Taking Control of Your Health Using benefit design and collaborative practices to improve the health

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Taking 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
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Why 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.

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Patients 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

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A 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.

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What is the ROI for Employers?
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Total 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.

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Asheville Average Annual Diabetic Sick-Leave
Usage
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Asheville 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

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Chicago 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

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Diabetes 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.

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MBGH 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

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Requirements 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

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Requirements 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

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Role 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

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Role 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.

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For more information

• Contact Jessica Westhoff, Director of Projects
  Communications
• 888-944-9090
• jwesthoff_at_mbgh.org
• www.mbgh.org