John Miall Risk Manager City of Asheville, NC Asheville Diabetes Disease Management Project John Miall Risk Manager City of Asheville, NC “Miall intro slide”

The Asheville Project “Asheville”

Diabetes-Related Comorbidities 2–4 times greater risk of heart disease 60–65% have hypertension 2–4 times greater risk of stroke 60–70% have some degree of nervous system damage Leading cause of adult blindness Leading cause of ESRD* (40% new cases) >50% lower limb amputations “comorbities” * End-Stage Renal Disease

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 “Diabetescosts”

Patient Incentives and Care Model Patient selection / recruitment Patient education — Mission + St. Joseph’s 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) “Incentives” *Pharmacy Benefit Manager

How They Do It “How?” “Patient making better food choice. Blood glucose much improved. 2 x 1.5c cm wound RLE. Referred to physician for evaluation and therapy.”

Clinical Outcomes: Avg. Glycosylated Hemoglobin HbA1c “Glycosylated”

City of Asheville Medical Costs Average annual aggregate medical claims “AshCosts” *including prescription drugs for diabetes

City of Asheville Diabetes Sick-Leave Usage Sick leave days “Sick-leave”

Sick Leave Usage By Time In Program Sick leave days “Sick-Program”

QUALITY OF LIFE Baseline At 14 Months into program Source: SF-36 Form “QLife” Baseline At 14 Months into program Source: SF-36 Form

Frequency/Severity Matrix High Frequency Low Severity High Frequency High Severity Frequency Low Frequency Low Severity Low Frequency High Severity “Freq/Severe”