COMMUNITYBASED CASE MANAGEMENT OF HIGH RISK POPULATIONS DECREASES HEALTHCARE COSTS

1
COMMUNITY-BASED CASE MANAGEMENT OF HIGH RISK
POPULATIONSDECREASES HEALTHCARE COSTS

• THE ASHEVILLE EXPERIENCE
• Barry A. Bunting, Pharm.D.
• Clinical Manager of Pharmacy Services
• Mission Hospitals
• Asheville, NC
• (barry.bunting_at_msj.org)

2
THE HJ PKKKHHROJECT
3
ASHEVILLE PROJECT STATUS

• gt1100 PEOPLE WITH CHRONIC DISEASES INVOLVED IN
  EMPLOYER SPONSORED WELLNESS PROGRAMS.
• DIABETES, ASTHMA, BLOOD PRESSURE AND CHOLESTEROL.
• FOR SEVEN SELF-INSURED EMPLOYERS (12,000 COVERED
  LIVES).

4
MODEL SUMMARY

• INTENSE SELF-CARE EDUCATION IS PROVIDED
• FREQUENT FACE-TO-FACE FOLLOW-UP BY A PERSONAL
  HEALTH COACH (specially trained community
  pharmacists/educators)
• FINANCIAL INCENTIVES TO ENCOURAGE PATIENT
  PARTICIPATION

5
EMPLOYER/HEALTH PLANCOMMITMENT

• Notifies employees a wellness program is
  available to them fordiabetes, asthma,
  hypertension, high cholesterol.
• Agrees to significantly reduce co-pays for
  disease related medications for patients who take
  disease specific classes and meet regularly with
  their health care coach.
• Agrees to pay for the self-care classes
  coaching sessions.

6
PATIENTS COMMITMENT

• Agrees to attend self-care education classes
  specific for their disease(s).
• Goes to a pharmacist they choose from a list of
  participating pharmacies/pharmacists.
• Meets with a program pharmacist or educator
  1x/month for 20-30 minutes.

7
COMMUNITY PHARMACISTS EDUCATORS COMMITMENT

• Receive certificate training.
• Counsel patients as frequently as 1x/mo.
  face-to-face.
• Monitors adherence/side effects/adverse
  events/non-Rx meds.
• Assesses comprehension/application of self-care
  instruction.
• Helps patients set/achieve goals.
• Coaching Praise em when they are doing well,
  pester em when they arent.
  ACCOUNTABILITY!!!!
• Assesses efficacy of treatment (download meters,
  check blood pressures, foot exams).
• Communicates encounter findings/recommendations
  to physician.
• Refers patient to their physician when
  indicated.

8
EACH PLAYER DOES WHAT THEY ARE GOOD AT

• Physicians diagnose and implement treatment
  plans.
• Educators educate.
• Patients are coached to comply with treatment
  plan.
• Patients self-manage 24hrs a day.
• Patients are regularly assessed, monitored, and
  - - -
• Changes recommended when Tx plan isnt working.
• Patients have convenient access to expert
  personal health coach.
• Employers encourage participation by providing
  incentives.
• Medications are taken as prescribed, more
  effectively and safely (people actually take
  their medications).
• Uses resources already available in the
  community.

9
SIMILAR PROGRAMS

• OHIO
• INDIANA
• GEORGIA
• TENNESSEE
• WISCONSIN
• WEST VIRGINIA
• NORTH CAROLINA
• Michigan, Oregon, Hawaii, Pennsylvania
  implementing

10
SIGNIFICANT OUTCOMES

• Net decrease in total health care costs avg.
  gt2000/pt/yr (diabetes)
• Net decrease in total health care costs avg.
  725/pt/yr (asthma)
• Diabetes missed work hours decreased by 50
• Asthma missed work hours decreased by 400
• ROI (calculated by employer, diabetes) of 41
• Approximately 10 of employees are enrolled in a
  disease management program

11
SIGNIFICANT OUTCOMES

• 80 of people with diabetes are enrolled
• No diabetes program participant on dialysis in 8
  years of program (1227 patient-years)
• Missions total health plan costs rose only 0.1
  in 2004 anddecreased 1 in 2005
• Mission City of Asheville have saved gt6
  million in 8 yrs

12
THE CHALLENGE
13
DOES IT COST LESS TO KEEP PEOPLE WELL THAN IT
DOES TO FIX THEM WHEN THEY BREAK?