[I have to say that my diabetes is under good control and I keep up with the latest research and recommendtions. However, I do know there are many diabetics who for one reason or another are not caeful about their diet or medications. Whether they are unable to read or research or their doctors don't take the time, I don't know, but I often hear diabetics saying, "Oh, I just take my medicine and eat what I always did." WRONG! This approach results only in putting off the inevitable and horrible side effects of diabetes. I've said it before and it needs saying again: Diabetes is going to cost us taxpayers a whole lot more than it is already--and that's a substantial amount as you can quantify from this small project. Without more attention to educating diabetics, like this project, we are going to be paying for millions of dialysis sessions, kidney transplants, aids to the blind, heart attack care, amputations and therapy (plus artificial limbs, electric wheelchairs, scooters, specially-equipped vehicles, etc., etc. and etc.)]

Improving Health and Cutting Costs in NC

Source: American Diabetes Association Publication date: 2002-08-20

In N.C., Improving Worker Health -- and Cutting Costs

By Ceci Connolly

Washington Post Staff Writer

Tuesday, August 20, 2002; Page A01

ASHEVILLE, N.C. -- When Bill Wilmer was diagnosed with diabetes 10 years ago, he didn't have the time or money to fight the deadly disease. Besides, Wilmer figured, with no cure in sight, why bother pricking himself with a syringe several times a day?

"I didn't think it made much difference, so I decided to do it my way -- like Frank Sinatra," he explained.

Today, the 65-year-old retiree is a model patient. His health has improved, he meets religiously each month with his pharmacist, and instead of quoting the Rat Packer, he's singing a new tune. "An ounce of prevention is worth a pound of cure," he said, sounding more like a schoolmarm than a former backhoe operator.

While federal and state lawmakers are struggling to find ways to control rising health care costs, this small city tucked between the Blue Ridge and Great Smoky Mountains has found a way to save thousands of dollars and improve the health of its employees. Unlike academic theories and political rhetoric, the six-year-old Asheville Project offers real-life lessons on the great potential -- and limitations -- of an approach known as disease management.

Built on the philosophy that better health leads to lower medical costs, the Asheville Project uses financial incentives to link highly trained pharmacists to city workers who have diabetes, hypertension, asthma or high cholesterol -- all expensive chronic illnesses. In a highly unusual arrangement, pharmacists are paid to counsel patients, offering advice on diet, exercise, stress reduction and medications. With the monthly sessions, pharmacists help patients stay on track and act as a bridge to physicians.

To lure employees such as Wilmer, the city made an irresistible offer: If he agreed to attend a health class and check in with pharmacist Beth DeWitt once a month, the city would give him free medications and supplies such as the glucose meter and test strips to monitor his blood sugar.

It wasn't altruism that prompted the city's generosity; it was savvy investing. "I'm getting a 4-to-1 return on my investment," said John Miall, the risk manager who approved the counterintuitive solution to soaring medical bills.

By hiring pharmacists to serve as coach-cheerleader for employees with chronic illnesses, the city has drastically reduced emergency procedures and complications caused by prescription misuse. Although drug costs rose, total health care spending on diabetics fell from $7,042 per patient in 1996 to about $4,000 apiece each year since the program began, in 1997.

What Miall spent for prescriptions, pharmacist payments and even additional doctor visits, he more than made up in reduced hospital visits, kidney dialysis and transplants. "I can afford a lot more medications and physician visits than I can trips to the emergency room," he said.

Absenteeism rates for participants fell from an average of 12.6 sick days a year to six, said city finance director Bill Schaefer. "Just having the people at work is a wonderful return on the dollar," not to mention the intangible benefits of healthier workers on the job, he said.

Yet many analysts caution that it will be difficult for larger companies and cities to replicate the creativity of this tightknit, progressive community or to expand disease management to numerous illnesses simultaneously. As many in Asheville can attest, it is not easy to shift responsibility -- and money -- to a new group of medical providers.

Doctors, including the president of the American Medical Association, have expressed skepticism about expanding the clinical duties of pharmacists, nurses or emergency medical technicians. Many physicians fear a loss of business or authority. Insurers have shown little willingness to reimburse pharmacists and other non-physician caregivers for the "cognitive services" or counseling that leads to better-informed, healthier patients.

Bob Burgin, president and chief executive of Mission St. Joseph's Health Care System here, said he initially worried about a decline in business if the city's program worked. But reducing emergency room demands has freed staff and beds for more lucrative procedures, such as hip replacements, angioplasty and other services targeted to aging baby boomers.

Finally, even the most successful disease management program is unlikely to solve what is becoming a cost crisis in America's health care system. "We're doing what we can to control costs, but we're scratching at the margins," Schaefer said.

Yet the success of the Asheville Project is winning converts. Blue Ridge Paper has begun enrolling hundreds of employees at its seven plants. Burgin was so impressed he adopted the program for his 5,000 workers and their 3,900 family members. Empowering patients, tapping underutilized medical professionals such as pharmacists, and reimbursing wellness instead of illnesses "is the only hope of controlling health care costs in the long term," he said.

Diabetes, in which the body has difficulty processing sugar, is a classic example, said Frank Vinocur, director of the diabetes division at the Centers for Disease Control and Prevention. About 17 million Americans have diabetes, and an additional 1 million cases are expected this year.

The medical and financial toll is enormous. Diabetes is the fifth-deadliest disease in the nation today, and the leading cause of blindness, kidney failure and amputations. In 1997, researchers put the annual cost of diabetes at $100 billion. Vinocur expects that to double or triple by 2025.

Although there is no cure, modest lifestyle changes, coupled with medical advances, make it possible for diabetics to live longer, more productive lives, said endocrinologist Jeff Russell. That is why Russell and hospital pharmacist Barry Bunting, coordinator of the Asheville Project, put diabetes at the top of the target list for disease management.

For many in the program, simple tips, financial assistance and a sense that someone cares has meant a remarkable improvement in their quality of life.

Patricia Ezzel, 51, said the city picked up her $250 in annual co-payments. But she no longer disappears from her job in human resources because of dizzy spells, elevated blood pressure and other ailments. And she learned that her favorite grapefruit juice makes it difficult for her liver to absorb blood pressure medicine.

Like Wilmer, Harry McDaniels was in denial about his diabetes and refused to pay $45 a month on test strips to check his blood sugar with a glucose meter.

"This program helped me come out of the closet," he said. The health classes revealed he was far from alone, and the tough love he gets from his pharmacist strikes just the right tone. "He'll say, 'Harry, let's control this, or your wife won't be seeing you anymore,' " McDaniels said. The monthly visits are key, he said, because "the meter's not going to lie."

Miall tapped pharmacists because they are convenient, available and "have an incredible knowledge of medication," he said. Bringing in pharmacists also helps reduce the $177 billion spent annually because of misuse of medications, said Crystal Wright, spokeswoman for the National Association of Chain Drug Stores.

For pharmacists, it is an opportunity to use some of the expertise developed over six years in school and to make about $40 a month for each patient they counsel. During an average shift at Eckerd, Amy Lugo said, she filled 350 to 500 prescriptions, and "most of the questions I got were, 'Where's the toilet paper?' "

Because of pharmacist intervention, 60 percent of patients in the diabetes program now take ACE inhibitors to help protect the kidneys, compared with none six years ago. McDaniels and Wilmer credit their pharmacists with recommending an aspirin a day for their hearts. In medical terms, the results are impressive, said Carol Cranor, a pharmacist who analyzed the Asheville data for the University of North Carolina.

Measurements of LDL, or "bad" cholesterol, and Hemoglobin A1c, or average blood-sugar levels, have fallen well below targets set by the American Diabetes Association. Regular eye and foot exams, central to diabetes care, are up, while smoking has been cut in half in the group.

In recent years, the city, hospital and Blue Ridge Paper have expanded the program to asthma, hypertension and high cholesterol, all of which benefit from early intervention. Officials say the medical and financial payoffs will likely come later, because it can take years or decades for heart disease to manifest itself.

Many patients, such as R. Patricia Leckey, enroll in several programs. A single woman who supports her elderly mother, Leckey has diabetes, asthma and high blood pressure, maladies that were costing her about $450 a month out-of-pocket. "I'm a triple whammy," she said, chuckling.

Working with pharmacist Bill Horton, Leckey walks more, passes up fast food and monitors her asthma with a machine that measures breathing capacity. She has not been to a doctor in four months and has not purchased an inhaler -- once a monthly expenditure -- in just as long.

For retired arson investigator Harley Shuford, the pharmacy sessions are a chance to get all his questions answered in layman's terms and to monitor his own health progress.

"In a nutshell," he said, "what it means for city employees is this gives you the knowledge, the equipment and incentive to control your own destiny."

-- Anonymous, September 15, 2002

Answers

It is too bad that more companies don't realize that it is cheaper in the long run to be preventative.

-- Anonymous, September 15, 2002