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Pioneering diabetes management effort grows

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ASHEVILLE, N.C.—As the Asheville Project celebrates its 10th anniversary, the innovative diabetes disease management program is being reproduced across the country.

So far, at least 80 employers in 20 locations are using the Asheville Project model, which was developed by the University of North Carolina, the North Carolina Pharmacist Assn. and the city of Asheville, N.C., and was first implemented in 1997 using employees and dependents of the city and Mission Health & Hospitals, the region's largest health care provider (BI, Aug. 15, 2005).

The Asheville Project, developed to produce significant savings for participating employers, provides employees with formal diabetes education and individualized counseling by trained pharmacists in diabetes management. In addition, the program waives employee copayments on all diabetes-related medications and supplies as long as they continue to receive counseling (see story, page 19).

The Asheville model also is the basis of the Diabetes Ten City Challenge, which was launched in 2005 and recently expanded into the Chicago metropolitan area by adding employer participants Pactiv Corp. of Lake Forest, Ill., the city of Naperville and the Jewish Federation of Metropolitan Chicago (BI, April 16).

In the first five years after implementation, the city of Asheville and Mission Health saw the average cost of care for diabetic plan members fall by an average of $2,000 per patient per year, and they had savings approaching $3,000 per patient in 2006 and are expecting similar savings this year, according to Barry Bunting, clinical manager in the pharmacy department at the hospital. The hospital is the area's largest employer, providing health care coverage to some 10,000 employees and their dependents, 350 of whom are participants in the Asheville Project.

Other employers across the country that have followed Asheville's lead also are reporting reductions in the cost of care for diabetes patients (see related story).

Moreover, the reduction in the cost of treating plan members with diabetes has had an overall dampening effect on the rate of increase in Mission Health's total health care costs over the past three years, according to Mr. Bunting.

Those costs, which total about $30 million annually, grew by only one-tenth of 1% between 2003 and 2004. In 2005, costs fell by 1%, and in 2006, the hospital's health care costs fell another 3%, Mr. Bunting said.

While such reductions are definitely an aberration at a time when the average cost of health benefits is growing at double-digit rates for many employers, they are definitely an anomaly for a hospital, whose health care utilization is typically higher than the average employer's, Mr. Bunting pointed out.

The reason Asheville started with diabetes was because it is the most costly chronic disease for employers, said Dan Garrett, one of the founders of the Asheville Project and now senior director of medication adherence programs at the APhA Foundation, a nonprofit organization affiliated with the American Pharmacists Assn. The Washington-based APhA joined the Asheville Project in 2002.

The American Diabetes Assn. estimates that diabetes, a chronic disease that afflicts more than 20 million Americans--7% of the U.S. population--costs employers more than $132 billion annually in both direct and indirect costs of emergency room visits, expensive and extended hospitalizations, disability insurance costs, absenteeism and lost worker productivity. People with diabetes typically have medical expenditures 2.4 times higher than those who do not have the disease.

Diabetes also is a condition that can be easily monitored, according to Alan Christianson, benefit and health services administrator at Mohawk Industries Inc., which implemented the Asheville Project model at its Dublin, Ga., plant five years ago. He spoke during an April 18 webinar sponsored by the Scottsdale, Ariz.-based Pharmacy Benefit Management Institute Inc. titled "Beyond the Asheville Project."

"Diabetes has tangible scores that can be used to determine progress," he said, referring to the results of the Hemoglobin A1C test, which measures blood glucose levels. The ADA recommends that A1C results be 7.0 or less.

Because of its consistent success in reducing diabetes-related health care costs for employers in the various venues in which it has been used, the Asheville diabetes model is now being applied to managing other chronic conditions including cardiovascular disease, asthma and depression. Currently more than 1,500 patients from 10 Asheville area employers are enrolled for diabetes, asthma, hypertension, lipid therapy management and depression, according to Mr. Garrett.

In addition to expanding the Asheville Project to other conditions, the APhA has taken it "on the road" as a program called HealthMapRx, which is being used by 80 employers and include the Diabetes Ten City Challenge participants.

"If it works in Asheville...there's no reason it won't work in any community," said Nancy Kennedy, executive director of the Northwest Georgia Healthcare Partnership, a coalition whose employer members implemented the Asheville Project model last year as part of the Diabetes Ten City Challenge after hearing about Mohawk's success. Ms. Kennedy also spoke at the webinar last week.

"Mohawk was planning its three-year celebration when we heard about the Ten City Challenge," Ms. Kennedy said. "Within 48 hours, we had four employers willing to participate."

Even though the Asheville Project model produces demonstrable results, it's not always an easy sell to employers since it does cost them money up front, said Gary Allen, executive director of the Hawaii Business Health Council in Honolulu, which has seven members participating in the Diabetes Ten City Challenge.

"But when you present a solution that has worked in other markets, they're more willing to try it," Mr. Allen said.

The Asheville Project model also is ideal for employers with large union populations since it does not involve increased cost-shifting, something anathema to organized labor, according to Bill Hembree, director of the Health Research Institute in Concord, Calif., who is talking with some labor groups in the Midwest about possibly implementing the model.

"This model can transfer to other locations, to other disease states, and the scaling of the model in the Ten City Challenge is an indication it has no limits," said John Miall, a consultant and former risk manager for the city of Asheville who was a member of the team that developed the original Asheville Project model.