Chronic Disease Management in Asheville, North Carolina
In collaboration with Mission Hospitals, pharmacists at the University of North Carolina Chapel Hill, and the North Carolina Pharmacists Association, the city of Asheville launched the Asheville Project in 1997. Initially designed to reduce the impact of diabetes on the health and wellness of city employees, retirees and their dependents, the Asheville Project has since incorporated asthma, cardiovascular disease, and depression modules.
A unique model, the Asheville Project focuses on a collaborative approach among the patient, the pharmacist care manager, and the physician to improve care and reduce costs.
How it works
The Asheville Project model relies on intensive education and ongoing interactions between patients and specially trained community pharmacists for coaching on diet, exercise, stress reduction, and medication management.
The specific steps in the project include:
- Local pharmacists receive in-depth training to provide counseling to patients.
- Employees and retirees volunteer to participate in one or more modules of the program.
- Individuals are assigned to a certified pharmacist care manager and attend training on managing their diseases.
- Individuals meet monthly with their pharmacist care managers, visit their treating physician regularly, and have labs drawn on a routine basis.
- Patient co-payments for medications and supplies are waived as long as they are actively participating in the program.
A critical component of the program is patient privacy. The city of Asheville Human Resources and Employee Health Services have created a culture of confidentiality around employee and retiree health issues. According to Wellness Coordinator Destiny Mattsson, “Participation rates have grown year after year thanks to the high level of trust employees and retirees have in the program. We estimate that nearly 100 percent of diabetics are enrolled in the program.”
Results of published data indicate that the city saves about $4.00 for every $1.00 it invests in the program for diabetes management. Medical studies of the Asheville Project revealed multiple outcomes over a six-year study period:
- Average annual medical expenses for a diabetic patient dropped by 40 percent in the first year of the program, and remain at nearly 60 percent less than the national average.
- The number of sick days taken by diabetic patients dropped to six from more than 12 days per year, and for asthma patients the number of sick days dropped to three from 11 days per year.
- Cardiovascular events, related ER visits, and hospitalizations reduced by half.
- Cardiovascular medication use increased almost threefold, while cardiovascular medical costs decreased by 46.5 percent in the six-year period.
- Average annual cardiovascular-related medical costs decreased to 19 percent from 30.6 percent of total health care costs.
- Asthma patients who made ER visits decreased to 1.3 percent from 9.9 percent and hospitalizations dropped to 1.9 percent from 4 percent.
Employee Health Services
The city of Asheville provides a free on-site walk-in clinic that is staffed by registered nurses who specialize in occupational health and is open to any city employee. The clinic averages 600 employee visits per month for both work-related and personal injuries and illnesses, reducing absenteeism for routine health and medical appointments.
City of Asheville