Post on 05-Jan-2016
transcript
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