Caren Kagan Evans
President and CEO
Senior Vice President
March 14, 2010
ASHEVILLE, N.C., SPAWNS A MOVEMENT WHILE IMPROVING THE HEALTH OF RESIDENTS
Pharmacists are qualified to do much more than just fill prescriptions; they can counsel patients and keep them on track. And companies that foot the bill for medical interventions that keep chronic diseases under control can actually save in the long run by avoiding costlier medical treatments.
Such was the thinking behind a 14-year-old health care movement called value-based insurance design, a benefit model that started in Asheville, N.C., to control emergency care costs for diabetics.
While value-based insurance or benefits design has caught on with several large self-insured employers and some insurers are testing such designs for fully insured programs (see story, page 12D), experts say they expect the still-difficult economy to slow adoption of such programs because they do not produce immediate savings for employers.
Employers, however, still are thinking about "how they can influence the decisions their employees make," said Andrew Webber, president of the Washington-based National Business Coalition on Health. "Employers found that employees, especially lower-income employees burdened by the high cost of prescriptions, were not compliant with their care. Employers are finding that it is in the best interest of companies to start removing barriers to care."
Essentially, this benefits strategy calls for companies to provide workers with chronic conditions the tools and extra money, via incentives such as lowered premiums or waived prescription and doctor visit copayments, to remove financial barriers to highly effective treatments. These steps, according to experts and case studies, help avoid even costlier care in the future.
The latest research shows that value-based health care designs can help companies at least break even, according to a January article in the journal Health Affairs that tracked studies at Harvard University, University of Michigan and other research.
Such newer data doesn't surprise people like John Miall, a retired 30-year human resources official with the City of Asheville who later founded his own consulting firm, Miall Consulting. He was one of the original drafters of what became the Asheville Project, which launched the movement in 1996.
Asheville and its local hospital decided to rein in health care spending for diabetic employees by paying for their medicine and health care counseling. The move, they hoped at the time and later realized, would avoid costly care such as emergency room visits, amputations and dialysis that often can be prevented by properly managing diabetes.
"This whole thing was born out of the frustration that paying for sick care wasn't working," Mr. Miall said. “The sick claims add up and that's the problem. We thought and later confirmed that paying for people when they are well and healthy is how you really save in the long run."
Diabetic workers, making up about 8% of Asheville's workforce, were struggling to pay for their prescriptions and treatment, so they devised ways to save, but they cost the city more in the long run, Mr. Miall said.
Mr. Miall told the story of a diabetic firefighter who tested his blood sugar levels only every other day because the test strips were too expensive. Not uncommon were tales of workers who took their medication every other day or split pills in half to save money, he added.
When the city and hospital decided to waive copays for preventative treatments, such as blood sugar monitoring and medications, and pay for regular one-on-one counseling with pharmacists - a group Mr. Miall described as “one of the world's most underutilized professions" - the city eventually saw the savings. Specifically, the city gradually saved between $1,200 and $1,872 per patient per year, according to 2003 research published in the Journal of the American Pharmaceutical Assn.
Anecdotally, Mr. Miall, then the head of human resources and risk management for Asheville, said the city paid for no dialysis treatments between 1998 and 2005, which is when he retired.
"Before that, given our workforce, we always had at least one worker a year in dialysis," he said. “So having no one in dialysis was a big deal for us," Mr. Miall said.
In addition to avoiding expensive interventions, the city also saw a drop in absenteeism and a spike in productivity, he added.
"What's funny is we just called it the "diabetes thing.' We didn't know we were changing health care," Mr. Miall said of value-based insurance design that has since grown to more than 100 employers nationwide.
Asheville's experiment was expanded in 2009 to the Diabetes 10 City Challenge, which involved 30 employers in 10 cities. Everyone eventually realized the savings, said Bill Ellis, executive director and CEO of the Washington-based American Pharmacists Assn. Foundation.
"It was an investment in what we called 'well care' and not "sick care,'" Mr. Ellis said. "More and more employers now are realizing they have to make a better investment. We are seeing a lot of discussion on this in Washington, even."
As a result of the Diabetes 10 City Challenge, employers saved an average of $1,100 in patient health care costs per year and employees saved an average $600 per year, according to 2009 research published in the Journal of the American Pharmacists Assn.
But despite the demonstrated savings, the progression of value-based designs in health care could slow, experts say.
"There's some resistance, a reluctance to talk about this because it costs money upfront, especially in a time when employers are scaling back," Mr. Ellis said. "There's emerging data, but there isn't that 25 years worth of data in place for people to make changes. This requires a mind shift - paying for wellness instead of sickness - that employers might not be ready to adopt."
January 25, 2010
Should you be spending more time with your neighborhood pharmacist? Or less?
Should you be spending more time with your neighborhood pharmacist? Or less?
By Kim Painter
Recent studies suggest either could be true for people who take medicines for chronic conditions such as diabetes, asthma and high blood pressure. For example, one new study suggests people who fill prescriptions by mail are less likely to run short of medication. But other studies show those who meet regularly with druggists stay healthier and save money for their insurers.
The studies come as pharmacists try to find their place in a world where prescriptions can be filled more cheaply by mail but where people struggle to use their medications consistently and correctly.
"The role of the neighborhood pharmacist is undergoing a major transformation," says Edith Rosato, a senior vice president at the National Association of Chain Drug Stores in Alexandria, Va.
Case in point: One big chain, Walgreens, just announced a four-city pilot program in which store pharmacists and nurse practitioners act as medication coaches for customers with type 2 diabetes. Such programs augment, but do not replace, physician care, Rosato says. They are needed, she says, because about half of people with chronic diseases fail to take medications correctly, which costs the health system $290 billion a year.
"There's a lot more that can go on in a pharmacy than filling a prescription," says William Elllis, executive director of the American Pharmacists Association Foundation, a non-profit group in Washington, D.C.
Pharmacists in one program studied by Ellis' group counseled 573 diabetes patients for a year and helped them normalize blood glucose, lower blood pressure and improve cholesterol levels while saving $1,079 each in health care costs (compared with projected costs).
Pharmacists can "provide that face-to-face conversation that just doesn't happen enough" in today's fractured health system, Ellis says.
But right now, most busy neighborhood pharmacists can't spend long hours counseling patients, says O. Kenrik Duru, an internist at the University of California-Los Angeles. They are too busy, he says, filling pill bottles, dealing with insurers and doctors' offices and serving long lines of customers - many of whom show up for simple refills.
Efficiency vs. personal touch
In a new study, Duru and researchers from Kaiser Permanente Northern California found diabetes patients in that system who refilled most prescriptions by mail were less likely to run out of medicine than those who went to pharmacies.
That was true even when costs were the same and people could get the same number of doses in each refill (something not true under many insurance plans, which allow 90-day refills by mail but only 30-day refills in person).
Pharmacist counseling is often crucial for someone on a new medication, Duru says. But efficient delivery may matter more for many people on long-term regimens, who may have trouble getting to stores regularly, he says.
Scott Monte, a pharmacist in Buffalo, is trying a hybrid approach: He and some partners have just opened a local business that refills most prescriptions by mail but encourages customers to come in to talk or to get urgent refills. Sometimes, pharmacists hop in their own cars to deliver orders.
People often dislike mail order, he says, because "they're dealing with an 800 number with an anonymous person on the other end."
Right now, one-third of prescriptions for chronic conditions are filled by mail, Duru's report says.
January 11, 2010
Appointment with the Pharmacist May Be Beneficial
When pharmacists take a more active role in patient care, disease outcomes are improved -- particularly for diabetes patients, a new study shows.
Diabetics who had an intensive consultation with a pharmacist regarding their medications, as well as subsequent follow-up, saw significant improvements in hemoglobin A1c and fasting plasma glucose, Erin Slazak, PharmD, of the University at Buffalo, and colleagues reported online in the Journal of the American Pharmacists Association.
The pilot study was small, with only 50 patients, and it lacked a control group, but Slazak said she and colleagues collected the data "because we wanted to show that we were having a positive effect on patient outcomes at the primary care level."
Adding a pharmacist to a patient's healthcare management team is not a new idea. Prior studies -- including the Asheville Project and the Diabetes Ten City Challenge -- have shown it improves disease outcomes and cost-effectiveness.
"There is an increasing body of evidence to support that pharmacists provide an effective and unique role in a collaborative disease management model," said Toni Fera, PharmD, of HealthMapRx and the lead investigator of the Diabetes Ten City Challenge.
"Medication adherence is critical to the management of chronic diseases, and pharmacists are uniquely trained to help patients understand why they need to take their medications," Fera said. "And it helps them overcome barriers that prevent patients from taking their medications appropriately."
Fera said there's "growing momentum" to include pharmacists in patient care. Medicare Part D plans, for example, allow pharmacists to provide medication therapy management services, which include a review of medications and proper use.
Some state-level programs exist, such as the one run by Slazak and colleagues.
Slazak said patients receive a one-hour consultation in which they bring in all their medication bottles -- prescription and nonprescription -- and have a thorough history taken. Pharmacists explain why each medication is relevant to treatment, and discuss necessary diet and lifestyle changes.
"We make sure the patient leaves with a solid understanding of why they're taking the medications they're taking," Slazak said.
She and colleagues will then make recommendations to the patient's physician regarding medications (in New York state, pharmacists don't have prescribing power, but in some states they can adjust medications as necessary, without consulting the patient's doctor).
They'll also follow up with the patient, either over the phone or in person, on a monthly or weekly basis, depending on the patient.
In their study, Slazak and colleagues found significant reductions in hemoglobin A1c and fasting plasma glucose after both six months and one year, compared with baseline (A1c -1.1%, P<0.0001 and fasting plasma glucose -39 mg/dL, P=0.003; and A1c -1.1%, P<0.0001 and fasting plasma glucose -35 mg/dL, P=0.005, respectively).
There were no significant decreases in other metabolic parameters, including blood pressure and cholesterol.
"There are a lot of possible reasons for that, mostly because we're focused on diabetes," Slazak said. "And our program was fairly new at the time, so we weren't working as closely with the providers as we are now."
She said the relationship between pharmacists and primary care providers is key to this type of collaboration. While physicians may have heeded 50% of pharmacists' recommendations at the beginning of the study, Slazak said, they now heed more than 90%.
The program also tended to reduce costs. Geometric mean costs tended to decrease versus baseline at six-month (-$84; P=0.785) and 12-month (-$216; P=0.414) assessments, despite nominal increases in diabetes and total medication costs. None of the changes was statistically significant.
The researchers have since matched the 50 patients in this study, which was conducted between 2006 and 2007, with 50 controls, for a more complete report, but the data has not yet been published.
While programs like this one have been appearing around the country, Fera said remaining challenges included determining how to incorporate the pharmacist into the existing healthcare system and how to coordinate care and sharing of information among providers.
"It really hinges on having the pharmacist prove a cost-benefit ratio to a physician group or third-party payer," Slazak said.
A co-author reported relationships with Bayer, Cadence, Cubist, Forest, Optimer, Ortho-McNeil, Schering-Plough, and Wyeth.
Community Pharmacy Struggles To Remain Relevant A broad consortium of players joins with the NCQA to
With an average of 12 prescriptions per person in 2008, consumers may have more contact with their corner pharmacy than with any other part of the health care system, but in many ways pharmacies are a black box.
"Transparency has increased for hospitals, nursing homes, and doctors...but there hasn't been the same type of information available about pharmacies beyond drug price comparisons," says Larry Boress, CEO of the Midwest Business Group on Health."As we try to educate employees to be more responsible consumers and more involved in managing their health, we need to know more about what pharmacies are doing."
While health plans can glean some information on pharmacy performance from claims data, they too are in the dark. There is minimal information to maximize the effectiveness of prescription expenditures, like data on dosing, side effects, and gaps in therapy. There are even gaps in basic services required by state pharmacy boards, such as offers for counseling on new prescriptions.
The Pharmacy Quality Alliance - a consortium of pharmacy chains, the American Pharmacists Association, payers, pharmaceutical companies, and others - is taking the lead in shining light on pharmacies by developing and implementing quality measures for community pharmacy, the sector with more than 60,000 storefronts.
PQA worked with the National Committee for Quality Assurance and a consultant to develop a starter set of 15 measures covering medication adherence/persistence, safety, appropriateness, and efficiency. Specific measures include the portion of days covered and gaps in therapy for four conditions, including diabetes and coronary heart disease. NCQA submitted the measures to the NQF for endorsement and acts as the owner of record for five measures that are now endorsed.
PQA's measures and efforts to promote their acceptance have multiple purposes. They are part of a broader effort aimed at changing the business model of pharmacies, creating a new source of revenue, and transforming the role of pharmacists into clinical services. That means they present a slippery slope to health plans that see quality measures in a narrower role for managing costs and improving medication outcomes.
PQA is working methodically to legitimize its measures and gain support for expanding clinical services into the pharmacy arena. All 15 measures were used in five demonstration projects aimed at tweaking them and working out operational issues like reporting. The projects were not intended to create formal quality ratings. Health plans, the Iowa Medicaid program, and the pharmacy schools at the University of Pittsburgh and the University of Iowa participated.
One of the demos was conducted by Highmark, the Pittsburgh, Pa., Blue Cross plan. It asked 50 Rite Aid pharmacies to test data capture, data completeness, and the performance reporting process. "We were not interested in evaluating the pharmacies; we were interested to see if meaningful data could be collected and reported, and if the measures will help in how we might use this data in the future," says Mark Conklin, PharmD, clinical pharmacy specialist.
In November, eight phase 2 demonstration projects were announced at PQA's annual meeting. "The first phase validated the feasibility of using the measures," says Laura Cranston, RPh, executive director at PQA. “The new demonstrations will test pharmacists' interventions to see if they can move the needle on the performance scale using the 15 quality measures. "The eight projects will test several different interventions, including pay-for-performance systems for pharmacists' services, in different target populations.
Conklin says Highmark's phase 2 project will see whether the systems can help to identify patients who are high risk for noncompliance. "We will also see if motivational interviewing techniques by pharmacists can affect compliance rates. We will not be implementing pay for performance. Rather, we will attempt to model how pharmacists' interventions and a pay-for-performance program might work, and if they are appropriate for further consideration."
Pharmacists say their push to develop quality measures, expand their role, and create compensation for themselves is necessary and appropriate.
"This is the future of pharmacy practice," says Edith Rosato, RPh, president of the National Association of Chain Drug Stores (NACDS) Foundation, a PQA member. "We have been tied to the dispensing of medications for many years, and unfortunately that has been marginalized in terms of reimbursement. With the advent of Part D and the mandate for medication therapy management, we saw an opportunity to expand our role."
Studies in 2006 and 2007 reported that the cost of dispensing a prescription ranged from $7 to $10. The Pharmacy Benefit Management Institute reports that in 2008, the average dispensing fee paid to pharmacies for brand drugs is $1.73, and generics is $1.69. However, some costs may be covered by payments for the drugs themselves.
"Filling scripts has become a commodity service, and dispensing fees will not rebound," says Bruce Roberts, CEO of the National Community Pharmacy Association.
But pharmacists say that patient care services are underutilized and that they can do more. “Pharmacists are experts in medications, and we are now being trained to help patients achieve optimal outcomes," says Starlin Haydon-Greatting, a pharmacist coach and program coordinator at the Illinois Pharmacists Association. “PharmD programs are six years and the goal is to prepare pharmacists who can assume expanded responsibilities in patient care like self-management, wellness, and prevention."
Haydon-Greatting points to the Diabetes Ten City Challenge (DTCC), a nationwide employer-funded health management program using pharmacist coaches to improve diabetes management.
A larger role for pharmacists is likely to drive up prescription expenses without a near-term reduction in total medical expenses.
The DTCC showed a 36.5 percent increase in medication costs in its first year. For 573 participants, total medication expenses increased from $1.8 million to $2.5 million. That $661,694 increase overrode a $485,335 decrease in medical claims for inpatient and outpatient services, which went from $5.7 million to $5.2 million. Total health care costs for the participants increased 5.3 percent, to $7.9 million.
Payments for pharmacists' therapy management and patient care services would also increase expenses. These expenses were $224,043 in the DTCC — $391 per patient. There were about 3,400 patient encounters, for an average of about $65 per visit. The average visit lasted 51 minutes.
A 2005 report by Lewin Associates, prepared on the advent of the Medicare Part D program, which mandates medication therapy management (MTM) services, said that pharmacists were seeking compensation at a rate of $2 to $3 per minute. At $2 per minute, the DTCC payment would have been $102 per visit. Data are scant on actual MTM fee-for-service payment rates.
While pharmacists would like fees for service, the mindset on payment for MTM services generally has been to embed it in a care coordination fee and funnel it to physician practices acting as medical homes. "It looks like health care reform will bundle payment into medical homes and ultimately it's going to come down to professionals negotiating for it," says Thomas Menighan, CEO of the American Pharmacists Association.
CMS says the health reform debate has cast doubt on the future of the Medicare medical home demonstration projects, including which practitioners can claim ownership of MTM services.
Health plans and PBMs have generally ducked fee-for-service payments to pharmacists for the medication therapy management required in Part D. They perform these services themselves through call centers, for example, or they carve out individual services to subcontractors.
Another issue that health plans face with an expanded role for pharmacists is determining the exact scope of patient care services. The NACDS and American Pharmacists Association say the MTM service model in pharmacy practice includes the five core elements: medication therapy review, personal medication record, a medication-related action plan, intervention and/or referral, and documentation and follow-up.
"Intervention" has not been defined, but pharmacists are interested in providing patient care services. For example, in the DTCC they coached patients in exercise, diet, and self-management. They also performed foot exams and immunizations. Health plans worry that these services could result in duplication and fragmentation of care.
Pharmacists have shown that they can be effective in patient care. In the DTCC, they improved medication-related measures like hemoglobin A1C, cholesterol, and blood pressure.
They also boosted preventive care scores - the number of people with current influenza vaccinations, foot exams, and referrals for eye exams. But nurses, diabetes educators, and others have demonstrated outcomes similar to those in the DTCC, so the critical factor may be the interventions themselves, not the individual who performs them.
Return on investment
'The issues and objections surrounding pharmacists' roles and quality improvement in community pharmacy are not new to Cranston and the members of PQA who are pushing for change.
The bottom line is that the community pharmacy sector knows it needs to show a positive return on investment. "Most of the phase 2 projects have an economic analysis built in that could lead to an actuarial model," says Cranston. "This analysis will look at total health care costs."
Clearly, health plans have to start developing their own positions and approaches to quality improvement in community pharmacy. Highmark, for one, is approaching this with its eyes open. "We see the potential that pharmacies and pharmacists offer, but this is a new area," says Conklin. “On the surface, things like data capture and reporting may seem straightforward, but widespread implementation and consistency can be more difficult. Furthermore, the data and measures themselves may not get at actual underlying performance or help us to manage services and benefits."
December 4, 2009
Benefit Design, Poetry at the US Chamber
Yesterday, the Labor, Immigration, and Employee Benefits Division of the US Chamber of Commerce convened a group of experts for a symposium called "The Case for Wellness Programs: From Evidence to Practice."
Representatives from Congress, CDC, insurers, and business spoke about the need for employers to invest in work-based health management programs for their employees as a way to both improve health and manage healthcare spending--in other words, sometimes you gotta spend money to save money.
Our own Deirdre Connelly gave the luncheon address. Deirdre remarked that she is pleased to hear our legislators talking about addressing the real driver of our healthcare costs--chronic diseases and conditions, such as Alzheimer's Disease, asthma, cancer, diabetes, heart disease, and obesity--as they debate the best way to move forward on this critical issue.
Controlling the costs associated with chronic diseases will move us a long way toward putting our healthcare system back on track--and making life better for patients.
First, disease prevention must be a higher priority. We must teach and encourage people to eat healthier, exercise more, and visit their doctors for regular check-ups. Vaccines also play a major role as they can help prevent diseases from developing in the first place.
Second, when people do become sick, we must help them manage their diseases so they don't suffer worsening consequences--and cost the system more in the long run.
Third, we must preserve the incentives for innovation that will lead to new and better healthcare for tomorrow.
From the common cold and chronic diseases to a global pandemic, our economy is impacted by the health of our workers. If an employer can prevent employees from becoming sick--or even better, help them get healthier--they will be more productive. We've seen examples from Asheville, the Diabetes Ten City Challenge, and many big corporations that show great results. More companies should be investing in employee health to save on healthcare spending.
But what I really liked was how Deirdre brought home the need for continued investment in research:
"Thinking about the effects of chronic diseases on the elderly reminds me of the words of the poet Dylan Thomas. His father, David, who was a robust man most of his life, became blind and frail in his eighties. Thomas was so pained at seeing his virile father weaken with age, that he did the only thing he knew--he wrote. He penned the poem 'Do Not Go Gentle Into That Goodnight' as his way of dealing with the affects of aging on his father.
We as a society, however, must not go gently, and allow preventable and treatable chronic diseases to burden the healthcare system. We must never stop our search for better medicines. Rather, we must harness the passion for discovery upon which this country was built and encourage the development of innovative treatments for chronic diseases."
November 20, 2009
Depression: Pharmacists Can Help Through Collaborative Care
Community pharmacists could make a tremendous difference in the care of patients with depression through better integration in a collaborative model of care, according to a white paper released by the American Pharmacists Association (APhA) Foundation.
Building on the success of pharmacists' services to patients with other chronic diseases in programs such as the Diabetes Ten City Challenge, the foundation convened a coordinating council to discuss the collaborative role of the community pharmacist in managing depression. After reviewing available literature on depression and its treatment, the council discussed the pharmacists' role and concluded, "Innovative approaches for expanding community pharmacist involvement in identification of patients with depression and in their care should be developed to maximize the impact pharmacists can make in the lives of those who suffer from the disease."
Depression affects more than 19 million Americans each year. The disease results in 400 million lost work days each year, and if left untreated, costs more than $43.7 billion in absenteeism from work, lost productivity, and direct treatment costs, pointed out a release from APhA.
With this in mind, the APhA Foundation's coordinating council, a group of national experts and caregivers in mental health and depression, developed "Expanding the Role of the Community Pharmacist in Managing Depression."
The council concluded that depression is best managed by collaboration among patients and their health care providers. The paper recommended involving pharmacists in identifying individuals at risk for depression; screening patients with comorbidities and other risk factors; providing medication therapy management (MTM) services and participating in collaborative practice arrangements; providing information on accessing patient assistance programs; serving as a source for information on depression and social support resources; and participating in local/regional/national mental health organizations, advisory boards, and other support resources.
Studies identifying barriers to pharmacist inclusion were brought to the council's attention. These included unfamiliarity with mental health issues, lack of time and other workplace infrastructure issues, and lack of financial support for implementing new care models. Council members encouraged continued research into collaborative care models and pharmacist involvement in providing care to patients with depression.
The paper concluded with specific recommendations to enhance the pharmacist's role in managing patients with depression, addressing issues such as education and training, collaborating with physicians to identify patients at risk, pharmacist's role in providing patient education, provider collaboration and communication, and quality of care and outcomes.
The Foundation’s coordinating council was made possible by a grant from Wyeth.
November 15, 2009
10 Ways to Cut Health-Care Costs Right Now
Employers and hospitals don't have to wait for Congress to address inefficiencies and waste
By Catherine Arnst
Seven hundred billion dollars. That's a ballpark estimate of how much money is wasted in the U.S. medical system every single year, according to a new Thomson Reuters (TRI) report. A sum equal to roughly one-third of the nation's total health-care spending is flushed away on unnecessary treatments, redundant tests, fraud, errors, and myriad other monetary sinkholes that do nothing to improve the nation's health. Cut that figure by half, and there would be more than enough money to offer top-notch care to every one of America's 46 million uninsured.
None of the health-care reform bills on the table in Washington do anything meaningful to address that wasted $700 billion. Nor do they call for changes in the underlying flaw that drives much of the waste—the fee-for-service system that pays doctors and hospitals for the amount of medical care delivered rather than for its quality. Under fee-for-service there is no financial incentive for doctors to eliminate waste, since they wouldn't pocket any of the resulting savings. They would just earn less.
By leaving this perverse reward system in place, Congress is virtually guaranteeing that health-care reform legislation, if passed, will do nothing to "bend the curve" of rising health-care costs, as President Barack Obama originally set out to do. Even the few cost-cutting efforts that the bills do include won't go into effect until at least 2013. As a result, U.S. health spending is on track to double over the next 10 years, to $5.2 trillion, about 21% of the gross domestic product.
Or possibly not. Politicians may be reluctant to rein in the medical-industrial complex, but the private sector is forging ahead. Faced with health-care costs that keep rising 6% to 7% every year—even during this year of negative overall inflation—plenty of insurers, hospitals, employers, and communities are figuring out how to offer better care for less money. They are willing to take experimental leaps in an attempt to solve some of the health system's most intractable problems.
A BIG STEP FORWARD
BusinessWeek has looked at 10 such attempts to lower health-care costs and improve patient care. These innovations cannot have the same impact as a comprehensive federal bill. Nor are the gains from private efforts assured. Paul B. Ginsburg, president of the nonprofit Center for Studying Health System Change, cautions that "there are a lot of things we know can improve health, such as wellness programs. But we don't know if they can save money on a large scale."
Still, companies and hospitals are taking the initiative, and some results are in plain view. "Three years ago, professional medical organizations were very reluctant to talk about inappropriate treatments, but I already see that changing," says Robert Kelley, vice-president for health-care analytics at Thomson Reuters. He points out that the American College of Cardiology recently published several standards of care for angioplasty and other common treatments, aimed at preventing unnecessary and costly interventions. Given that about one in six U.S. health-care dollars is currently spent on cardiovascular procedures, "that's a big step forward," says Kelly. Here are some others.
1. CRACK DOWN ON FRAUD AND ABUSE
Crime pays big when it comes to health care. This huge industry is run pretty much on the honor system. As law enforcement agencies have cracked down harder on illegal drugs, organized crime has diverted resources into multimillion-dollar medical scams, where there is less chance for detection. The FBI figures that fraudulent billings to Medicare, Medicaid, and private insurers account for 3% to 10% of total health spending, and the bureau concedes its estimates may be low. "Everywhere we look, we see evidence of fraud," says Lewis Morris, chief counsel for the Office of the Inspector General at the U.S. Health & Human Services Dept.
Medical fraud can range from fake claims to kickbacks to doctors to rigged payment schemes spanning several states. For years private insurers relied on law enforcement to chase down scams, with little effect. Now the industry is seizing the initiative. The Blue Cross & Blue Shield Assn. reports that its antifraud efforts resulted in savings of $350 million last year, a 43% increase from 2007. "Previously we had claims people investigate fraud," says Lee S. Arian, head of WellPoint's (WLP) antifraud unit and a former federal prosecutor. "Now we hire law enforcement professionals with experience investigating crime."
Insurers are also trying to stop crime before it starts. Anthem Blue Cross of California came up with a strategy designed to identify so-called phantom providers of medical equipment, phony companies set up to file fake reimbursement claims. Working with federal files on fraudsters, Anthem fingered 10% of 500 newly registered companies as fakes. An added bonus: News coverage of the effort caused requests at Anthem for new provider ID numbers to drop dramatically.
2. DEVELOP A HEALTHY WORKFORCE
When Johnson & Johnson (JNJ) CEO William C. Weldon met with President Obama over the summer, he communicated a key message: Prevention pays. Weldon knows, because J&J has been offering comprehensive wellness programs to its 100,000 employees since 1995. Internal studies found that in the four years ended in 2002, those efforts saved $225 per employee per year.
J&J's experience proves wrong the conventional medical wisdom that it takes decades before efforts to help people develop healthier lifestyles can produce savings. Although many workplace wellness programs are little more than window dressing, serious efforts can yield important reductions.
J&J offers a huge array of programs, including free smoking cessation classes, online tools for weight and stress management, and 30 on-site fitness centers. Employees who enroll get a $500 discount on their insurance premiums. About 85% of employees participate as a result. "Seventy percent of health-care costs could be prevented through lifestyle modification," says Dr. Fikry W. Isaac, J&J's executive director of global health services.
3. COORDINATE CARE THROUGH FAMILY DOCTORS
A patient suffering from one or more chronic diseases may depend on several doctors, and rarely do they communicate with one another. This lack of care coordination means it's nearly impossible to arrange complementary treatments, cross-check prescriptions, and avoid ordering the same diagnostic tests over and over. The resulting duplications and follow-up care cost the nation $25 billion to $50 billion a year.
A solution is emerging from the medical trenches in the form of the "patient-centered medical home." Under this model, a primary-care doctor is the point person for all of a patient's medical needs, organizing care with specialists, pharmacists, and physical therapists and sharing electronic medical records with all. A 2004 study estimated the U.S. health-care bill could fall by 5.6% if every patient had a medical home.
North Carolina is already reaping savings. In 1998 the state set up Community Care of North Carolina (CCNC), a partnership between the state and some 4,000 primary-care doctors. Enrolled in the program are 870,000 Medicaid recipients and 97,000 children. CCNC pays doctors Medicare rates plus a monthly fee of $2.50 per enrollee to cover the extra time the doctors need to manage overall care. A Mercer study found that the program saved the state $161 million on health-care costs in 2006 alone.
4. MAKE HEALTH A COMMUNITY EFFORT
We are not a fit nation. One-third of U.S. adults are obese, and health spending on this group grew 80% from 2001 to 2006, to $166.7 billion. Rochester, N.Y., has decided to do something about it.
In 2005, Wegmans Food Markets CEO Danny Wegman recruited six other local employers, including Bausch & Lomb, Eastman Kodak (EK), and Xerox (XRX), along with the Rochester Business Alliance, to set up a health and fitness program for all of the metropolitan area's 1.04 million people. The campaign, called "Eat Well. Live Well," challenges individuals to eat five cups of fruit and vegetables and walk 10,000 steps each day. More than 44,000 people have participated over the past three years, making it the world's largest wellness program.
The group's collaboration didn't stop at fitness. The companies joined with doctors and insurers to substitute generic drugs for brand-name medicines, had their own efficiency experts help three hospitals streamline operations free of charge, and contributed $685,000 toward establishing a regional electronic health records system. Wegmans Vice-Chairman Paul S. Speranza says Rochester's health costs have dropped from 5% below the national average in 2005 to 15% below this year. "We believe collaboration, in Rochester or nationally, is the answer," he says, "whether there is legislation or not."
5. STOP INFECTIONS IN HOSPITALS
Far too often, the biggest danger to patients is not their disease but the hospitals that treat them. Every year 1.7 million patients develop infections while in hospital, and 99,000 die as a result. These hospital-acquired infections add $30 billion to the nation's annual health-care bill—and almost all are preventable. "For a long time there was a sense that a lot of these infections were inevitable," says Dr. Donald Goldmann, senior vice-president of the nonprofit Institute for Healthcare Improvement. "But in the last five or six years medical professionals have come to realize we can do a lot better if we follow a zero-tolerance policy."
The key is keeping the hands and clothes of hospital personnel clean, as well as any tools that come in contact with patients. In 2001, Dr. Peter Pronovost of Baltimore's Johns Hopkins Hospital came up with a five-item checklist that proved highly effective at curbing contamination. It calls for all staff to wash their hands before touching patients; clean patients' skin with strong antiseptic; wear masks, caps, and gowns; and take other common-sense precautions. Using the list, the Keystone Project, a collaboration of 77 Michigan hospitals started in 2003, reduced catheter-related infections to zero. The state hospital association estimates 1,700 lives and $246 million were saved in the project's first three years. Keystone is now being rolled out to all 50 states.
6. GET PATIENTS TO TAKE THEIR MEDICINE
Three out of four Americans do not take their medicine as directed. This noncompliance leads to additional doctor visits, hospitalizations, and treatments that together add some $177 billion a year to the nation's health-care bill, according to the National Council on Patient Information & Education.
People don't take their pills because they forget, they don't think the drugs work, they neglect to refill prescriptions, or they can't afford the medications. To address the problem, GlaxoSmithKline (GSK) and the American Pharmacists Association Foundation joined forces four years ago to start the Diabetes Ten City Challenge. Pharmacists closely monitored the medications of more than 1,000 participants at 30 companies and waived co-pays for prescriptions. Average care costs dropped nearly $1,100 per participant per year—and patients were healthier.
A 2005 study estimated that every dollar spent on such medication-adherence programs can save $7 for patients with diabetes, $5 for those with high cholesterol, and $4 for high blood pressure. It's "one of the best ways to improve care ... and get more out of each health-care dollar,"says Dr. John O'Brien, an assistant professor at the College of Notre Dame School of Pharmacy in Maryland. Consequently, the National Consumers League is planning a major campaign next year to persuade the public to take their pills.
7. DISCUSS OPTIONS NEAR THE END OF LIFE
One-quarter of Medicare dollars are spent in the last year of patients' lives. The costs of end-of-life care vary wildly, however. The Dartmouth Institute for Health Policy has found that spending is nearly three times higher in Manhattan than in areas of Colorado, mainly because patients in Manhattan average 21.9 days in the hospital during their last six months, compared with only 6.3 days in Grand Junction, Colo. Yet higher costs don't translate to longer or better lives.
Aetna (AET) discovered that high-quality care for the dying actually lowers costs. The insurer started its Compassionate Care program in 2004 to educate terminally ill patients and their families about treatments, living wills, and hospice care. "It was about dignity, not cost control," says Dr. John W. Rowe, former CEO of Aetna. Instead of unneeded tests and futile treatments, patients got more nursing care, pain management, and psychological support, says Rowe, now a Columbia University professor.
Program participants were twice as likely as average patients to choose hospice care. Costs came down 20%, yet surveys showed that both patients and their families were more satisfied than those not in the program. Such counseling efforts "are not about 'death panels,'" says Dr. Elliott S. Fisher, a professor at Dartmouth Medical School. "This is about better care, aligned with what patients want."
8. USE INSURANCE TO MANAGE CHRONIC DISEASE
In 2009, UnitedHealthcare (UNH) introduced the Diabetes Health Plan, a new type of benefit that offers financial rewards to patients who manage their disease properly. Three companies, including General Electric (GE), are testing the plan, and 15 more workplaces signed on to roll it out in 2010. Employees who participate in the UnitedHealthcare plan must adhere to specific treatment guidelines and agree to be tracked by the insurer to make certain they are sticking with the program. In return, co-pays on their diabetes drugs are waived, along with other fees related to managing their disease.
The United plan is part of a larger trend in managed care called "value-based insurance design." The idea is to contain costs by giving financial incentives to patients based on their particular health issues rather than offering one-size-fits-all plans. "One issue in the health-reform debate is that we're paying an awful lot for health care and yet we don't have the healthiest outcomes," says Dr. Edmund J. Pezalla, national medical director for pharmacy management at Aetna (AET), which is also experimenting with value-based insurance design. "There are things providers and patients can do together to achieve better outcomes."
The impact of tailoring plans to employees with specific diseases could be significant. United estimates that diabetes costs the health-care system $174 billion a year.
9. LET WELL-INFORMED PATIENTS DECIDE
When Floyd "Jack" Fowler Jr. holds focus groups of heart patients, he's amazed at their misplaced faith in the benefits of medical procedures. "They all think they'll die if they don't have bypass surgery or angioplasty," says Fowler—even though studies show that both procedures extend lives or prevent heart attacks in only a tiny minority of especially sick patients. But hardly anyone knows this, he says.
Fowler's nonprofit Foundation for Informed Medical Decision Making has sought for years to give patients both that knowledge—and a choice. The idea is to explain thoroughly to people the benefits and risks of medical procedures they may be facing. At the Spine Center
at Dartmouth-Hitchcock Medical Center, for example, patients with back problems are shown a video that walks them through various procedures and provides data showing that outcomes are similar whether or not they have surgery. Once the program started, spinal surgery rates dropped 30%.
So far, shared decision-making efforts reach only a small number of patients. But given that as much as 37% of health spending is wasted on unnecessary care, the idea is catching on. Washington State passed the nation's first law two years ago encouraging informed decision-making, and other states are expected to follow, says Dr. Lance Lang, senior medical director at Health Dialog.
10. APOLOGIZE TO THE PATIENT
Doctors regularly complain that fear of malpractice suits forces them to order far more tests and procedures than necessary. Although President Obama has said he is open to legislation that would limit malpractice awards, there may be a simpler solution. Sometimes all it takes is an apology.
The Sorry Works! Coalition, founded in 2005, is persuading hospitals to disclose mistakes to patients and their families. Under the policy, as soon as a hospital discovers an error, the patient is informed, the cause is investigated, and changes in procedure are recommended. If the provider is at fault, the patient is offered a settlement.
The University of Michigan Health System adopted the policy in 2001 and reports that malpractice claims fell from 121 a year to 61 in 2006. The honesty "takes away some of the anger of patients and the 'gotcha' of plaintiff lawyers," says Douglas B. Wojcieszak, who founded Sorry Works! after losing his brother to a medical error. "You don't need any legislation, judge, or politician to do this—it's simply customer service." The University of Illinois Medical Center in Chicago started a formal apology program in 2006 and says the number of claims has since declined 40%, despite a 20% increase in clinical activity.
Special Section: Diabetes
Diabetes do's & don'ts
If you are one of the 21 million Americans with diabetes, you may not be taking your medications. Only 50 to 60 percent of Americans take drugs as they've been prescribed for their chronic illnesses. And, says Roger P. Austin, R.Ph., a certified diabetes educator writing in Diabetes Spectrum, 12 percent don't ever fill their prescriptions at all.
What are the health repercussions for people with diabetes? Researchers find that in the U.S. 57 percent of people with diabetes have failed to reach their target A1C level (a long-term measure of glucose control), 71 percent have not been lowered blood pressure to prescribed levels and 48 percent have not reduced LDL cholesterol levels sufficiently. No wonder heart disease is the number one killer of people with diabetes, claiming two out of three people with the disease.
According to the New England Healthcare Institute, often people fail to take their medications because of cost and because of the difficulty of managing multiple prescription regimens. They suggest these obstacles could be overcome if drugs used to prevent or manage chronic diseases cost less and were easier to take, and if patients had support and worked with case managers.
That's the approach that is being taken by two innovative programs: The American Heart Association's (AHA) The Heart of Diabetes program and the Diabetes Ten City Challenge, the brainchild of the American Pharmacists Association Foundation.
"Too often people are not in a position to afford medications," explains Robert H. Eckel, M.D., past president of the AHA. "The Heart of Diabetes helps people realize they can live a healthy lifestyle without breaking the bank. Medication is important, but lifestyle efforts are also vital."
They can improve heart health and control diabetes. To help people eat well for less, the AHA is working with Jonni McCoy, author and founder of miserlymoms.com. "I am trying to take the intimidation out of eating healthfully and being on a budget at the same time," says McCoy. To enroll in The Heart of Diabetes program and find her favorite tips for economizing, sign up at the AHA web site, IKnowDiabetes.org.
The Diabetes Ten City Challenge was a project to explore if employers, working with pharmacists, could offer employees with diabetes support and benefits (free counseling with trained pharmacist-coaches and waived co-pays for diabetes medications and supplies) and, as a result, improve employee health and save everyone involved money.
And it worked! For the 30 participating companies, the average health care expense per employee participant fell $1,079 a year. Each employee’s total medical expenditures fell by $600 per year. And those participants saw an improvement in their A1C levels and other important measures of health and healthy behavior.
Sandra Moore, one of the participants, who works for Hamilton Health Care in Dalton, GA, says, "I meet monthly with the pharmacist, and my A1C has gone from 8 to almost 5 and my blood pressure has dropped from 190/110 to 120/67!"
To find out more about this cost-saving program, visit diabetestencitychallenge.com.
- Kalia Doner
University of Illinois at Chicago
Results of the Diabetes Ten City Challenge (http://www.diabetestencitychallenge.com) released by the American Pharmacists Association (APhA) Foundation demonstrate how employers and pharmacists can work together to help people with diabetes manage their disease and reduce healthcare costs.
The data, published in the May/June issue of the Journal of the American Pharmacists Association (JAPhA), show average total healthcare costs were reduced annually by $1,079 per patient compared to projected costs if the DTCC had not been implemented.
Data for the more than 500 participants included in the analysis show patients saved an average of $593 per year on their diabetes medications and supplies, in part, because employers waived co-pays to encourage people to participate in the DTCC.
According to the analysis, there also were improvements in key clinical measures, including a 23 percent increase in the number of participants achieving the American Diabetes Association A1C (blood glucose) goal of <7; an 11 percent increase in the number of participants achieving National Cholesterol Education Program goals; and a 39 percent increase in the number of participants with a combined diastolic/systolic blood pressure goal achievement of 130/80.
Improvements in preventive care measures were also assessed. The percentage of participants with current flu vaccines increased from 32 to 65 percent. Those with current eye exams increased from 57 to 81 percent, and participants with current foot exams increased from 34 to 74 percent.
Through the DTCC, conducted by the APhA Foundation through HealthMapRx™ with support from GlaxoSmithKline, employers established a voluntary health benefit for employees, dependents and retirees with diabetes.
Thirty employers in 10 cities, including the Midwest Business Group on Health in Chicago, waived copayments for diabetes medications and supplies if participants met regularly with a specially trained pharmacist "coach" who helped them track their A1C, blood pressure and cholesterol and manage their disease through exercise, nutrition and other lifestyle changes. Pharmacists communicated with physicians after visits and referred patients to other healthcare providers for additional care or education as needed.
In Illinois, 35 pharmacists, including pharmacists from the College of Pharmacy's department of pharmacy practice, saw approximately 250 patients across the state over the course of the program.
Faculty from the college helped train other pharmacists in diabetes care using the American Pharmacists Association's Diabetes Certification Program. Anyone interested in getting involved should contact Starlin Haydon-Greatting by email at email@example.com, call the Illinois Pharmacists Association (IPhA) office at (217) 522-7300 or visit IPhA's Web site at http://www.ipha.org.
September 28, 2009
PILOT PROGRAM HELPS CITY WORKERS TAKE CONTROL OF THEIR DIABETES
Colorado Springs city employees with diabetes have seen improved health markers and saved money through a national pilot program designed to help people take more responsibility for their health.
More than 60 city employees saw a significant drop in their bad cholesterols and their A1C levels, a key measure of blood sugars, according to a recently published study on the program.
At the same time, the employees saved an average of about $372 in copays for diabetic drugs and supplies.
The city is among 10 cities and 30 employers that participated in The Diabetes 10 City Challenge, conducted by the American Pharmacists Association Foundation. The program is ongoing, but the study focused on people who participated in the program from 2006 to 2007.
The program works like this: An employer waives copays on all diabetes-related drugs and supplies such as insulin and testing strips. In exchange, the participant agrees to meet monthly with a pharmacist coach who goes over his or her health status and offers advice on nutrition, exercise and drugs.
The concept of personal responsibility and prevention is widely regarded as a key part of reining in health care costs, yet its effectiveness has been hard to quantify in studies. William M. Ellis, chief executive officer of the pharmacists association, hopes the results of this program will help change that.
"We feel pretty good that this approach has contributed to some new thinking in how health care benefits are designed around the country," he said.
Other cities in the program had results comparable to those in Colorado Springs, he said. The association did not rank cities against one another, but overall, participants saw improvements in blood-sugar levels, cholesterol and blood pressure.
Colorado Springs began offering the benefit to employees in 2006. Of the 338 eligible diabetics, 126 signed up. Sixty two were included in the study published earlier this year in the Journal of American Pharmacists Association.
The study found that the employees' medical costs went from $4,404 in 2006 to $3,281 in 2007, said Mark Cauthen, who oversees the city's benefits and wellness team. Spending on medications, by contrast, went up, from $3,553 to $4,366, as people took more control of their diabetes. That led to an average savings of $310.
Yet compared to the estimated cost of $8,881 for an unmanaged diabetic, the savings could be as much as $1,234, Cauthen said.
Perhaps the biggest financial incentive, though, is increased productivity and less sick leave.
"If people are feeling better when they're at work, then their production goes up," Cauthen said.
The city paid a fee of $166 per employee for them to participate in the program in the first year, in addition to the waived copays. That fee dropped to $83 by the third year, Cauthen said.
Dee Brown, 49, who works in the city's communication office, was one of the first to sign up. After being diagnosed as either diabetic or pre-diabetic a year before and getting conflicting information from physicians, she was full of questions. The coaching, she said, helped her understand the disease and how to control it.
"I think there's a point of panic that strikes you," she said about the diagnosis, adding that there’s comfort in having someone to walk you through it.
Her coach was Tammy Lopez, the city's in-house pharmacy director and one of two pharmacists who have coached the city employees.
"I'm kind of their personal motivator," Lopez said. Sessions can cover a wide array of topics from counting carbohydrates to exercising, but Lopez believes the success lies in accountability and engagement. "They know they're going to see me," she said.
September 28, 2009
Spotlight on Diabetes Ten City Challenge
The diabetes epidemic is one of the greatest challenges facing our healthcare system today. Nearly 24 million Americans - 7.8% of the U.S. population - have diabetes and that number could increase to 50 million by 2025.
With annual costs of $174 billion, diabetes not only accounts for more than 15 million work days absent, 120 million work days with reduced performance and an additional 107 million work days lost due to unemployment disability attributed to diabetes, but it also multiplies the potential for heart disease, stroke, blindness, amputations and kidney failure.
Through the Diabetes Ten City Challenge, sponsored by the APhA Foundation with support from GlaxoSmithKline, employers provide employees, dependents and retirees with diabetes a voluntary health benefit, waive co-pays for diabetes medications and supplies and help people manage their diabetes on a day to day basis with the help of a specially-trained pharmacist "coach".
An interactive guide to the causes and symptoms
Today, 30 employers and hundreds of local pharmacists in ten cities are working together to help people manage their diabetes. A new report published in the May/June 2009 issue of the Journal of the American Pharmacists Association (JAPhA) documents favorable economic and clinical results for employers and participants. Employers realized an average annual savings of almost $1,100 in total health care costs per patient when compared to projected costs if the DTCC had not been implemented and participants saved an average of almost $600 per year.
Participants also improved in all of the recognized standards for diabetes care, including decreases in A1c, LDL cholesterol and blood pressure; and increases in current flu vaccinations and foot and eye exams.
With one out of every five dollars in healthcare attributed to diabetes, the Diabetes Ten City Challenge represents a promising practice in designing a patient-centered health benefit, one that improves outcomes for patients and manages costs for everyone involved.
September 28, 2009
Ten City Challenge does job
NEW YORK - Chain drug pharmacists who participated in a long-term program to improve diabetes care helped cut costs by nearly $1,100 per patient per year.
As part of the program - the Diabetes Ten City Challenge -specially trained pharmacists met regularly with patients to provide education and monitor their condition. Pharmacists from such chains as Walgreen Co. and Kerr Drug tracked key diabetes indicators, including hemoglobin A1C, blood pressure and cholesterol levels.
The pharmacist coaches also taught people to manage diabetes by eating right, exercising regularly, visiting their doctors, taking medications as prescribed and keeping current with flu vaccines and foot and eye exams to prevent the costly complications of diabetes.
The 573 participants, who were in the program for an average of 14.8 months, saved an average of $593 per year on their diabetes medications and supplies because employers waived co-pays.
"When people are supported and empowered to make the lifestyle changes necessary to manage a chronic disease, significant improvements are possible," says William Ellis, chief executive of the American Pharmacists Association Foundation, which conducted the program through HealthMapRx, with support from GlaxoSmithKline.
Making a name for herself in pharmacy
An unusual first name sometimes becomes something to live up to, Starlin Haydon-Greatting, BPharm, told Pharmacy Today. "Last year, I got the Pharmacist of the Year award for the Illinois Pharmacists Association (IPhA), and the pharmacist who introduced me said that I was on the level of Cher and Prince, needing only one name to describe me!" she said. Her name is more than just a quirky conversation starter, though. Haydon-Greatting explained that her name comes from an old Irish legend; a young girl named Starlin Ann dons her fallen father's armor to rally her people and stave off an invading force. "I have been kind of like that!" she said, explaining, "I've always been a person who fought for out-of-the-box thinking... We need to challenge ourselves and move forward. That's kind of how I've led my life."
Coordinating and providing MTM This envelope-pushing streak is revealed in her pharmacy career. Today, Haydon-Greatting is IPhA's Clinical Program Coordinator and Illinois Diabetes Pharmacist Network Coordinator. She is responsible for providing medication therapy management (MTM) through the APhA Foundation's Diabetes Ten City Challenge program in Illinois. "I act as the center - the cog - so that there's a central person from whom pharmacists can get assistance," she explained. Her responsibilities are varied, to say the least. "Sometimes I'm a drug information person, sometimes I'm a criteria person, sometimes I'm a quality assurance person, sometimes I have to be the one who says you don't have your documentation in on time, sometimes I'm a pharmacoeconomic analyst...Every aspect that I have studied, from the first day in college all the way up - and I'm still learning - goes into what I do," she said.
The Diabetes Ten City Challenge in Illinois is a partnership with the Midwest Business Group on Health, which is based in Chicago, but includes patients throughout much of Illinois. "I have 12 employers total, including the Tri-State Health Care Coalition in Quincy...They represent about 250 patients; they're being seen by 35 pharmacist coaches who are providing diabetes education and MTM services,"Haydon-Greatting told Today.
Haydon-Greatting believes that simple face time with a pharmacist coach is perhaps one of the most valuable elements of the Ten City Challenge program. "It's face time that improves adherence, and it's face time that lets you figure out if a medication is really working for them," she explained. "You create such a great relationship with these patients when they finally have somebody believing in them and taking the time to move them forward. Some move quickly, and some don't move so quickly, so we have to be flexible."
In addition to her management responsibilities, Haydon-Greatting also travels frequently to employers involved in the program to do her own pharmacist coaching. She explained that she sets up shop in the location's conference room and sees patients either during lunch or immediately after work. While many patients initially put up some resistance to MTM services, Haydon-Greatting thinks that pharmacists have the potential to break down those barriers. She described one case in which she broke down a particularly tough motorcycle enthusiast: "One really beautiful day, I stayed outside where everybody takes their little breaks, and the Harley guys were there with their prized possessions. I was admiring one, and I said, what's her name? ... They were impressed that I was interested in what they were driving," she said.
After this break, during counseling "my one Harley guy unclasped his arms, took his feet off the table, and said, 'You know, you ask me about my goals. Well one of my goals is that I bought this really great set of leather chaps, and I can't get into
them!'" With a common element finally established, Haydon-Greatting was able to get this patient to open up. Now he's not only eating healthily, controlling his diabetes, and fitting into his chaps; he's also one of her biggest supporters.
The Diabetes Ten City Challenge in Illinois has been a great success, Haydon-Greatting said. "Employers are interested in expanding to the cardiovascular module," she added, "because within diabetes you are already monitoring their cardiovascular process, their lipids, their blood pressure, and so forth. When you add the cardiovascular module ... you extend to the people taking hypertensive medications, and you're getting three times the patients." Counseling these patients can help Haydon-Greatting and her colleagues identify the metabolic syndrome patients who are at risk for developing type 2 diabetes. "This way, we can proactively prevent the full diagnosis of diabetes in some of them," she explained.
"Employers are interested in this, because they tend to have more of those patients, and they're often not exercising or eating right or creating lifestyle changes," Haydon-Greatting said. Personal responsibility is, to her, essential to good patient care. She believes that working individually with patients and instilling a sense of the importance of proper health is essential. "The caution about MTM is we can't make it a cookie-cutter fix," she explained. "In medicine, every single person is different. ...We have guidelines, we have protocols, we have flow charts, but we have to be able to have an alternative when someone doesn't meet those criteria, so that they can still move forward and create better health for themselves."
A personal calling
Diabetes care is a very personal mission for Haydon-Greatting. Her grandmother had diabetes, and Haydon-Greatting remembers her grandmother's "array of colored pills" piquing a clinical interest at an early age. She herself suffered from gestational diabetes while pregnant with her twin daughters and, later, her son. "My mind started going on about all the diabetes. My grandmother had diabetes; she died with the disease, and we never made any great impact. While I was up in Alaska [on a rotation with the Indian Health Service], I was doing diabetes studies with the Native American population because of the high incidence and prevalence of the disease. There's always been this common thread of diabetes education running through my life," she told Today.
Haydon-Greatting's professional career has covered a wide range of practice areas, from providing drug information with Drug Facts & Comparisons as a student pharmacist at the St. Louis College of Pharmacy, to working to better integrate pharmacy with the rest of the hospital at Memorial Medical Center in Springfield, IL, after graduating. Later in her career, she gained a great deal of experience working with the government through the Illinois state Medicaid program. "I had a 6-week contract with them at first," she explained, "and I did that from 1990 to 2001. That's longer than 6 weeks!" She also runs her own business, SHG Clinical Consulting, to help keep various MTM programs going in the Illinois region.
It was as a consulting pharmacist, after leaving Illinois Medicaid that Haydon-Greatting saw the potential MTM could have in treating diabetes. "I kept on watching the progress of Asheville, NC, where the APhA Foundation was helping the city run an MTM diabetes care program," she said. "I realized that this was exactly what I was trying to do when I worked in government...Here's this group down there proving that if you have a pharmacist coach work with a patient with chronic illness, they improve outcomes and save money in the long term, she added." Inspired by the Asheville Project's progress, Haydon-Greatting started polishing her clinical skills in preparation for the possible arrival of MTM to Illinois. "The Ten City Challenge was out there, but the last thing I thought was that Chicago would get picked. It did and it's been the best!" she told Today.
Passing the baton
Haydon-Greatting knows that she isn't on her own in working to change pharmacy in Illinois - let alone across the country. "It's a group of clinical pharmacists who are helping do this - forward-thinking people who are moving the profession forward - and it's my honor to work with all of them," she told Today. Building a community is always at the forefront of her mind, and she urges pharmacists everywhere to work together. "We have to be a collegial group that supports each other," she said. Haydon-Greatting has personally acted on this mission, creating a clinical advisory committee for her branch of the Diabetes Ten City Challenge. "You've got to have a network support system, because what if somebody gets a patient that they don't know how to coach?" she noted.
Today, with the Ten City Challenge working efficiently and effectively in Chicago and around the country, the stage is set for further progress in pharmacy and in MTM. "We're going to have some great batons to hand off to the next generation," Haydon-Greatting concluded. "This really isn't about me, it's about all those pharmacists out there who are going to pharmacy school to make a difference in the lives of their patients."
July 31, 2009
Diabetes Ten City Challenge empowers people to make healthy change
By William M. Ellis, CEO, American Pharmacists Association Foundation
July 31, 2009
City of Charleston, SC employee Bobby Stephens knew firsthand the dangers of diabetes. He saw his mother-in-law suffer amputations and blindness and friends go on dialysis because of the disease. Yet in six years of treatment for his own diabetes, he never really understood his medications, nor was he able to keep his condition under control. That changed when he met James Sterrett, PharmD.
Sterrett is a pharmacist who worked with Stephens in the Diabetes Ten City Challenge (DTCC), a program that helped people take charge of their diabetes with help from a pharmacist "coach." Stephens volunteered to participate in the DTCC through the city of Charleston, which is one of 30 employers in 10 cities that were part of the program.
Through the DTCC, employers offered a voluntary health benefit for employees and their family members with diabetes, waiving co-pays for diabetes medications and supplies if they worked with a pharmacist coach to manage their disease.
The DTCC was conducted by the American Pharmacists Association (APhA) Foundation through HealthMapRx, with support from GlaxoSmithKline, in an effort to pursue new ways of reducing health care costs and managing diabetes, which affects nearly 24 million Americans and costs more than $174 billion annually.
Pharmacists who are specially trained in diabetes care met with participants regularly to provide education and monitor their condition. They tracked key diabetes indicators such as hemoglobin A1C (a laboratory test showing average blood sugar control over the previous two to three months), blood pressure, and cholesterol levels. They also taught people to manage diabetes by eating right, exercising regularly, visiting their doctors and taking medications as prescribed.
Final economic and clinical results of the DTCC, published in the May/June issue of the Journal of the American Pharmacists Association (JAPhA), show that overall average health care costs were reduced by nearly $1,100 per patient per year when compared to projected costs if the DTCC had not been implemented. Aggregate data for 573 participants, who were in the program for an average of 14.8 months, show patients saved an average of $593 per year on their diabetes medications and supplies because of the waived co-pays.
Participants improved across all key clinical indicators, including the number of people achieving A1C, blood pressure, and cholesterol goals. Influenza vaccination rates increased, as did the numbers of participants with current eye and foot examinations that help prevent devastating complications associated with diabetes.
Stephens and other DTCC participants say the relationship with their pharmacist and the chance to better understand–and manage–their diabetes has changed their lives. Since enrolling in the DTCC in April 2006, he has lost 40 pounds and reduced his A1C levels from 9.7 to below 6 (the American Diabetes Association recommends A1C levels below 7).
The American Diabetes Association calculated that diabetes accounted for $58 billion in lost productivity in 2007, including 15 million sick days and a staggering 120 million days lost to "presenteeism," when employees are at work but not "all there."
The financial incentives in the DTCC helped participants afford the care necessary to manage their condition and lead productive lives. City of Charleston Wellness Coordinator Jan Park, RN says removing financial barriers empowers people to take control of their disease; and the one-on-one counseling with the pharmacist coach helps them stay accountable, set goals and stay on track.
Chronic disease is responsible for seven of 10 American deaths and 75% of the nation's $2.2 trillion health care bill. Earlier this year, the APhA Foundation announced a partnership with Mirixa Corp., the nation's largest pharmacy-based patient care network, to offer the DTCC collaborative care model to employers nationwide for diabetes and other chronic diseases through HealthMapRx.
The results of the Diabetes Ten City Challenge demonstrate that when people are supported and empowered to make the lifestyle changes necessary to manage a chronic disease, significant improvements are possible.
It's an idea whose time has come.
10-city challenge shows diabetes can be controlled
10-city challenge shows diabetes can be controlled
Nearly 14 months ago, 174 City of Colorado Springs employees with diabetes entered the Diabetes 10-City Challenge, a program to test how much diabetes and its treatment costs could be controlled.
They exercised, ate healthy foods and met regularly with a pharmacist to track insulin levels, blood pressure and cholesterol.
The results: more than 65 percent of them reduced indicators for the disease and reported feeling better. And, the average medical savings totaled $1,234 per person.
Nationwide, the program showed average total health care savings of $1,079 per patient.
A total of 573 people participated in the program for 14.8 months.
Treatment for the more than 23 million Americans who have diabetes is estimated to cost of $174 billion a year.
According to the American Pharmacists Association:
- 200,000 people die of diabetes related complications every year.
- Thousands are affected by blindness, kidney failure and problems of the lower extremities.
- In 2007, diabetes was responsible for 15 million absent work days, 120 million work days with reduced performance and additional 107 million work days lost due to unemployment disability.
July 06, 2009
Incentives and Coaches Help Lower Diabetes Costs and Improve Outcomes
High satisfaction, cost savings, and improvement in key clinical indicators among diabetics headline first-year results of Taking Control of Your Health (TCYH), an employer-based diabetes management program of the non-profit Midwest Business Group on Health. In one year, employers' return on investment of actual savings per participant was $1,467, yielding $126,162 for the 86 participants, compared with projected costs for diabetics not in the program. Average total health care costs for participants declined by almost $625.
"We've demonstrated the value of collaboration between patients, physicians, and pharmacists to improve care and reduce costs," says Larry Boress, MBGH president and chief executive, in an announcement." A key barrier to improvement in chronic disease is the lack of medication compliance. Rarely do people have just diabetes-they often have other conditions, including hypertension, cardiac problems, and depression, requiring them to take an average of five to 13 medications. Having a pharmacist coach helps patients understand the importance of taking their drugs and managing their health."
The TCYH program, which now has more than 200 participating patients, is open to covered employees, dependents, and retirees from employer members of MGBH. There are three key elements of the program:
- The employer reduces or waives co-pays for diabetic drugs and supplies
- Patients commit to education and face-to-face coaching on diabetes self-management in return for reduced drug costs
- Pharmacists are trained as diabetes coaches to assist patients on a regular basis.
MBGH partners with the Illinois Pharmacist Association to train pharmacists in patient education, monitoring of clinical conditions, and motivation according to guidelines of the American Diabetes Association. The objective is to enable patients to reach individual goals for medication compliance, fitness, and weight management.
"The results of this program show the effectiveness of having pharmacists establish relationships with program participants to serve as diabetes coaches," says Starlin Haydon-Greatting, RPh, clinical project coordinator, Illinois Pharmacists Association. "In addition to the physician community, the involvement of pharmacists serving as coach, clinician and cheerleader for patients has been invaluable in helping patients manage their diabetes."
The first-year results looked at 86 participants who received benefits from four Chicago-area based employers: the City of Naperville, Jewish Federation of Metropolitan Chicago, Hospira and Pactiv Corp.
MBGH was one of more than 30 employer groups throughout the country that participated in the Diabetes Ten City Challenge, a national employer-based diabetes self-management program conducted by the American Pharmacists Association (APhA) Foundation through its HealthMapRx program.
Results of the Challenge, released in April by the Foundation, demonstrate how employers and pharmacists can work together to help diabetics manage their disease and reduce healthcare costs.
The data are scheduled for publication in a peer-reviewed article in the May/June issue of the Journal of the American Pharmacists Association. They show that average total healthcare costs were reduced annually by $1,079 per patient compared with projected costs if the Challenge had not been implemented, according to an announcement from the Diabetes Ten City Challenge, sponsored by the APhA Foundation with support from GlaxoSmithKline.
Aggregate data for 573 participants, who were in the program for an average of 14.8 months, show patients save an average of $593 per year on their diabetes medications and supplies because employers waived their co-pays to encourage participation in the program.
The analysis also reveals improvements in key clinical measures-including A1C (blood glucose), cholesterol, and blood pressure-and increases in preventive care measures, including the number of people with current influenza vaccinations, eye exams, and foot exams.
June 29, 2009
Pharmacists need a place at the health reform table
By Natalie D. Eddington
To help guarantee health care reform that reduces costs and builds "health care teams that work" (to use President Barack Obama's words), pharmacists must play a key role in the planning process being undertaken by the federal government.
The health care reform principles being considered are well grounded in developing strategies to promote the prevention and management of chronic diseases. Essential to the success of those strategies is the fully integrated role of pharmacists, the country's most accessible health care professionals.
Patients' easy access to their pharmacists results in adherence to medications, a critical issue in disease management and control. In the United States, medications comprise approximately 10 percent of health care expenditures, and a staggering $117 billion of this is attributed to medication misuse and patient noncompliance. Adherence to, or the appropriate use of, medications is especially problematic for patients with chronic diseases such as diabetes and hypertension.
In addition to their role in dispensing medications, pharmacists provide chronic disease management programs that promote patient wellness, reduce costs and prevent medication errors. With extensive expertise in appropriate medication therapy and an understanding of adverse effects of medications, pharmacists can identify drug interactions, administer lifesaving immunizations and alert patients if they need more urgent care.
In community pharmacies in almost every state today, pharmacists customize their roles in direct patient care, coaching patients on disease, diet, health goals and the importance of properly taking their medicines. In groundbreaking programs, such as the Asheville Project in North Carolina and the P3 (Patients Pharmacists Partnerships) Program in Maryland (both diabetes management programs) pharmacists foster appropriate medication therapy management for the patients, complementing the treatment and counsel provided by a patient's physician.
The American Pharmacists Association Foundation's Ten City Challenge Project, which followed the Asheville model, showed a decrease in health care costs of $1,079 per patient compared with projected costs if the program had not been implemented. It also showed an increase in the number of patients achieving health care goals established by the American Diabetes Association.
In Maryland, the innovative P3 Program, launched by the University of Maryland School of Pharmacy, has also shown a reduction in health care costs and improvements in specific health care clinical endpoints while reaching populations with long histories of lack of access to health care. Pharmacists have proved that their expertise in drug therapy and their active engagement in chronic disease management programs improve health and reduce costs.
Recently, thought leaders from the pharmacy profession representing academia, industry, community pharmacies and professional organizations gathered at the University of Maryland School of Pharmacy for a round-table discussion on pharmacists' potential role in the federal government's health care reform plans. The group was greatly disappointed that the White House had neglected to invite a representative of the pharmacy profession to sit at the health care reform table. There was a clear and strong consensus in the group that pharmacists must play a key role in that reform.
Based in community pharmacies on nearly every street corner in the country, and in hospitals, clinics and long-term care settings, pharmacists have clearly demonstrated their impact on improving health and reducing costs.
The federal government is now in the process of defining the details of health care reform, and from the pharmacy perspective, successful reform must include insurance reimbursement for pharmacist services beyond dispensing, including chronic disease management, medication therapy management programs and the administration of lifesaving immunizations.
A successful health care reform package must also include community-based programs delivered by pharmacists that have proven track records, programs that have amassed evidenced-based data on pharmacy services' impact on those goals of improving health care and reducing costs.
Pharmacists must be included as reimbursable providers under any health care reform, and patients should have access to these services without restrictions.
Natalie D. Eddington, dean of the University of Maryland School of Pharmacy, is a member of the American Pharmacists Association, the American Association of Colleges of Pharmacy, the American Society of Health-System Pharmacists and the National Community Pharmacists Association. Her e-mail is firstname.lastname@example.org.
June 29, 2009
PROGRAM TACKLES COST OF CARE
A program in which employers, pharmacists and people with diabetes collaborate to attempt to rein in skyrocketing diabetes-related health care costs and improve patient health shows significant promise, according to the American Pharmacists Association (APhA) Foundation.
In the Diabetes Ten City Challenge (DTCC), conducted by APhA with support from GlaxoSmithKline PLC, 30 employers in 10 cities set up a voluntary health benefit for employees, dependents and retirees with diabetes (see story on page 208 on the Midwest Business Group on Health, one of the DTCC participants).
Under the DTCC program, employers waived co-payments for diabetes medications and supplies if patients met regularly with a local pharmacist “coach” who helped them track their blood sugar levels and cholesterol and encouraged them to manage their disease through exercise, nutrition and lifestyle changes.
The specially trained pharmacists also communicated with the patients’ doctors when necessary.
Data released recently on 573 diabetes patients enrolled in the program for at least one year show that average total health care costs were reduced annually by nearly $1,100 per patient, or 7.2%, compared with projected costs without the DTCC program. Patients saved an average of $593 per year on their diabetes medications and supplies.
Major improvements in key health measures also were evident, including a 23% increase in the number of patients achieving the American Diabetes Association blood sugar level goal, an 11% increase in the number of patients reaching optimal cholesterol levels and a 39% increase in the number of patients getting their blood pressure under control.
Study results appear in the May/June issue of the Journal of the American Pharmacists Association.
The DTCC model is being implemented through HealthMapRx, a program started by the APhA Foundation in 2007 for diabetes and other chronic diseases. HealthMapRx is now a partnership of the Foundation and Mirixa Corp.
The nonprofit Midwest Business Group on Health (MBGH) has announced first-year results of Taking Control of Your Health (TCYH), an employer-based diabetes management program. The results indicate high satisfaction, cost savings and improvement in key clinical indicators used to measure how well a patient is managing diabetes.
MBGH was one of 30 groups throughout the country that participated in the Diabetes Ten City Challenge.
Under the TCYH program, the employers realized a savings of $1,467 per participant in just one year, or $126,162 for all 86 participants, compared with projected costs for diabetics not in the program. Average total health care costs for participants declined by almost $625.
With over 200 participating patients, TCYH is open to covered employees, dependents and retirees from employer members of MBTH. It has three elements: employers reduce or waive co-pays for diabetic drugs and supplies; patients sign an agreement committing themselves to education and face-to-face coaching on diabetes self-management in return for reduced drug costs; and pharmacists are trained as diabetes coaches to assist patients.
June 23, 2009
America’s Health Care Priorities IV: Businesses, Competition and Innovation
By Catherine Rampell
Economix asked all sorts of health care experts and stakeholders this question: What should the priorities for health care reform be?
We are running their responses in loosely-themed batches throughout the day. The third batch - about businesses, competition and innovation - is below. Find other proposals from economists, patient and consumer advocates, doctors, insurance companies, tax and public finance experts and more here.
Controlling Chronic Diseases
Billy Tauzin is the president and chief executive of Pharmaceutical Research and Manufacturers of America (PhRMA). He is a former United States congressman from Louisiana.
A flurry of activity is taking place on Capitol Hill as Congress explores ways to hold down the cost of health care reform. President Obama has repeatedly stressed that as a nation, we spend more than $2 trillion a year on health care yet many patients are not getting the quality care they need to better fight their disease. While many proposals have been put on the table to help address these concerns, one extremely promising topic must stay front and center in the debate: reducing the devastating impact of chronic disease.
Collectively, chronic diseases like cancer, diabetes and heart disease are the greatest drivers of health care spending in the United States. They hurt the American economy and, most importantly, they affect the health, well-being and productivity of millions of Americans.
If we don't act soon to better equip ourselves to win the fight against the growing epidemic of chronic disease, our health care security - and economic security - will surely continue to be threatened.
This is the problem: 75 percent of all health care spending in the United States involves the treatment of chronic disease. In America, more than 162 million cases of seven chronic diseases were reported in 2003. The annual cost of treatment for just those seven chronic diseases was $277 billion. The costs associated with lost productivity were even greater: $1 trillion, for a total cost of $1.3 trillion.
We now live in a country where more than half the adult population is overweight, and obesity is an ever-growing problem. Current obesity trends are frightening: If they continue - to cite just one shocking example - one of every three children born in 2000 will get diabetes in his or her lifetime.
It is well-known that exercise, healthy eating and medicines can help prevent and manage diabetes. The good news is that there are chronic disease management programs that are gaining more traction around the country - like the Diabetes Ten City Challenge – that offer free screenings and medicines to participants suffering from diabetes. These programs are modeled from the Asheville Project in North Carolina, a diabetes management program that helped patients bring their blood sugar under control within a year and yielded an average 34 percent savings in health care costs.
Such innovative initiatives bring together public officials, local businesses, health care professionals and patients. The value differs for each participant, but they all share a common goal: reducing the effects of disease. If pursued on a nationwide scale, such approaches offer great promise to significantly improve patient care and decrease costs.
At this point in the health reform process, it's all about the numbers. While the Congressional Budget Office has begun to score health reform proposals to help calculate the price tag for reform, it hasn't scored the potential savings to the federal government of chronic disease prevention and management programs. It's admittedly difficult to quantify the long-term impact of prevention initiatives, but we are seeing more and more evidence from smaller-scale programs like the Ten City Challenge of the potential economic impact of such coordinated approaches. We believe such programs are critical long-term investments that will help bend the curve and also improve and save lives.
We firmly encourage Congress and the administration to ensure that prevention and wellness remain core principles of health care reform - and we remain committed to working with all stakeholders to help enact a health reform bill this year that ensures all Americans have access to high-quality and affordable health care coverage.
JUNE 19, 2009
MANY DON’T FOLLOW THE DOCTOR’S ORDERS
BY ERNEST BOYD
OHIO PHARMACISTS ASSOCIATION
Affordable, accessible and quality - these are the terms most often used to describe the health care system we all hope to achieve. However, there is another term that all too often goes unmentioned, yet it's as critical as the others - adherence.
The idea of "following doctor's orders" may sound simple enough, but too often the doctor's advice to manage disease through diet and exercise, smoking cessation, taking medications properly or following other treatment regimens is not followed.
The Centers for Disease Control National Health and Nutrition Examination Survey of 2008 found many cases of chronic disease are undiagnosed, untreated or uncontrolled. Improving adherence among those with chronic illness can reduce overall health care spending. For example, better adherence to diabetes medications would significantly lower total health spending: for every $1 spent on diabetes medications, $7.10 less is spent on other health care services.
The Diabetes Ten City Challenge is a great example of how adherence can make a difference. This successful program worked through employers to incentivize employees and dependents to better manage their diabetes care. Using a team approach of pharmacist coaches, physicians, and community health resources, the results were outstanding. Total health care costs for the participating employers were significantly reduced, as was absenteeism and workers' compensation claims.
Medication adherence is the extent to which the patient follows the doctor's instructions about the timing, dosage and frequency of prescribed medicines. However, many patients acknowledge not taking their medicines as directed.
According to the New England Journal of Medicine, (2004), among patients who actually fill their prescriptions, 50 percent to 60 percent don't take their medicines as prescribed, meaning they skip doses, take less than the recommended amount, or stop taking the medicine earlier than they are instructed to do so.
Successful treatment of disease depends on the patient both receiving appropriate medical advice and following it. Pharmacists play an important role in helping patients adhere to prescription labels and to stick with an overall treatment regimen. Along with health care providers and patients, we all should strive for better adherence rates as one way to help improve our health care system.
There are many reasons for the ability, or inability, to follow doctor's orders. Certainly, some patients are unable to afford treatment costs or co-payments, or lack even adequate access to care.
Right now, Congress is preparing for sweeping changes to our system of health care. Our federal leaders are addressing the cost of health care and how to increase access for all. Lawmakers also must consider the quality of health care and how to encourage healthy lifestyles and adherence to treatment regimens.
June 18, 2009
Pharmacists Have Solution to Address White House’s Economic Case for Health Care Reform
The American Pharmacists Association (APhA) recently applauded the report by the White House Council of Economic Advisers (CEA) which provides a comprehensive analysis of the economic impact of health care reform.
The report provides an overview of current economic impacts of healthcare in the United States and a forecast of where we are headed in the absence of reform; an analysis of inefficiencies and market failures in the current health care system; a discussion of the key components of health care reform; and an analysis of the economic effects of slowing health care cost growth and expanding coverage, points out a recent APhA news bulletin.
"The CEA report makes clear that the total benefits of health care reform could be very large if the reform includes a substantial reduction in the growth rate of health care costs," the document noted. "This level of reduction will require hard choices and the cooperation of policymakers, providers, insurers, and the public. While there is no guarantee that the policy process will generate this degree of change, the benefits of achieving successful reform would be substantial to American households, businesses, and the economy as a whole."
"We are pleased to see the White House acknowledging the economic impact of workers with chronic diseases that are not optimally treated," said Thomas E. Menighan, APhA executive vice president and CEO-designate.
"Reducing absenteeism and increasing workers' productivity when they are on the job have been real keys to the Asheville Project and other APhA Foundation projects that demonstrate the effectiveness of pharmacist medication therapy management interventions. We at APhA are working hard to make sure MTM services are included in health care reform legislation, and we are especially pleased to see growing support for this concept from our colleagues in medicine, employer and consumer organizations, and the pharmaceutical industry."
"American hospitals, physicians, pharmaceutical companies, and academic researchers have developed techniques and prescription drugs that permit the treatment of a host of previously untreatable conditions," CEA explained. However, despite leading the world in GDP devoted to healthcare, the health care system in the United States trails a host of countries in life expectancy of men and women.
An increasing evidence base indicates that pharmacists help keep health care costs down through pharmacist-provided patient care services, such as educating patients on how to take their prescription medications properly and safely, as well as administering health screenings and immunizations. With current costs to the health care system to treat chronic diseases at $1.3 trillion annually, taking medications properly can help prevent the need for catastrophic or emergency care.
Patient care programs like the APhA Foundation's Diabetes Ten City Challenge and the Asheville Project, demonstrate how employers and pharmacists can work together to help people manage their chronic disease and reduce health care costs. In the Asheville Project; days of sick time decreased every year (1997-2001) for one employer group, with projected increases in productivity estimated at $18,000 annually. These programs utilize pharmacists as the patient's health care coach. Pharmacists stand ready to be part of the solution and active participants in developing the framework for a reformed health care system, concluded APhA.
June 15, 2009
Diabetes Ten City Challenge demonstrates positive clinical, economic outcomes
Final program results published in JAPhA show success of pharmacist interventions
The Diabetes Ten City Challenge (DTCC) - an employer-funded, collaborative health management program using community-based pharmacist coaching, evidenced-based diabetes care guidelines, and self-management strategies - demonstrated positive clinical and economic outcomes, according to results published in the May/June 2009 Journal of the American Pharmacists Association (JAPhA). For 573 patients with diabetes who had baseline and year 1 medical and pharmacy claims and two or more documented visits with pharmacists, statistically significant improvements were observed for mean glycosylated hemoglobin (A1C; decrease from 7.5% to 7.1%, P = 0.002), mean low-density lipoprotein cholesterol (decrease from 98 to 94 mg/dL, P < 0.001), and mean systolic blood (decrease from 133 to 130 mm Hg, P < 0.001) over a mean of 14.8 months of participation in DTCC. Other Health Plan Employer Data and Information Set (HEDIS) diabetes process-of-care indicators, such as influenza vaccination rate (from 32% to 65%), eye examination rate (57% to 81%), and foot examination rate (34% to 74%), improved for patients between the initial and final evaluation periods. Average total health care costs per patient per year were reduced by $1,079 (7.2%) compared with projected costs.
Pharmacist 'coaches' at center of model's success
DTCC - an implementation of the Patient Self-Management Program for diabetes - is modeled after several successful APhA Foundation programs and other projects that tested the pharmacist "coach" model for managing chronic diseases such as asthma, cardiovascular disease, high cholesterol, and osteoporosis. Earlier this year, the APhA Foundation announced a partnership with Mirixa Corporation, the nation's largest pharmacy-based patient care network, to offer the DTCC collaborative care model to employers nationwide for diabetes and other chronic diseases through Health-MapRx. Supported by GlaxoSmithKline, DTCC worked via the establishment of a voluntary health benefit for employees, dependents, and retirees with diabetes by self-insured employers. A total of 30 employers in 10 cities waived copayments for diabetes medications and supplies if participants met regularly with a pharmacist coach, who helped patients manage A1C, blood pressure, and cholesterol and recommended exercise, nutrition, and other lifestyle changes as needed. After each patient visit, pharmacists communicated with physicians and, if necessary, referred patients to other health care providers for additional care or education.
"The Diabetes Ten City Challenge demonstrated the power of partnership and the impact of putting patients at the center of their own care," said Toni Fera, BPharm, PharmD, Director of Patient Self-Management Programs for Health-Map RX
Driving fundamental change in U.S. health care
According to study authors Fera, Benjamin M. Bluml, BPharm, and William M. Ellis, BPharm, MS, of the APhA Foundation, DTCC and the process of care used provide a promising model that blends important elements of a "reformed" health care delivery process by integrating accessibility, patient-centered focus, and value achieved by helping patients make clinical improvement while managing costs. The APhA Foundation has observed several factors driving successful program implementation, including employers that are willing to invest in incentives for patients and providers to improve health and lower costs. Successful networks have a robust infrastructure to handle administrative functions, operational processes, and clinical coaching; an effective system of performance-driven accountability; a wide-ranging geographic reach of its pharmacists; and an ability to lead in client service. The authors also expect advances in health information technology to aid in the expansion of the model used in DTCC. According to the American Diabetes Association, 23.6 million individuals in the United States have diabetes, 5.7 million of whom are unaware that they have the disease. The direct cost of diabetes totaled $174 billion in 2007, translating to $1 of every $5 spent on health care being attributed to the disease. "Chronic disease is responsible for 7 of 10 American deaths and 75 percent of the nation's $2.2 trillion health care bill," said Ellis, who is CEO of the APhA Foundation. "The collaboration between the APhA Foundation and Mirixa through HealthMapRx provides an opportunity to transform health care delivery in local communities and drive fundamental change in the U.S. health care system. Our goal is to make this model as widely available as possible and encourage employers to invest in helping their employees manage all chronic conditions."
June 4, 2009
PHARMACISTS SAY: Pharmacists want to be paid more to better manage patients’ care
By helping patients make better choices, pharmacists say they can help save billions
Drugstore giant Walgreen Co.'s chief executive, Greg Wasson, would like to have his army of "coaches" taking on a greater role for President Barack Obama should the White House and Congress come together to expand health-insurance coverage to the nation's uninsured.
With more than 25,000 pharmacists at Walgreens stores alone, the chief executive of the nation's largest pharmacy chain sees his company's efforts go beyond just filling prescriptions as part of a solution he calls medication therapy management.
By helping patients stick to taking their medications and making better and more cost-effective choices, Wasson believes the country's pharmacists could help save billions of dollars in medical-care costs. That money could be used to provide benefits to more people.
When patients don't take their medications, they can become sicker. It's not uncommon to see them wind up in the hospital, emergency room or in need of a surgery that costs thousands of dollars.
"Fifty percent of patients are non-compliant with their medications after the first four or five months," Wasson said. "That costs the health-care system."
To make medication therapy management work, Wasson said, pharmacies would need to be paid more. Drugstores have long complained about the fees they are paid to dispense drugs, typically from $2 to $4 per dispensed prescription; Walgreens says costs are more than $10 per prescription.
Payments to pharmacies also would need to include the time to provide patient consultations, plus wellness advice and other tips.
Neither Walgreens nor lobbyists for the pharmacy industry are providing specifics on how much drugstores would need. But getting pharmacists more involved has shown to be successful on a small scale. The Midwest Business Group on Health launched a pilot program in 2007 in which pharmacists helped four Chicago employers lower costs for workers with diabetes by more than $1,400 per employee in one year.
The Illinois Pharmacists Association trained about 200 pharmacists to coach diabetics in the program to "enable patients to reach individual goals for medication compliance, fitness and weight management," the Midwest Business Group's program description says.
Direct and indirect costs of diabetes to the U.S. health-care system are more than $130 billion a year and include emergency room visits, hospital stays and absenteeism, the Chicago group said, citing national studies. Given diabetics are on many more medications than the average person who takes drugs, Wasson sees his army of pharmacists being able to rein in costs through medication therapy management across a broad spectrum of ailments and diseases.
"Pharmacists can play a key role," Wasson said. "Pharmacists are the most accessible health-care provider and one of the most trusted professionals next to nurses.
June 1, 2009
PHARMACY-LED DIABETES PROGRAM SAVES BIG
By: Fred Gebhart, Contributing Editor
- The Illinois program was part of the nationwide Diabetes Ten City Challenge, coordinated by the APhA Foundation.
- The program centers on pairing each patient with a personal pharmacist who coordinates care, teaches diabetes management, and coaches lifestyle changes.
- After one year, patients showed improvement in HbA1c, BP, LDL cholesterol, weight, and BMI.
- Not only did companies save $1,467 per patient per annum; they reported lower absenteeism, higher productivity, and higher employee morale.
Chicago-area employers cut healthcare costs by almost $1,500 per person per year using Taking Control of Your Health (TCYH), a pharmacy-based treatment program for employees with diabetes. The Illinois program was part of the nationwide Diabetes Ten City Challenge (DTCC) project coordinated by the American Pharmacists Association (APhA) Foundation.
"This wasn't an untried program; it was based on the Asheville Project, which works - and works extremely well," said Pamela Hannon, director of benefits and employee health services for Hospira Inc., a maker of medical equipment.
"We're not focusing on diabetes, we're focusing on the total person. Diabetes is typically just one of several conditions, along with cardiovascular disease, cholesterol, weight problems, exercise, diet, you name it. It makes absolute sense to treat the person and not the disease."
A dedicated, hands-on provider is key to the program, Hannon said. Every patient has a personal pharmacist who monitors and coordinates care, teaches diabetes management, and coaches lifestyle changes. Participants start with a one-hour pharmacist consultation, then have follow-up visits every other month, with telephone or e-mail consults as needed. The goal is to help patients take control of their lives.
"Pharmacists have the skills and the training to empower patients to take ownership and control of their condition," said participating pharmacist Starlin Haydon-Greatting, who is also clinical program coordinator for the Illinois Pharmacists Association (IPhA).
"When you are eye to eye with someone, holding their hand, checking their feet, you can change lives. Personal involvement is how adult education and lifestyle change happen."
Hospira, the City of Naperville, the Jewish Federation of Metropolitan Chicago, and Pactiv Corp., the maker of Hefty garbage bags, enrolled more than 200 diabetic employees in TCYH.
The program was coordinated by the Midwest Business Group on Health (MBGH), based in Chicago. MBGH member companies spend more than $2.5 billion on healthcare annually year for over two million people.
Employers eliminate or reduce diabetes-related co-pays for employees who join TCYH. The IPhA trained more than 200 pharmacists and created a statewide network to provide diabetes-care services. The program began in 2007
and is still growing.
"We liked the concept of direct contact," said MBGH Executive Director Larry Boress. "Disease management companies focus all of their efforts on 10 to 15 percent of the chronic disease population. This gives everyone personal attention. It was just a matter of convincing our employers to try a new approach. Now that we have hard data, we are reaching out to other companies and public employers."
After one year, participants showed statistically significant improvement in hemoglobin A1c, systolic and diastolic blood pressure, LDL cholesterol, weight, and body mass index. Employers saved $1,467 in direct healthcare costs per employee during the 12-month trial. Companies also reported lower absenteeism, higher productivity, and higher employee morale.
Chicago-area companies did better than DTCC participants nationwide. Data published in the May/June issue of the Journal of the American Pharmacists Association showed mean annual savings of $1,079 per employee. In Chicago and in the national sample, clinical improvements were similar.
"You have to get employer buy-in for this to expand," said incoming IPhA President Dennis Bryan. "Saving more than $1,400 per employee per year is going to get their attention in a hurry."
Each employer negotiated its own network contract, Haydon-Greatting said. In some cases, employees visit nearby chain, independent, or hospital pharmacies for care. Haydon-Greatting works with employees at Pactiv, which provides consulting space at the company work site. Fees paid to pharmacists vary by contract, but hourly rates are comparable to those paid for pharmacy relief work in the same geographic area. Pharmacists are paid directly by participating employers.
"We hope that other employers and government sees that paying pharmacists for care services is a direct benefit," she said. "We cut employers' healthcare costs for these employees dramatically."
May 29, 2009
Haydon-Greatting and Midwest Business Group on Health: Standing on Chicago’s “big shoulders”
Legislators can look to Obama's home state for great example of MTM.
The Diabetes Ten City Challenge (DTCC) article published in the May/June issue of the Journal of the American Pharmacists Association included data from 8 of the 10 areas involved in the effort. Beginning the Asheville-like interventions later, four Chicago-area employers have now analyzed their data on 86 workers, and the results are even more impressive than those reported earlier about this APhA Foundation project.
Starlin Haydon-Greatting, a Springfield, IL, pharmacist who helped the Illinois Pharmacists Association (IPhA) recruit and train pharmacists for the medication therapy management (MTM) project, told pharmacist.com how gratifying it is to see community-based MTM efforts finally succeeding. Haydon-Greatting, who worked with the Illinois Medicaid program for 17 years, noted, "All the things we have done since 1990 is allowing this to happen. Back then, we didn't have the data, and people didn't grasp why pharmacists needed an identifier number. But now we have employers asking for the services and a large group of patients who can tell others what pharmacists have done for them."
What they can do is impressive, the data show. The Midwest Business Group on Health reported on the DTCC effort, which is called the Taking Control of Your Health (TCYH) program in Chicago, earlier this month. Employers' return on investment per participant was $1,467 or $126,162 for all 86 participants, compared with the projected costs for patients with diabetes not in the program. Average total health care costs for participants declined by almost $625.
The TCYH program, which now has more than 200 participating patients, is open to covered employees, dependents, and retirees from employer members of the Midwest Business Group on Health. Haydon-Greatting first became involved in certificate training of pharmacist-coaches as a volunteer with IPhA. She is now a consultant handling that program and helping to expand into cardiovascular diseases. She also works with an IPhA advisory board with faculty representatives from five area schools of pharmacy.
In addition to the Chicago sites, Haydon-Greatting noted that other Illinois locations, especially Quincy, is handling even more patients than the Chicago program. After years of working in the government though, she wonders, "What is the likelihood that the federal government will see what pharmacists are doing in the current debate over health care reform?"
Maybe the Obama administration will be different, she hopes, adding that government always links to things that have happened before. Haydon-Greatting will be there, telling her Members of Congress about the DTCC effort, MTM, and pharmacists' capabilities.
Will you? Pharmacists could do well to replicate for the profession the actions described about Chicagoans by Carl Sandburg in his poetic tribute to the "city of big shoulders": "Come and show me another city with lifted head singing so proud to be alive and coarse and strong and cunning."
May 18, 2009
Employers in Diabetes Wellness Project Experience Decline in Health Care Costs
A program that linked diabetics with pharmacist "coaches" for face-to-face discussions about managing diabetes improved patient health outcomes and reduced employer costs, the project's director told BNA.
Results from the American Pharmacists Association (APhA) Foundation’s Diabetes Ten City Challenge indicated that average total health care costs per patient per year decreased by $1,079, or 7.2 percent, when compared with projected costs.
The results, published in the May/June edition of the Journal of the American Pharmacists Association, were based on medical and pharmacy claims for 573 project participants. Individuals who took part in the program for at least 14.8 months also showed reductions in glucose, cholesterol, and blood pressure levels, among other health improvements, the study noted.
"We wanted to see what way we could improve our financial outcomes, short of passing on higher premiums and greater deductibles to employees," Jason Hopkins, HR director at Hamilton Health Care System, told BNA.
"What this project demonstrates is an opportunity to transform health care delivery in communities by encouraging employers to invest in helping their employees manage chronic disease," project director William Ellis, executive director and chief executive officer of the APhA Foundation in Washington, D.C., told BNA May 5.
Thirty U.S. employers in 10 geographic areas took part in the program, sponsored by the APhA Foundation with support from pharmaceutical giant Glaxo-SmithKline Inc. The project, which began in January 2006 and ended in December 2007, was open only to employers that are self-insured, the journal article said, "and therefore at risk for medical and prescription costs for their employees and other beneficiaries under the established health plan."
To participate, employers agreed at a minimum to waive copayments for diabetes medications and certain supplies for eligible employees and retirees, and their dependents who volunteered for the project. In exchange, participants signed agreements to commit to specified diet and exercise regimens and to take prescription medications as directed by their pharmacists and medical providers. Patients who did not adhere to the agreement were dropped from the program.
Employer Took Action to Curb Rising Costs.
Hamilton Health Care System Inc. in Dalton, Ga., jumped at the chance to participate in the diabetes program, said HR Director Jason Hopkins. "We wanted to see what way we could improve our financial outcomes, short of passing on higher premiums and greater deductibles to employees," he told BNA May 6. Hopkins said diabetes and related conditions among Hamilton's 1,500 benefit-eligible employees comprised 20 percent of its health plan costs. This influenced the chief executive officer to suggest enrolling in the diabetes challenge.
Hamilton was alerted to the program by Northwest Georgia Healthcare Partnership, a community-based organization in Dalton that addresses the health care needs of 130,000 residents in Whitfield and Murray counties.
"We took the lead because we had a consumer education workgroup that has been struggling with the epidemic problem of diabetes in our community," Nancy Kennedy, executive director of Northwest Georgia, told BNA May 6.
Communication Is Key.
Hopkins said that, based on prescription drug claims, Hamilton identified 250 employees who were affected by diabetes and invited them to learn about the project. A total of 34 employees volunteered to participate. "I really feel like we could have communicated this even better," he said. "I believe there are groups of associates who know they have these conditions and need to know more about the program and how easy it is to sign up for it."
Kennedy agreed. "One of the most important pieces is the employers doing their due diligence up front," she said. "Employers should present this in a way so employees understand what the company is doing and why it is doing it."
After participating in the Diabetes Ten City Challenge for a year, Hamilton was saving $611 in health care costs per participant. "We believe the savings will be even greater in subsequent years," Hopkins said. Hopkins said Hamilton now offers a similar wellness program for eligible individuals who have cardiovascular conditions such as hypertension. A total of 200 participants are enrolled in the diabetes and cardiovascular programs.
May 15, 2009
Pharmacy jobs in Florida projected to grow 23 percent
by Margie Manning Senior Staff Writer
Tampa General Hospital has doubled the number of pharmacists on its staff since 2001 and is looking for more. So is the James A. Haley Veterans Administration Hospital.
There's a continuing shortage of pharmacists nationwide, and Florida, with its above-average number of senior citizens, ranks among the states most in need of professionals who dispense medications and, increasingly, provide medication management, according to industry groups and academics.
The Florida Agency for Workforce Innovation has projected employment in the field of pharmacy to grow by 23 percent between 2008 and 2016, or 2.92 percent average growth per year, which is much faster than the average for all occupations projected by the agency.
The U.S. Department of Health and Human Services estimated in December that there would be a shortfall of 29,000 pharmacists by 2020. By 2030, there's expected to be 38,000 fewer pharmacists than are needed, the department said.
The current economic downturn has slowed hiring somewhat, said Kevin Sneed, clinical director and assistant dean of the division of clinical pharmacy at USF Health. Additionally, shortages of pharmacists are more regional than they have been in the past with more job openings in rural areas than the Tampa-St. Petersburg metro area, said Gary Levin, dean of the School of Pharmacy at Lake Erie College of Osteophathic Medicine in Bradenton.
But as the population ages and the first wave of baby boomers turns 65 in 2010, there will be "tremendous opportunity" for pharmacists, said Sneed, who has a major role in developing the four-year doctor of pharmacy, or PharmD, program that University of South Florida expects to begin in 2011.
People under 65 annually consume 10.1 prescriptions on average, while those 65 and over consume 23.5 prescriptions on average, according to an assessment of pharmacist work force needs prepared for USF Health.
70 career paths
The demand for pharmacists is closely tied to the number of retail prescriptions, which grow in volume each year, the USF analysis said.
But dispensing medicine in a retail store is only one of about 70 career paths within pharmacy, said Levin.
Pharmacists can help manage medication therapy for patients with chronic illnesses and those enrolled in the Medicare prescription drug program. Some give immunizations. Many work in nursing homes because every long-term care facility in Florida is required to employ a consulting pharmacist, Sneed said.
Others work at hospitals, such as the Haley VA facility, which Sneed said has gone from a staff of 50 six years ago to 90 currently.
There were about 35 pharmacists on staff at Tampa General in 2001 when Earnest Alexander was hired. Now, there are about 70 to 75 pharmacists on staff, said Alexander, manager of clinical pharmacy services. They not only dispense medications but also are charged with making sure it's the right medication given the patient's condition, history and ability to tolerate the drug.
The hospital’s transplant center and its intensive care and burn units require pharmacists with specialized knowledge, as do its 11 disease-specific accreditations and certifications, Alexander said.
Pharmacists also work at pharmacy benefit managers, companies that process pharmacy claims and operate mail-order pharmacies through which they ship prescriptions to patients. WellDyneRx Inc., a national PBM that recently
opened a facility in Lakeland, currently employs three pharmacists, but as it ramps up operations, it could have as many as 100 pharmacists over the next few years, said Damien Lamendola, president and CEO.
Another employment model is Walgreen Co. (NYSE: WAG), which has large numbers of pharmacists working out of a central distribution center where they fill prescriptions that are shipped to retail stores for pickup by customers. The program was rolled out in nearly 400 Florida stores last year and early this year and is expected to be in place in every Walgreens in Florida by year's end.
It was developed as a way to deal with a shortage of pharmacists and also to allow pharmacists in the stores to become more patient-oriented, Levin said.
Depending on the position, pharmacy generally is a six-figure job, Sneed said. Pharmacists right out of school start at about $100,000 at Tampa General, Alexander said. Signing bonuses sometimes are offered for positions in
which the pharmacist works overnight or has a particular specialty. A signing bonus is more likely to fill a position in a rural area, not in the Tampa metro area, Levin said.
The demand for pharmacists in Florida is strong enough that neither Sneed nor Levin expects the planned USF pharmacy program to impact enrollment at the five existing programs in the state, including at LECOM.
"University of Florida had over 2,000 applications for 300 spots in 2007, and we've seen similar numbers and ratios in other schools," Sneed said. "We don't see ourselves as competing. We see ourselves as offering more."
The cost of caring for a patient with diabetes fell by $1,079 a year when a pharmacist "coach" worked with the patient, according to a study sponsored by the American Pharmacists Association Foundation.
The "Diabetes Ten City Challenge," which covered the Tampa Bay area and nine other communities, found that pharmacists and employers working together to help people manage their diabetes also led to improved clinical outcomes.
Although the study showed positive results, many pharmacies could not offer the same level of coaching services right now, said William Ellis, CEO of the Foundation and study co-author. He said the following should happen:
- Pharmacies need to redesign space to create private consultation rooms
- Electronic health information systems are needed for better data exchange
- Employers need to view pharmacy coaching services as a long-term savings and not solely as an expense
- Payors have to change the way they reimburse pharmacists to include payment for coaching services.
May 13, 2009
Investing in Health at Work
By Michael M, GSK Communications
President Obama held a roundtable discussion at the White House on Tuesday with the CEOs of several employers that have found innovative ways to lower health care costs and improve the health of employees.
There are a number of employers out there that have recognized that the driver of healthcare costs in this country is the epidemic of chronic diseases--diabetes, asthma, heart disease - and that many of these diseases can be prevented or better managed, which may result in lower spending on healthcare in the long run. So these employers--companies like Pitney Bowes and GSK, and cities like Asheville, New Orleans, and the participants of the Diabetes Ten City Challenge, and the CEO Roundtable on Cancer--have instituted what has come to be known as value-based benefit design/health management.
The goal is to make it easier for employees to take an active part in managing their health by implementing work-based programs to encourage and support them to make behavioral changes to prevent obesity, control diabetes, exercise, etc. The work-based initiatives range from on-site gyms and healthy cafeteria options to eliminating copays for medicines that treat chronic diseases.
In a fact sheet release by the White House, the Administration noted that "...employers are discovering that improving quality of care can reduce health care costs. Small actions in the workplace can generate large benefits."
"The President hopes that by encouraging more employers to adopt similar programs, we can improve the productivity of our workforce, delay or avoid many of the complications of chronic diseases, and slow medical cost growth," the statement said.
These companies have been investing in prevention and disease management programs, and many are seeing savings. I think I'll send the President the link to GSK's Center for Value-Based Health Management.
May 7, 2009
Diabetes care: Employers save money after lowering costs for employees’ preventive care
Study finds that employees took better care of themselves without a co-pay, saving money on emergency care, absenteeism
By Bruce Japsen | Tribune reporter
Chicago employers lowered costs for their workers with diabetes by more than $1,400 per employee over a year's time thanks to an experimental program that helped pay for their drugs and provided consultations at the pharmacy counter.
The pilot program, launched in 2007, saved four area employers $1,467 per worker, or more than $126,000, said the Midwest Business Group on Health, a Chicago-based coalition of employers that coordinated the program. There were 86 workers from Hospira Inc., Pactiv Corp., the City of Naperville and the Jewish Federation of Metropolitan Chicago that participated in the program from July 1, 2007, to June 30, 2008. Given the program's success, Midwest Business Group is hoping more employers participate in the future.
Direct and indirect costs of diabetes to the U.S. health-care system are more than $130 billion a year and include emergency room visits, extended hospital stays and absenteeism, the Chicago group said, citing national studies. About 20 million people have diabetes, including more than 600,000 in the Chicago area.
"Not only did we realize an improvement in clinical indicators and cost savings, but we were pleased to see a high level of satisfaction from our participating employees regarding their overall diabetes care," said Judith Hearn, health and welfare manager for Pactiv, the Lake Forest-based maker of Hefty garbage bags.
As part of the program, employers waived or reduced the so-called co-payment or co-insurance in hopes that workers with diabetes would take better care of themselves and avoid costly hospitalizations. In addition, the Illinois Pharmacists Association trained about 200 pharmacists to "coach" diabetics in the program to "enable patients to reach individual goals for medication compliance, fitness and weight management," Midwest Business Group said.
Diabetics need greater attention partly because they typically take seven to 12 prescriptions, and that makes compliance difficult. Inadequate treatment can lead to blindness, amputations of limbs or even death. More than 200,000 Americans die of diabetes-related complications each year.
The program is modeled after a similarly successful effort by the city of Asheville, N.C., that lowered costs and showed a 50 percent drop in sick days and no worker's compensation claims filed by participating diabetes patients between 1997 and 2003. Asheville has expanded its program to people with asthma and high blood pressure.
May 6, 2009
Medical and economic results from Diabetes Ten City Challenge
Medical and economic results from Diabetes Ten City Challenge show significant benefits in patient health, lower healthcare costs - and higher pharmaceutical usage
A collaborative effort among the American Pharmacists Assn. Foundation (APhA Foundation; Washington, DC), a couple dozen employer-based health plans, and with financial support from GlaxoSmithKline, called the Diabetes Ten City Challenge (DTCC), was initiated during 2005. The goal was to evaluate the medical and economic benefits of active intervention in patient care, in the form of patient coaching by pharmacists. Final economic and clinical results have just been published in the J. of APhA (May/June; 2009;49:e52-60).
"It's well known that diabetes is a national public health issue, with one of every five healthcare dollars being spent on it," says William Ellis, executive director of the APhA Foundation and a coauthor of the study. "DTCC shows that intervention results in improved patient health and lower overall insurance costs, and that the model of using pharmacists as coaches can work on a broad basis."
The study comprised 573 patients, in ten cities nationally, whose employer-based plans agreed to cover the costs of medication co-pays and of interventions, over a two-year period ending in December 2007 (overall data were normalized for one year for each individual patient). Statistically significant improvements were seen in glycosylated hemoglobin, cholesterol and blood pressure - all relevant to diabetes care, along with better vision testing and foot examination patterns.
Factoring in the extra costs (of the coaching and other interventions, and of greater medication use), and comparing patient health costs to a projected level based on actual medical claims plus inflation, the study showed an overall savings of $1,079, or 7.4%, per patient, despite medication costs rising 32% over what had been projected. (Measurements of actual pharmaceutical consumption are not part of what APhA reported in the published study.)
"Larger-scale tests like these demonstrate the value of medication in managing chronic disease, which is a message that needs to be heard in Washington as well as in the healthcare system," says Andy Hartsfield, VP of public policy and advocacy at GSK.
He says that the scale-up of the program (which traces back to the Asheville Project of the 1990s) gives it national relevance. GSK is going on to set up a similar program just for the city of New Orleans (which was to have been in the study, but the Katrina hurricane disrupted that). APhA Foundation, meanwhile, is looking to conduct a similar study for depression patients.
May 1, 2009
Pharmacist Coaches Help Chronic Disease Patients
Les Masterson, for HealthLeaders Media
As the rate of chronic disease skyrockets, health costs balloon, and physicians struggle with demands on their time, health officials have increasingly turned to pharmacists as a possible solution.
Pharmacists have taken on a greater presence on the healthcare team in programs like the Asheville Project and Medicare Part D's Medication Therapy Management, which have featured pharmacist coaches helping chronic disease patients manage their ailments.
The latest example is the Diabetes Ten City Challenge, which the American Pharmacists Association (APhA) Foundation created to test whether the pharmacist coach model works in diverse geographies and various employer types.
The final economic and clinical results for the DTCC found that combining pharmacist coaches with value-based insurance design helped diabetic patients manage their chronic disease.
According to the study that was published in the May/June issue of the Journal of the American Pharmacists Association, average healthcare costs for those involved in the project were reduced by $1,079 per patient annually and the participants saved an average of $593 per year on their diabetes medications and supplies because DTCC employers waived copays.
The program also improved patients' key clinical measures, including lowering A1C and cholesterol levels to achieve American Diabetes Association and National Cholesterol Education Program goals; and lowering diastolic/systolic blood pressure levels to below the 130/80 goal. The project also fostered improvements in preventive care measures, including flu vaccinations, current foot exams, and current eye exams.
William M. Ellis, CEO of the American Pharmacists Association (APhA) Foundation in Washington, DC, and co-author of the study, says the results show that pharmacist coaches could impact chronic disease, reduce adverse drug events, and improve medication compliance.
Pharmacist coaches can meet with patients longer than doctors, who are stretched for time, and they can help fill a gap left by physician shortages.
"Physicians today are asked to do so much in an office visit in a really short amount of time," says Ellis. "The things they have to cover with a patient are really more than I think can be done in a lot of office visits. To have the extra support of a pharmacist to reinforce those things is valuable."
According to the study, the APhA Foundation found successful pharmacist coaching programs feature the following:
- An employer that invests in incentives for patients and providers to improve health and lower costs
- Employers who are involved in program implementation and have an open culture with their employees
- Receptiveness of healthcare providers who support community-based collaborative care
- A local network of pharmacists with the motivation, training, and time to help patients manage their care
- Health plans willing to provide claims data for analysis
"This whole area, I think, is emerging from pharmacy networks that are based on drug distribution to the emergence of pharmacy networks that will be based on patient care," says Ellis.
The employers that took part in DTCC were self-insured so they were at risk for both medical and prescription costs for their employees and beneficiaries. The employers/health plans created incentives for patients and pharmacists, including waived copays for medications and certain supplies, and pharmacists were paid for their coaching services.
During regularly scheduled appointments, pharmacists "applied aprescribed process of care that focuses on clinical assessments and progress toward clinical goals and work with each patient to establish self-management goals. In addition, they worked with other healthcare providers and could recommend adjustments in the patients' treatment plans when appropriate," according to the study.
These private visits allowed patients to ask questions, and the pharmacists were able to identify problems and teach self-management skills.
One of the 10 DTCC sites was led by the Northwest Georgia Healthcare Partnership (NGHP), based in Dalton, GA. The nonprofit includes healthcare providers, businesses, payers, government, and educators, who look to improve the health of residents in Whitfield and Murray counties.
Nancy Kennedy, executive director of NGHP, says an important part of the DTCC is that pharmacists are not replacing doctors or diabetes educators. Instead, they are there to help patients between doctors' appointments and update the physicians about their patients' health.
Similar to many parts of the nation, Northwest Georgia is facing a primary care physician shortage. Through visits with patients, the pharmacists are able to provide face-to-face case management.
She says patients feel a close bond with pharmacists and aren't afraid to ask them medical questions. Having that friendly relationship also allows for more honest communication.
"That accountability, face-to-face accountability, with someone in your community that you know, that you see on a regular basis to me is what makes this program so phenomenal and strong," says Kennedy.
One of the businesses that participated in Northwest Georgia, Hamilton Health Care System, made sure the project was not just a freebie for diabetics. The patients had to follow their prescription regimen, exercise regularly, and maintain a proper diet to remain in the program.
"We both have skin in the game so to speak," says Jason Hopkins, director of human resources at Hamilton Health Care System, about the employer and employee. "That helps both the investment we put forth to these individuals, but also in theory motivates them to comply."
Hopkins says Hamilton did not achieve great financial savings and probably broke even in the DTCC, but added that the health system should realize preventive savings through diabetics taking better care of themselves.
Hopkins says many businesses are reactive when it comes to tackling rising health costs. They pass costs onto employees by increasing copays and deductibles. That works to a certain extent, but employers must draw the line eventually, he says.
"I think what this tells the healthcare community is that one, you can incentivize your associates to take better care of themselves, that's what the healthcare providers want to see, but from the industry standpoint I think this proves to them that they don't have to push off more cost onto their employees. They can actually pay more, but ultimately in the long run see better financial outcomes because [employees] are taking better care of themselves," says Hopkins.
Though DTCC showed positive results, many pharmacies could not offer the same level of coaching services at this point. In order to have more pharmacist coaches, Ellis says the following should happen:
- Pharmacies will need to redesign their areas to create private consultation rooms
- Healthcare will need to improve health information systems, such as electronic health records, which could lead to better data exchange
- Employers will need to understand pharmacy coaching programs bring long-term savings and not view them solely as an expense
- Payers will have to change the way they reimburse pharmacists to include payment for providing coaching services
Ellis says pharmacists add value to the healthcare system by providing evidence-based treatments that can improve patients' health. Better health means lower employer costs and increased productivity.
"We're at a point now in healthcare that a lot of people are looking at the healthcare system in total and looking at how can we revitalize it, how can we change it, how can we improve it? This is an example of the promising practices that could lead to a reformed healthcare system in this country," says Ellis.
The APhA Foundation is now looking to expand the tenets of the DTCC to other disease states, including hypertension, low back pain, asthma, and chronic obstructive pulmonary disorder.
April 20, 2009
Diabetes ‘challenge’ yields health savings
By JIM FREDERICK
Retail pharmacists working with the cooperation of local employer-based health plan sponsors can dramatically reduce the costs of diabetic health care, a major, multi-year demonstration project has found. The result, said project leaders, could be profound changes in the U.S. healthcare delivery model.
Results of the Diabetes Ten City Challenge, released April 6 by the American Pharmacists Association Foundation, show clearly that the intervention and counseling of diabetes patients by trained pharmacists can have a measurable impact on the health costs those patients incur over an extended time period. Buoyed by the results of the long-term demonstration project, APhA will publish the results in a peer-reviewed article in the May/June issue of the Journal of the American Pharmacists Association.
Data gathered by project leaders show that average total healthcare costs were reduced by $1,079 per patient per year, compared with projected costs if the Ten City Challenge program had not been implemented, according to APhA.
Pharmacist coach Dale Klemm demonstrates a foot exam as part of the Diabetes Ten City Challenge, which matches patients to community pharmacist "coaches" who provide hands-on education.
The APhA Foundation launched the Ten City Challenge in 10 U.S. communities in 2005, with support from GlaxoSmithKline. The program was coordinated by HealthMapRx - a partnership of the APhA Foundation and Mirixa Corp. that offers incentive programs to encourage patients with chronic conditions to better manage their conditions. The HealthMapRx programs match patients to community pharmacist "coaches" who provide hands-on education, monitoring and evaluation of health improvements.
The goal of the Ten City Challenge, according to APhA, "was to fundamentally change the way chronic disease is managed and paid for through a value-based benefit design model "that would" align incentives for all stakeholders," including employer-sponsored health plans.
The results of that effort took a long time to compile and evaluate. But the benefits arising from a regular series of patient interventions by pharmacists participating in the diabetes project were clear and profound.
"Aggregate data for 573 participants, who were in the program for an average of 14.8 months, show patients saved an average of $593 per year on their diabetes medications and supplies," APhA reported.
The program also demonstrated improvements in key clinical measures, according to the group. Among the gains: a 23% increase in the number of participants achieving goals set by the American Diabetes Association; an 11% increase in the number of participants achieving National Cholesterol Education Program goals; and a 39% increase in the number of participants with a combined diastolic/systolic blood pressure goal achievement of 130/80.
“The Diabetes Ten City Challenge demonstrated the power of partnership and the impact of putting patients at the center of their own care," said Toni Fera, director of patient self-management programs for HealthMapRx and lead author of the report.
April 14, 2009
Pharmacist-coach project reduces health costs
By Lydell C. Bridgeford
A disease management program in which pharmacists served as health coaches to patients with diabetes is reducing health care costs and improving medication adherence, according to the sponsors of Diabetes Ten City Challenge.
In the program, the average total health care costs were reduced annually by $1,079 per patient, compared to projected costs if the program had not been implemented.
The initiative involves 30 employers in 10 cities that waived copayments for diabetes medications and supplies if participants met routinely with a specially trained pharmacist. The pharmacist-coach educates patients about tracking their A1C, blood pressure and cholesterol, as well as managing their disease through exercise, nutrition and other lifestyle changes.
The Diabetes Ten City Challenge and the American Pharmacists Association Foundation recently released aggregate data for 573 participants, which show that individuals in the program for 14.8 months saved an average of $593 per year on their diabetes medications and supplies.
In addition, the percentage of participants with current flu vaccines grew from 32% to 65%; those with current eye exams spiked from 57% to 81%; and those with current foot exams increased from 34% to 74%.
Other findings included a 23% increase in the number of participants achieving the American Diabetes Association A1C (blood glucose) goal of <7; a 11% jump in the number of participants achieving National Cholesterol Education Program goals; and a 39% increase in the number of participants with a combined diastolic/systolic blood pressure goal achievement of 130/80.
The project "provides a promising collaborative care model that blends important elements of a 'reformed' health care delivery process by integrating accessibility, patient-centeredness and value achieved by helping patients to make clinical improvements while managing costs" says Benjamin M. Bluml, the APhA Foundation's vice president for research and the study's co-author.
April 13, 2009
Diabetes Disease Management Pilot Program Yields Big Cost Savings
A diabetes disease management program conducted by the American Pharmacists Association Foundation is being made available to employers nationwide as a result of a series of successful tests.
The program, the Diabetes Ten City Challenge, has yielded substantial savings for employers even after they've waived co-payments for participants and paid for individual counseling. Patients also saved money and improved in several key clinical areas associated with the condition, officials said.
Results of the Diabetes Ten City Challenge, which will be published in a peer-reviewed article in the May/June issue of the Journal of the American Pharmacists Association, show average reductions in per-patient health care costs of $1,079 a year. Aggregate data for 573 participants, who were in the program an average of 14.8 months, showed they saved an average of $593 per year on their diabetes medication and supplies.
The data also identified improvements in blood glucose, cholesterol and blood pressure levels, all of which usually are elevated in diabetes patients. Moreover, the analysis found increases in usage of preventive care, such as flu vaccinations as well as eye and foot exams.
The program is based on the Asheville Project model, in which employers waive co-payments and deductibles for prescription drugs and related monitoring devices, such as glucose meters, for plan members who agree to receive periodic counseling from pharmacists. In addition, the employer pays an hourly fee to the pharmacists.
While the Asheville Project, first implemented in 1997, involved just employees and dependents of the North Carolina city and Mission Health & Hospitals, the region’s largest health care provider, the DTCC included 30 employers in 10 cities across the United States.
The same process of care used in the Asheville Project and the DTCC will be made available to employers nationwide through HealthMapRx, a Reston, Virginia-based partnership between the APhA Foundation and Mirixa Corp., said Bud Meadows, senior vice president of sales and development at Mirixa. The National Community Pharmacists Association sponsors Mirixa.
Using its technology, Mirixa will use claims data from employers' third-party administrators or insurers to identify prospective patients and then monitor interventions provided and patients' progress. The program also will match patients with community pharmacist coaches.
Meadows estimated the program will cost employers "only a couple of hundred dollars annually" in addition to counseling fees, which average about $400 annually per person.
But the return on investment is quick and builds over time, Meadows said.
"We've had some clients who have been in the program for three or four years, and we see the savings continue to improve because the patients better manage their condition and their medical expenses go down," Meadows said.
In the first five years after implementation, for example, the city of Asheville and Mission Health saw the average cost of care for their diabetic plan members fall an average of $2,000 per patient per year, growing to nearly $3,000 per patient in the sixth year of the program.
"The second thing is ...self-insured employers ... are seeing reductions in their reinsurance premiums," Meadows said.
Although the program has consistently yielded savings for employers, some health benefits experts expressed concern that economic conditions could deter some employers from adopting it.
"I do worry about the timing about getting some commitments in the current economic environment," said Andrew Webber, president of the National Business Coalition on Health in Washington, whose members were among participants in the DTCC. "That's what we're hearing from our coalitions and the individual employers that we talk to."
However, he said he hoped some employers consider adopting the program because of the short time frame in which it produced health care cost savings.
"Usually it takes longer" for a typical disease management program to produce savings, Webber said. "It's a very good sign that this program is showing and demonstrating some gain in a short period of time."
At least one of the DTCC participants has decided to continue the program despite its cost: Pactiv Corp., a Lake Forest, Illinois-based food and food-service packaging company.
"Pactiv results from 2007-08 in the Diabetes Ten City Challenge have been positive," a company spokeswoman said. "Pactiv participants are still engaged in this program and, as a group, are achieving the clinical outcomes as recommended by the American Diabetes Association. In addition, preliminary data analysis of the group shows a reduction in the overall health care costs for the group. "
April 13, 2009
Diabetes pilot program yields big cost savings
Ten City Challenge going national to help employers, patients
WASHINGTON—A diabetes disease management program conducted by the American Pharmacists Assn. Foundation is being made available to employers nationwide as a result of a series of successful tests.
The program, the Diabetes Ten City Challenge, has yielded substantial savings for employers even after they've waived copayments for participants and paid for individual counseling. Patients also saved money and improved in several key clinical areas associated with the condition, officials said.
Results of the Diabetes Ten City Challenge, which will be published in a peer-reviewed article in the May/June issue of the Journal of the American Pharmacists Assn., show average reductions in per-patient health care costs of $1,079 a year. Aggregate data for 573 participants, who were in the program an average of 14.8 months, showed they saved an average of $593 per year on their diabetes medication and supplies.
The data also identified improvements in blood glucose, cholesterol and blood pressure levels, all of which usually are elevated in diabetes patients. Moreover, the analysis found increases in usage of preventive care, such as flu vaccinations as well as eye and foot exams.
The program is based on the Asheville Project model in which employers waive copayments and deductibles for prescription drugs and related monitoring devices, such as glucose meters, for plan members who agree to receive periodic counseling from pharmacists. In addition, the employer pays an hourly fee to the pharmacists.
While the Asheville Project, first implemented in 1997, involved just employees and dependents of the North Carolina city and Mission Health & Hospitals, the region's largest health care provider, the DTCC included 30 employers in 10 cities across the United States.
The same process of care used in the Asheville Project and the DTCC will be made available to employers nationwide through HealthMapRx L.L.C., a Reston, Va.-based partnership between the APhA Foundation and Mirixa Corp., said Bud Meadows, senior vp of sales and development at Mirixa. The National Community Pharmacists Assn. sponsors Mirixa.
Using its technology, Mirixa will use claims data from employers' third-party administrators or insurers to identify prospective patients and then monitor interventions provided and patients' progress. The program also will match patients with community pharmacist coaches.
Mr. Meadows estimated the program will cost employers "only a couple of hundred dollars annually" in addition to counseling fees, which average about $400 annually per person.
But the return on investment is quick and builds over time, Mr. Meadows said.
"We've had some clients who have been in the program for three or four years, and we see the savings continue to improve because the patients better manage their condition and their medical expenses go down," Mr. Meadows said.
In the first five years after implementation, for example, the city of Asheville and Mission Health saw the average cost of care for their diabetic plan members fall an average of $2,000 per patient per year, growing to nearly $3,000 per patient in the sixth year of the program.
"The second thing is...self-insured employers...are seeing reductions in their reinsurance premiums," Mr. Meadows said.
Although the program has consistently yielded savings for employers, some health benefits experts expressed concern that economic conditions could deter some employers from adopting it.
"I do worry about the timing about getting some commitments in the current economic environment," said Andrew Webber, president of the National Business Coalition on Health in Washington, whose members were among participants in the DTCC. "That's what we're hearing from our coalitions and the individual employers that we talk to."
However, he said he hoped some employers consider adopting the program because of the short time in which it produced health care cost savings.
"Usually it takes longer" for a typical disease management program to produce savings, Mr. Webber said. "It's a very good sign that this program is showing and demonstrating some gain in a short period of time."
At least one of the DTCC participants has decided to continue the program despite its cost: Pactiv Corp., a Lake Forest, Ill.-based food and foodservice packaging company.
"Pactiv results from 2007-08 in the Diabetes Ten City Challenge have been positive," a company spokeswoman said. "Pactiv participants are still engaged in this program and, as a group, are achieving the clinical outcomes as recommended by the American Diabetes Assn. In addition, preliminary data analysis of the group shows a reduction in the overall health care costs for the group. "
April 13, 2009
Giving a little can mean getting a lot more back
WHILE IT MAY be a tough sell in the middle of a recession, investment in health care can be beneficial for employers as well as employees.
As we report on page 3, results of the Diabetes Ten City Challenge program to improve diabetes care management show that employers who are prepared to spend more on health care now for certain workers are reaping cost savings more quickly than anticipated.
Ignoring conventional wisdom on health care cost control, the employers found that by reducing financial barriers to care, such as copayments for diabetes patients, the overall health care costs of those patients fell quickly.
For years, employers have seen increased cost-sharing with employees as the key to reducing health care expenses. While this certainly can help save money, the approach isn't perfect. Increasing the cost of accessing care clearly can result in deteriorating health for people with chronic conditions, and as those conditions worsen, costs leap.
What is most encouraging about the Diabetes Ten City Challenge is the speed with which the participating employers saw their costs decline. For a relatively modest investment, employers saw substantial cost reductions within 15 months. That is the type of return on investment that even cash-strapped companies should strive for.
April 11, 2009
Diabetics focus of medical-home pilot
By Jill Coley
A medical home is more than your doctor's office. It is a comprehensive approach to medicine, with one source coordinating the full range of patient care. And that concept is gaining traction in the Lowcountry.
Palmetto Primary Care Physicians, a large Charleston area primary practice, along with BlueCross BlueShield of South Carolina, is launching a year-long pilot project designed to give 1,500 diabetic patients a medical home.
Ron Piccione, chief executive officer of Palmetto Primary, said "We're incorporating other individuals into the mix to assist doctor and patient in communication, education and resources."
The project will focus on members of BlueCross BlueShield of South Carolina, BlueChoice HealthPlan of South Carolina and the state health plan. There is no co-payment or extra charge to patients.
Piccione said Palmetto Primary, which has 18 clinics in the tri-county area, also is working to bring on board other carriers, such as Medicare and Medicaid. Other chronic conditions also might be considered in the future, he said.
The American Medical Association endorsed the medical home concept in 2008, and experts have for years lauded the patient-centered approach as a way to reduce costs and improve outcomes in treating patients with chronic disease.
Diabetes costs the U.S. $174 billion, or $1 out of $5 spent on health care, according to an article in the Journal of the American Pharmacists Association. The journal published the results of a 10-city diabetes challenge, which included Charleston.
Researchers found that diabetics who worked with pharmacists, who were contracted through employers, reduced care costs by $1,079 annually, and patients saved an average of $593 per year on medications and supplies.
Participants met regularly with trained pharmacist coaches to help them track their disease and communicate with their physicians, referring patients as needed to other health care providers.
In the Palmetto Primary pilot project, case managers will work to reduce gaps in care, such as missed appointments with specialists, lack of transportation and taking medication properly. They also will perform outreach, such as registering patients for wellness clinics.
Electronic medical records will be critical to the project, integrating information from the health plan, case manager and local emergency rooms.
April 9, 2009
Pharmacists in Diabetes Ten City Challenge Critical to Success
Eileen Koutnik-Fotopoulos, Staff Writer
The Diabetes Ten City Challenge (DTCC) is showing promise in curbing diabetes-related health care costs and improving patient health with the help of pharmacists, according to a study published in the May/June issue of the Journal of the American Pharmacists Association.
In the DTCC program, sponsored by the American Pharmacists Association with support from GlaxoSmithKline, 30 employers in 10 US cities established a voluntary health benefit for employees, dependents, and retirees with diabetes.
As part of the program, employers waive copays for diabetes medications and supplies and help patients manage their diabetes on a daily basis with the assistance of a specially-trained pharmacist coach. The pharmacists counsel patients on their treatment regimens, help patients track their blood sugar levels and cholesterol, and encourage them to control their disease through exercise, nutrition, and lifestyle changes.
The newly released data on 573 diabetic patients enrolled in the program for at least 1 year indicated that the average total health care costs were lowered annually by $1079 per patient (7.2%), compared with projected costs without the program. The patients also saved an average of $593 per year on their diabetes medications and supplies.
The findings also showed major improvements in key health measures: a 23% rise in the number of patients reaching their goal blood sugar levels set by the American Diabetes Association; an 11% increase in the number of patients achieving their optimal cholesterol numbers; and a 39% increase in the number of patients keeping their blood pressure under control.
The DTCC program is an outgrowth of the successful Asheville Project launched in Asheville, North Carolina, in 1997.
April 7, 2009
Prevention and Intervention in Action
Diabetes is a huge problem in the US, both in terms of health and healthcare spending. For individuals, poorly-managed diabetes can lead to complications such as blindness and limb amputation. For employers, workers with poorly-managed diabetes often require costlier treatments and miss days of work. However, medication adherence is often a challenge for patients with chronic diseases, like diabetes. That's where the Diabetes Ten City Challenge (DTCC) comes in.
The DTCC, conducted by the American Pharmacists Association (APhA) Foundation with support from GSK, brought employers, pharmacists, and people with diabetes together to improve the health of patients with diabetes while reigning in skyrocketing healthcare costs. Thirty employers in 10 US cities established a voluntary health benefit for employees, dependents and retirees with diabetes.
Employers waived co-payments for diabetes medications and supplies to encourage people to manage their diabetes. Patients worked with local pharmacist "coaches" who helped them track their blood sugar levels and cholesterol, and control their disease through exercise, nutrition and lifestyle changes--and who were compensated for their time. The pharmacists also communicated with the patients' doctors if needed.
Data released yesterday on 573 diabetic patients enrolled in the program for at least 1 year show that average total health care costs were reduced annually by nearly $1100 per patient, or 7.2 percent, compared with projected costs without the DTCC program. Patients also saved an average of $593 per year on their diabetes medications and supplies. Improvements were seen in blood sugar levels, cholesterol levels, and blood pressure levels, as well as flu vaccination rates, eye exams, and foot exams.
April 6, 2009
Pharmacist-led diabetes program shows promise
A program that gets employers, pharmacists and people with diabetes to work together to reign in skyrocketing diabetes-related health care costs as well as improve patient health is showing promise, according to a report released today by the American Pharmacists Association (APhA) Foundation.
In the "Diabetes Ten City Challenge" conducted by the APhA with support from GlaxoSmithKline, Inc. 30 employers in 10 U.S. cities established a voluntary health benefit for employees, dependents and retirees with diabetes.
As part of the DTCC program, employers used incentives, such as waiving co-payments for diabetes medications and supplies, to encourage people to manage their diabetes with the help of local pharmacist "coaches" who help patients track their blood sugar levels and cholesterol, and to control their disease through exercise, nutrition and lifestyle changes. These specially trained pharmacists, who are matched to patients through the HealthMapRx program, also communicate with the patients' doctor if needed.
Data released today on 573 diabetic patients enrolled in the program for at least 1 year show that average total health care costs were reduced annually by nearly $1100 per patient, or 7.2 percent, compared with projected costs without the DTCC program. Patients also saved an average of $593 per year on their diabetes medications and supplies.
Significant improvements in key health measures were also evident, including a 23-percent increase in the number of patients achieving their goal blood sugar level set by American Diabetes Association; an 11 percent increase in the number of patients achieving optimal cholesterol levels; and a 39-percent increase in the number with patients getting their blood pressure under control.
Improvements in preventive care practices were also seen; the number of people up-to-date on flu vaccination rose from 32 percent to 65 percent; those with current eye exams increased from 57 percent to 81 percent; and those with current foot exams increased from 34 percent to 74 percent.
The study results appear in the May/June issue of the Journal of the American Pharmacists Association.
"The Ten City Diabetes Challenge demonstrated the power of partnership and the impact of putting patients at the center of their own care,"Dr. Toni Fera, pharmacist and director of Reston, Virginia-based HealthMapRx, LLC, said in a statement issued by the APhA Foundation.
"The Ten City Diabetes Challenge provides a promising collaborative care model that blends important elements of a 'reformed' health care delivery process by integrating accessibility, patient-centeredness, and value achieved by helping patients to make clinical improvements while managing costs," added co-author Dr. Benjamin M. Bluml, APhA Foundation vice president for research.