabetes 10 City ChallengeParticipating Employers
- Charleston City of Charleston, Mt. Pleasant,
North Chas, CPW, Piggly Wiggly, Roper Hospital - Chicago City of Naperville, Jewish Federation of
Metropolitan Chicago, Jones Lang LaSalle, Pactiv
Corporation - Colorado Springs City of Colorado Springs
- Honolulu Quality Healthcare Alliance, Time
Supermarkets, Punahou School, Outrigger Resorts - Los Angeles University of Southern California
- Milwaukee City of Milwaukee
- Pittsburgh Heinz Westinghouse, Joy Global,
Carnegie Mellon, Transtar, DDI, Ellwood City
Forge, General Nutrition (WV OH) - Tampa Manatee County, Pinellas Sheriffs Dept.
11MBGH Providing leadership coordination
- Recruitment of employers
- Coordination of implementation for consistency
- Identify and acquire funding to support common
approaches - Development of common materials
- Assistance with enrollment
- Provision of screening materials and vendor
- Media relations
- User group of participating employers
- Communicating with employers, pharmacy network,
physicians and APhA - Negotiating rates with pharmacy network
- Reporting of results to community
- Assisting employers in replicating model in other
locations - Oversight of all activities
12Requirements for Employers
- Willingness to invest in diabetic employees
health to enhance QOL, reduce sick days and lower
hospitalization costs - Promote program, orient and enroll patients
- Capability to (or use a PBM) provide
reduced/waived co-pay prescription cards - Provide access to data from TPA to track total
health care costs for enrollees - Provide payment to pharmacist/CDE providers,
preferably via electronic payment
13Requirements for Patients
- Agree to meet with a qualified Pharmacist on an
ongoing basis for education, monitoring and set
personal goals for diabetes self-management - Works with pharmacists to complete knowledge and
skills assessments and receive training - Meet at least quarterly with a qualified
pharmacist to set self-management goals, have
scheduled tests and procedures to monitor
performance
14Role of Pharmacists
- Illinois Pharmacist Association serving as
Network Coordinator, recruiting, training and
monitoring pharmacists - Pharmacists must be a CDE or BCPS, or pass the
NISPC Diabetes exam, or have completed an ACPE
level Diabetes Certificate Training Program - Agree to have private consultation areas for
patient education or go to worksite for
counseling - Administer to patients the knowledge, skills and
performance assessments - Collaborate with local DECs and MDs
- Maintain documentation and report outcomes
- Pharmacists get paid for visits, screenings and
counseling
15Role of the Physician Diabetes Education
Centers (DEC)
- Physicians are responsible for overall care of
patient and changes in therapy - DEC is responsible for intensive education when
indicated - The PSMDiabetes program is complementary to
scheduled or referred physician and DEC visits - Physicians will receive summary reports after
each patient session with pharmacist/DEC - Physicians will be notified about the program by
the employer/payer when patient enroll - Data from the Asheville project indicate that
physician outpatient and DEC visits increase.
16For more information
- Contact Jessica Westhoff, Director of Projects
Communications - 888-944-9090
- jwesthoff_at_mbgh.org
- www.mbgh.org