Transcript THE ASHEVILLE PROJECT - Canadian Healthcare Network

COMMUNITY-BASED CASE
MANAGEMENT OF HIGH RISK
POPULATIONS
DECREASES HEALTHCARE COSTS
THE ASHEVILLE EXPERIENCE
Barry A. Bunting, Pharm.D.
Clinical Manager of Pharmacy Services
Mission Hospitals
Asheville, NC
([email protected])
THE HJ
PKKKHHROJECT
“ASHEVILLE PROJECT”
STATUS
>1100 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).
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
EMPLOYER/HEALTH PLAN
COMMITMENT

Notifies employees a wellness program is available to them for
diabetes, 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.
PATIENT’S
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.
COMMUNITY PHARMACIST’S &
EDUCATOR’S COMMITMENT

Receive certificate training.

Counsel patients as frequently as 1x/mo. face-to-face.

Monitors adherence/side effects/adverse events/non-Rx meds.
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Assesses comprehension/application of self-care instruction.

Helps patients set/achieve goals.

Coaching: Praise ‘em when they are doing well, pester ‘em
when they aren’t. 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.
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.
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Patients are regularly assessed, monitored, and - - -

Changes recommended when Tx plan isn’t working.
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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.
SIMILAR PROGRAMS

OHIO

INDIANA

GEORGIA

TENNESSEE

WISCONSIN

WEST VIRGINIA

NORTH CAROLINA

Michigan, Oregon, Hawaii, Pennsylvania implementing
SIGNIFICANT OUTCOMES

Net decrease in total health care costs avg. >$2000/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 4:1

Approximately 10% of employees are enrolled in a disease
management program
SIGNIFICANT OUTCOMES

80% of people with diabetes are enrolled

No diabetes program participant on dialysis in 8 years of program
(1227 patient-years)

Mission’s total health plan costs rose only 0.1% in 2004 and
decreased 1% in 2005

Mission & City of Asheville have saved >$6 million in 8 yrs
THE CHALLENGE
DOES IT COST LESS TO
KEEP PEOPLE WELL THAN
IT DOES TO FIX THEM
WHEN THEY BREAK?