John Miall Risk Manager City of Asheville, NC

1. John MiallRisk ManagerCity of Asheville, NC Asheville Diabetes Disease Management Project

2. The Asheville Project

3. 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 nervoussystem damage • Leading cause of adult blindness • Leading cause of ESRD* (40% new cases) • >50% lower limb amputations * End-Stage Renal Disease

4. 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

5. 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) *Pharmacy Benefit Manager

6. 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.”

7. Clinical Outcomes:Avg. Glycosylated Hemoglobin HbA1c

8. City of Asheville Medical Costs Average annual aggregate medical claims *including prescription drugs for diabetes

9. City of Asheville Diabetes Sick-Leave Usage Sick leave days

10. Sick Leave Usage By Time In Program Sick leave days

11. QUALITY OF LIFE • Baseline • At 14 Months into program Source: SF-36 Form

12. Frequency/Severity Matrix Severity High FrequencyLow Severity High FrequencyHigh Severity Frequency Low FrequencyLow Severity Low FrequencyHigh Severity