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April 13, 2009
Diabetes Disease Management Pilot Program Yields Big Cost Savings
A diabetes disease management program conducted by the American Pharmacists Association Foundation is being made available to employers nationwide as a result of a series of successful tests.
The program, the Diabetes Ten City Challenge, has yielded substantial savings for employers even after they've waived co-payments for participants and paid for individual counseling. Patients also saved money and improved in several key clinical areas associated with the condition, officials said.
Results of the Diabetes Ten City Challenge, which will be published in a peer-reviewed article in the May/June issue of the Journal of the American Pharmacists Association, show average reductions in per-patient health care costs of $1,079 a year. Aggregate data for 573 participants, who were in the program an average of 14.8 months, showed they saved an average of $593 per year on their diabetes medication and supplies.
The data also identified improvements in blood glucose, cholesterol and blood pressure levels, all of which usually are elevated in diabetes patients. Moreover, the analysis found increases in usage of preventive care, such as flu vaccinations as well as eye and foot exams.
The program is based on the Asheville Project model, in which employers waive co-payments and deductibles for prescription drugs and related monitoring devices, such as glucose meters, for plan members who agree to receive periodic counseling from pharmacists. In addition, the employer pays an hourly fee to the pharmacists.
While the Asheville Project, first implemented in 1997, involved just employees and dependents of the North Carolina city and Mission Health & Hospitals, the region’s largest health care provider, the DTCC included 30 employers in 10 cities across the United States.
The same process of care used in the Asheville Project and the DTCC will be made available to employers nationwide through HealthMapRx, a Reston, Virginia-based partnership between the APhA Foundation and Mirixa Corp., said Bud Meadows, senior vice president of sales and development at Mirixa. The National Community Pharmacists Association sponsors Mirixa.
Using its technology, Mirixa will use claims data from employers' third-party administrators or insurers to identify prospective patients and then monitor interventions provided and patients' progress. The program also will match patients with community pharmacist coaches.
Meadows estimated the program will cost employers "only a couple of hundred dollars annually" in addition to counseling fees, which average about $400 annually per person.
But the return on investment is quick and builds over time, Meadows said.
"We've had some clients who have been in the program for three or four years, and we see the savings continue to improve because the patients better manage their condition and their medical expenses go down," Meadows said.
In the first five years after implementation, for example, the city of Asheville and Mission Health saw the average cost of care for their diabetic plan members fall an average of $2,000 per patient per year, growing to nearly $3,000 per patient in the sixth year of the program.
"The second thing is ...self-insured employers ... are seeing reductions in their reinsurance premiums," Meadows said.
Although the program has consistently yielded savings for employers, some health benefits experts expressed concern that economic conditions could deter some employers from adopting it.
"I do worry about the timing about getting some commitments in the current economic environment," said Andrew Webber, president of the National Business Coalition on Health in Washington, whose members were among participants in the DTCC. "That's what we're hearing from our coalitions and the individual employers that we talk to."
However, he said he hoped some employers consider adopting the program because of the short time frame in which it produced health care cost savings.
"Usually it takes longer" for a typical disease management program to produce savings, Webber said. "It's a very good sign that this program is showing and demonstrating some gain in a short period of time."
At least one of the DTCC participants has decided to continue the program despite its cost: Pactiv Corp., a Lake Forest, Illinois-based food and food-service packaging company.
"Pactiv results from 2007-08 in the Diabetes Ten City Challenge have been positive," a company spokeswoman said. "Pactiv participants are still engaged in this program and, as a group, are achieving the clinical outcomes as recommended by the American Diabetes Association. In addition, preliminary data analysis of the group shows a reduction in the overall health care costs for the group. "