John Miall Risk Manager City of Asheville, NC

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John MiallRisk ManagerCity of Asheville, NC

Asheville Diabetes Disease Management Project
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The Asheville Project
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Diabetes-Related Comorbidities

• 24 times greater risk of heart disease
• 6065 have hypertension
• 24 times greater risk of stroke
• 6070 have some degree of nervoussystem damage
• Leading cause of adult blindness
• Leading cause of ESRD (40 new cases)
• gt50 lower limb amputations

End-Stage Renal Disease
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Diabetes-Related Indirect Costs

• 8.3 sick-leave days annually
• 1.7 sick-leave days for employees without
  diabetes
• 47 billion in productivity forgone due to
  disability, absence, and premature mortality

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Patient Incentives and Care Model

• Patient selection / recruitment
• Patient education Mission St. Josephs
  Diabetes Center
• Matching patients to pharmacists
• Incentives
• PBM co-pay waivers
• Labs without co-pays
• Glucose meters
• The operative word in pharmaceutical care is
  care (Madge testimonial)

Pharmacy Benefit Manager
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How They Do It

• Patient making better food choice. Blood
  glucosemuch improved. 2 x 1.5c cm wound RLE.
  Referredto physician for evaluation and therapy.

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Clinical OutcomesAvg. Glycosylated Hemoglobin
HbA1c
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City of Asheville Medical Costs
Average annual aggregate medical claims
including prescription drugs for diabetes
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City of Asheville Diabetes
Sick-Leave Usage
Sick leave days
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Sick Leave Usage By Time In Program
Sick leave days
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QUALITY OF LIFE

• Baseline
• At 14 Months into program

Source SF-36 Form
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Frequency/Severity Matrix
Severity
High FrequencyLow Severity
High FrequencyHigh Severity
Frequency
Low FrequencyLow Severity
Low FrequencyHigh Severity