Project aims to better participants' lifestyles

Under the Asheville Project model, employers elect to waive copayments and deductibles for the cost of prescription drugs and related monitoring devices such as glucose meters for plan members who agree to receive periodic counseling from pharmacists trained to advise diabetes patients.

In addition to absorbing the costs of the drugs and devices, the employer pays an hourly fee to the pharmacists, which averages between $2 and $3 per minute. Initial counseling visits average 60 minutes, while subsequent appointments usually take about 30 minutes. Although patients are required to meet with their assigned pharmacist-counselors only once every three months, visits typically average 7.2 per patient per year.

The cost of prescription drugs for employers will double after the first year, but savings are produced almost immediately by reducing or eliminating the occurrence of expensive complications that stem from uncontrolled diabetes such as increased hospitalizations, kidney dialysis and lower limb amputations. Annual net savings average between $1,600 and $3,200 per participant.

"Initially they (participants) enroll to save money. They stay because somebody is actually coaching them," said Barry Bunting, clinical manager in the pharmacy department at Mission Health & Hospitals in Asheville, N.C. "Accountability is a huge part of it."

However, if participants fail to show up for their counseling appointments or decide to drop out of the program, their copayments return to normal levels.

But in addition to the accountability, "there's also a support mechanism so they can be successful," said Bill Ellis, president of the APhA Foundation in Washington.

The support is the counseling component, he explained.

"It's very labor-intensive," Mr. Ellis said.

The regular visits with pharmacists provide an opportunity for participants to ask questions, "the little things they forget to ask their doctors," Mr. Bunting said.

And because participants are seeing the same counselors each time, they develop a bond with the counselor, which fosters trust, he said.

"Most chronically ill people have tried different approaches before, but they were boot camp-type changes, eight weeks long, so they failed," said Gary Allen, executive director of the Hawaii Business Health Council in Honolulu, which has seven employer members using the model via the Diabetes Ten City Challenge.

"What we're trying now is a real simplistic way of getting the program across to them," he said. For example, instead of advising participants to "diet and exercise," the pharmacists "encourage movement and watching portions and to love themselves and realize why they're doing this. They have to move at their own pace. The individuals that make it their decision may make it a lifestyle. That's the vision and goal of the Asheville Project," Mr. Allen said.