COMMUNITY-BASED 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@msj.org)

2. THE HJ PKKKHHROJECT

3. “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).

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. 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.

7. 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. 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.

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 isn’t 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 • Netdecrease in total health care costs avg. >$2000/pt/yr (diabetes) • Netdecrease 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

11. 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 anddecreased 1% in 2005 • Mission & City of Asheville have saved >$6 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?