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

1. The Asheville Project
“Asheville”

2. 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

3. 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”

4. 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

5. 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.”

6. Clinical Outcomes: Avg. Glycosylated Hemoglobin
HbA1c
“Glycosylated”

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

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

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

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

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