COMMUNITY-BASED CASE COMMUNITY-BASED CASE MANAGEMENT OF HIGH RISK MANAGEMENT OF HIGH RISK

POPULATIONSPOPULATIONSDECREASES HEALTHCARE COSTSDECREASES HEALTHCARE COSTS

THE ASHEVILLE EXPERIENCE

Barry A. Bunting, Pharm.D.

Clinical Manager of Pharmacy Services

Mission Hospitals

Asheville, NC

(barry.bunting@msj.org)

THE HJ THE HJ PKKKHHROJECTPKKKHHROJECT

““ASHEVILLE ASHEVILLE PROJECT” STATUSPROJECT” 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: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 EMPLOYER/HEALTH PLANPLAN

COMMITMENTCOMMITMENT 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 PATIENT’S COMMITMENTCOMMITMENT

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 COMMUNITY PHARMACIST’S & &

EDUCATOR’S COMMITMENTEDUCATOR’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.

EACH PLAYER DOES EACH PLAYER DOES WHAT THEY ARE GOOD WHAT THEY ARE GOOD

ATAT 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.

SIMILAR PROGRAMS

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

SIGNIFICANT OUTCOMESSIGNIFICANT 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 OUTCOMESSIGNIFICANT 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

THETHE CHALLENGE CHALLENGE

DOES IT COST LESS TO DOES IT COST LESS TO KEEP PEOPLE WELL KEEP PEOPLE WELL

THAN IT DOES TO FIX THAN IT DOES TO FIX THEM WHEN THEY THEM WHEN THEY

BREAK?BREAK?