John MiallJohn MiallRisk ManagerRisk Manager

City of Asheville, NCCity of Asheville, NC

Asheville Diabetes Disease Management Project

The Asheville ProjectThe Asheville Project

Diabetes-Related ComorbiditiesDiabetes-Related Comorbidities

2–4 times greater risk of heart disease2–4 times greater risk of heart disease 60–65% have hypertension60–65% have hypertension 2–4 times greater risk of stroke2–4 times greater risk of stroke 60–70% have some degree of nervous60–70% have some degree of nervous

system damagesystem damage Leading cause of adult blindnessLeading cause of adult blindness Leading cause of ESRD* (40% new cases)Leading cause of ESRD* (40% new cases) >50% lower limb amputations>50% lower limb amputations

* End-Stage Renal Disease

Diabetes-Related Indirect CostsDiabetes-Related Indirect Costs

8.3 sick-leave days annually8.3 sick-leave days annually

1.7 sick-leave days for employees without 1.7 sick-leave days for employees without diabetesdiabetes

$47 billion in productivity forgone due to $47 billion in productivity forgone due to disability, absence, and premature mortalitydisability, absence, and premature mortality

Patient Incentives and Care ModelPatient Incentives and Care Model

Patient selection / recruitmentPatient selection / recruitment Patient education — Mission + St. Joseph’s Patient education — Mission + St. Joseph’s

Diabetes CenterDiabetes Center Matching patients to pharmacistsMatching patients to pharmacists Incentives:Incentives:

– PBM* co-pay waiversPBM* co-pay waivers– Labs without co-paysLabs without co-pays– Glucose metersGlucose meters

The operative word in pharmaceutical care is The operative word in pharmaceutical care is ““carecare” (Madge testimonial)” (Madge testimonial)

*Pharmacy Benefit Manager

How They Do ItHow They Do It

““Patient making better food choice. Blood glucosePatient making better food choice. Blood glucosemuch improved. 2 x 1.5c cm wound RLE. Referredmuch improved. 2 x 1.5c cm wound RLE. Referredto physician for evaluation and therapy.”to physician for evaluation and therapy.”

HbA1c

Clinical Outcomes:Clinical Outcomes:Avg. Glycosylated HemoglobinAvg. Glycosylated Hemoglobin

7.607.00

6.206.8 6.7 6.98 6.7

0.001.002.003.004.005.006.007.008.009.00

Basel

ine

8 M

onths

14 M

onths

24 M

onths

42 M

onths

48 M

onths

60 m

onths

City of Asheville Medical City of Asheville Medical CostsCosts

4651

3902

4,5355,021

3,554

6,127

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Base

line

14 M

onth

s

24 M

onth

s

36 M

onth

s

48 M

onth

s

60 m

onth

s

Ave

rage

ann

ual a

ggre

gate

med

ical

cla

ims

*including prescription drugs for diabetes

City of Asheville Diabetes City of Asheville Diabetes Sick-Leave UsageSick-Leave Usage

6.00 5.68 5.81 5.67

8.46

12.60

0

2

4

6

8

10

12

14

Sic

k le

ave

days

Sick Leave Usage By Time In Sick Leave Usage By Time In Program Program

11

6.25.6

8.47.6

3.9

0

2

4

6

8

10

12

Baseline 1 Year 2 Years 3 Years 4 Years 5 Years

Sic

k le

ave

days

QUALITY OF LIFEQUALITY OF LIFE

0%10%20%30%40%50%60%70%80%90%

Baseline At 14 Months into programSource: SF-36

Form

Frequency/Severity MatrixFrequency/Severity Matrix

High FrequencyHigh FrequencyLow SeverityLow Severity

High FrequencyHigh FrequencyHigh SeverityHigh Severity

Low FrequencyLow FrequencyLow SeverityLow Severity

Low FrequencyLow FrequencyHigh SeverityHigh Severity

Severity Severity

Fre

qu

ency

Fre

qu

ency