July 31, 2009
Diabetes Ten City Challenge empowers people to make healthy change
By William M. Ellis, CEO, American Pharmacists Association Foundation
City of Charleston, SC employee Bobby Stephens knew firsthand the dangers of diabetes. He saw his mother-in-law suffer amputations and blindness and friends go on dialysis because of the disease. Yet in six years of treatment for his own diabetes, he never really understood his medications, nor was he able to keep his condition under control. That changed when he met James Sterrett, PharmD.
Sterrett is a pharmacist who worked with Stephens in the Diabetes Ten City Challenge (DTCC), a program that helped people take charge of their diabetes with help from a pharmacist "coach." Stephens volunteered to participate in the DTCC through the city of Charleston, which is one of 30 employers in 10 cities that were part of the program.
Through the DTCC, employers offered a voluntary health benefit for employees and their family members with diabetes, waiving co-pays for diabetes medications and supplies if they worked with a pharmacist coach to manage their disease.
The DTCC was conducted by the American Pharmacists Association (APhA) Foundation through HealthMapRx, with support from GlaxoSmithKline, in an effort to pursue new ways of reducing health care costs and managing diabetes, which affects nearly 24 million Americans and costs more than $174 billion annually.
Pharmacists who are specially trained in diabetes care met with participants regularly to provide education and monitor their condition. They tracked key diabetes indicators such as hemoglobin A1C (a laboratory test showing average blood sugar control over the previous two to three months), blood pressure, and cholesterol levels. They also taught people to manage diabetes by eating right, exercising regularly, visiting their doctors and taking medications as prescribed.
Final economic and clinical results of the DTCC, published in the May/June issue of the Journal of the American Pharmacists Association (JAPhA), show that overall average health care costs were reduced by nearly $1,100 per patient per year when compared to projected costs if the DTCC had not been implemented. Aggregate data for 573 participants, who were in the program for an average of 14.8 months, show patients saved an average of $593 per year on their diabetes medications and supplies because of the waived co-pays.
Participants improved across all key clinical indicators, including the number of people achieving A1C, blood pressure, and cholesterol goals. Influenza vaccination rates increased, as did the numbers of participants with current eye and foot examinations that help prevent devastating complications associated with diabetes.
Stephens and other DTCC participants say the relationship with their pharmacist and the chance to better understand–and manage–their diabetes has changed their lives. Since enrolling in the DTCC in April 2006, he has lost 40 pounds and reduced his A1C levels from 9.7 to below 6 (the American Diabetes Association recommends A1C levels below 7).
The American Diabetes Association calculated that diabetes accounted for $58 billion in lost productivity in 2007, including 15 million sick days and a staggering 120 million days lost to "presenteeism," when employees are at work but not "all there."
The financial incentives in the DTCC helped participants afford the care necessary to manage their condition and lead productive lives. City of Charleston Wellness Coordinator Jan Park, RN says removing financial barriers empowers people to take control of their disease; and the one-on-one counseling with the pharmacist coach helps them stay accountable, set goals and stay on track.
Chronic disease is responsible for seven of 10 American deaths and 75% of the nation's $2.2 trillion health care bill. Earlier this year, the APhA Foundation announced a partnership with Mirixa Corp., the nation's largest pharmacy-based patient care network, to offer the DTCC collaborative care model to employers nationwide for diabetes and other chronic diseases through HealthMapRx.
The results of the Diabetes Ten City Challenge demonstrate that when people are supported and empowered to make the lifestyle changes necessary to manage a chronic disease, significant improvements are possible.
It's an idea whose time has come.