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The Asheville Program

The Asheville Program. It’s the System That Needs Care. Over half of all healthcare via managed care Largest increase in 6 years in costs It’s evolution not revolution Giving patients the resources to be well Buy VALUE Taiwanese healthcare system. UN -Managing Care.

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The Asheville Program

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  1. The Asheville Program

  2. It’s the System That Needs Care • Over half of all healthcarevia managed care • Largest increase in 6 yearsin costs • It’s evolution not revolution • Giving patients the resources tobe well • Buy VALUE • Taiwanese healthcare system

  3. 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

  4. 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.

  5. Patient Incentives and Care Model • Patient selection / recruitment • Patient education — Mission + St. Joseph’s 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)

  6. 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.”

  7. APPROPRIATE MEDICATION

  8. Clinical Outcomes:Avg. Glycosylated Hemoglobin HbA1c

  9. Direct Medical Costs Over Time11Cranor 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. 2003;43:173-84.

  10. Average Annual Diabetic Sick-Leave Usage (COA)

  11. Sick Leave Usage By Time In Program

  12. DIABETES IN WORK FORCE • Average of 1000 employees over 5 years • 60 to 100 diabetics expected • 32 = average annual percentage of workers with lost time injuries for 5 years • 1.97 to 3.2 = expected number of lost time injured workers in average year with diabetes

  13. CITY INDEMNITY INJURIES BY YEAR

  14. DIABETES MANAGEMENT INDEMNITY CASES

  15. Conclusions • Health care costs are driven by sick people • Employers must evaluate what they want out of their health plans in terms of performance and design benefits to achieve those goals • Employers benefit by lowering oreliminating barriers to care. • Physicians with patients in the programhave recognized the positive impact on care. • Collaboration plus innovation leads toreduced healthcare costs.

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