1. COMMUNITY-BASED CASE MANAGEMENT OF HIGH RISK POPULATIONS DECREASES HEALTHCARE COSTS THE ASHEVILLE EXPERIENCE Barry A. Bunting, Pharm.D. Clinical Manager of Pharmacy Services Mission Hospitals Asheville, NC (barry.bunting@msj.org)

2. THE HJ PKKKHHROJECT

3. “ASHEVILLE PROJECT” 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).

4. MODEL SUMMARY: X INTENSE SELF-CARE EDUCATION IS PROVIDED X FREQUENT FACE-TO-FACE FOLLOW-UP BY A PERSONAL HEALTH “COACH” (specially trained community pharmacists/educators) X FINANCIAL INCENTIVES TO ENCOURAGE PATIENT PARTICIPATION

5. EMPLOYER/HEALTH PLAN COMMITMENT X Notifies employees a wellness program is available to them for diabetes, asthma, hypertension, high cholesterol. X 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”. X Agrees to pay for the self-care classes & coaching sessions.

6. PATIENT’S COMMITMENT X Agrees to attend self-care education classes specific for their disease(s). X Goes to a pharmacist they choose from a list of participating pharmacies/pharmacists. X Meets with a program pharmacist or educator 1x/month for 20-30 minutes.

7. COMMUNITY PHARMACIST’S & EDUCATOR’S COMMITMENT X Receive certificate training. X Counsel patients as frequently as 1x/mo. face-to-face. X Monitors adherence/side effects/adverse events/non-Rx meds. X Assesses comprehension/application of self-care instruction. X Helps patients set/achieve goals. X Coaching: Praise ‘em when they are doing well, pester ‘em when they aren’t. ACCOUNTABILITY!!!! X Assesses efficacy of treatment (download meters, check blood pressures, foot exams). X Communicates encounter findings/recommendations to physician. X Refers patient to their physician when indicated.

8. EACH PLAYER DOES WHAT THEY ARE GOOD AT X Physicians diagnose and implement treatment plans. X Educators educate. X Patients are coached to comply with treatment plan. X Patients self-manage 24hrs a day. X Patients are regularly assessed, monitored, and - - - X Changes recommended when Tx plan isn’t working. X Patients have convenient access to expert personal health coach. X Employers encourage participation by providing incentives. X Medications are taken as prescribed, more effectively and safely (people actually take their medications). X Uses resources already available in the community.

9. SIMILAR PROGRAMS X OHIO X INDIANA X GEORGIA X TENNESSEE X WISCONSIN X WEST VIRGINIA X NORTH CAROLINA X Michigan, Oregon, Hawaii, Pennsylvania implementing

10. SIGNIFICANT OUTCOMES X Net decrease in total health care costs avg. >$2000/pt/yr (diabetes) X Net decrease in total health care costs avg. $ 725/pt/yr (asthma) X Diabetes: missed work hours decreased by 50% X Asthma: missed work hours decreased by 400% X ROI (calculated by employer, diabetes) of 4:1 X Approximately 10% of employees are enrolled in a disease management program

11. SIGNIFICANT OUTCOMES X 80% of people with diabetes are enrolled X No diabetes program participant on dialysis in 8 years of program (1227 patient-years) X Mission’s total health plan costs rose only 0.1% in 2004 and decreased 1% in 2005 X Mission & City of Asheville have saved >$6 million in 8 yrs

12. THE CHALLENGE

13. DOES IT COST LESS TO KEEP PEOPLE WELL THAN IT DOES TO FIX THEM WHEN THEY BREAK?