The Asheville Project

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The Asheville Project
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Its the System That Needs Care

• Over half of all healthcarevia managed care
• Largest increase in 6 yearsin costs
• Its evolution not revolution
• Giving patients the resources tobe well
• Buy VALUE
• Taiwanese healthcare system

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Frequency/Severity Matrix
Severity
High FrequencyLow Severity
High FrequencyHigh Severity
Frequency
Low FrequencyLow Severity
Low FrequencyHigh Severity
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UN-Managing Care

• Kaiser physicians know what things needto be
  done for diabetic patients, but dueto the
  constraints of modern medical practice they
  seldom have the time to do them.
• Managed Care News 1999 Apr.
• Ultimately, all care is managed by patients.
• Dan Garrett, Exec. Dir. NCAP

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Diabetes-Related Comorbidities

• 24 times greater risk of heart disease
• 6065 have hypertension
• 24 times greater risk of stroke
• 6070 have some degree of nervoussystem damage
• Leading cause of adult blindness
• Leading cause of ESRD (40 new cases)
• gt50 lower limb amputations

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Diabetes-Related Indirect Costs

• 8.3 sick-leave days annually
• 1.7 sick-leave days for employeeswithout
  diabetes
• 47 billion in productivity forgonedue to
  disability, absence, andpremature mortality

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In the Beginning

• Partnering with hospital system, NCAPh, NCCPC,
  UNC School of Pharmacy
• Invitation to all pharmacists in community
• Responses of independents vs. chains
• Two weekends (32 hours) of training by physicians
  and diabetes educators
• Compensation after results
• Fee schedule
• 2,400 first year, ongoing average of 48.02 per
  monthly visit through 2002.

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Patient Incentives and Care Model

• Patient selection / recruitment
• Patient education Mission St. Josephs
  Diabetes Center
• Matching patients to pharmacists
• Incentives
• PBM co-pay waivers
• Labs without co-pays
• Glucose meters
• The operative word in pharmaceutical care is
  care (Madge testimonial)

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How They Do It

• Patient making better food choice. Blood
  glucosemuch improved. 2 x 1.5c cm wound RLE.
  Referredto physician for evaluation and therapy.

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APPROPRIATE MEDICATION
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Clinical OutcomesAvg. Glycosylated Hemoglobin
HbA1c
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City of Asheville Medical Costs
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HEALTH CARE COSTS
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City of Asheville Diabetes
Sick-Leave Usage
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Sick Leave Usage By Time In Program
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QUALITY OF LIFE
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Conclusions

• Pharmacists have had the opportunity toserve on
  the frontline of patient care, andhave made a
  difference.
• Physicians with patients in the programhave
  recognized the positive impact on care.
• Collaboration plus innovation leads toreduced
  healthcare costs.
• Employers benefit by lowering oreliminating
  barriers to care.