john miall risk manager city of asheville, nc asheville diabetes disease management project
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