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MBGH_Diabetes_Program_Overview_3-31-09

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					Taking Control of Your Health
    Midwest Business Group on
    Health (MBGH)
   MBGH is a Chicago-based, non-profit coalition of Midwest employers
    working together to improve the quality and cost-effectiveness of
    health care for purchasers and the health status of their
    constituents.

   Founded in 1980, membership includes over 80 large, self-funded,
    private employers such as Abbott Laboratories, Boeing, Kraft,
    Northwestern University and University of Chicago.

   MBGH also serves public employers, including the City of Chicago,
    City of Gary, City of Naperville, State of Illinois and the Village of
    Oak Lawn.

   Member organizations cover over 2 million lives and spend over
    $2.5 billion on health care.

   Employers are represented by those responsible for designing and
    managing health benefits: VP of HR, Director/Manager of Benefits,
    Medical Director, Wellness Coordinator

   MBGH is one of over 70 coalitions in the U.S.A.
                                       2
    MBGH Activities
   Learning Network
       Programs on health benefit management, strategies and trends
       Employer-only roundtables on health benefits, pharmacy
        management, union benefits, wellness programs
       Medicare Employer Forum calls
       Health Plan & Health System User Groups

   Midwest Health Purchaser Foundation (MBGH partner)
       Purchasing groups for audits, Chicago HMOs, disease management,
        incentive programs, worksite & health management programs, and
        pharmacy benefits

   Health Benefit Projects & Quality Initiatives
       “HPQ-Select” - employer tool to identify how employee health
        impacts productivity
       “Readiness to Change” - survey to determine employers’ readiness to
        adopt value-based benefit strategies
       “Taking Control of Your Health” - a pilot to determine if waived
        drug co-pays linked with specially trained pharmacist counselors
        increases diabetic patient compliance with treatments

                                     3
A Problem
Why should employers address
diabetes?

   Significant and costly problem
   Most problems caused by patients allowing
    conditions to get worse:
       Not   knowing how to reduce risks
       Not   staying on medications
       Not   eating correctly
       Not   being screened regularly
   Proper treatment, education and motivation
    of patients could dramatically improve
    health outcomes in short amount of time



                                5
Why should employers address
diabetes?

   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 nationwide
   $132 billion in direct and indirect costs for
    diabetes each year, nationwide




                               6
Diabetes-Related Conditions

   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 renal failure
    (40% new cases)
   >50% lower limb amputations


                          7
A Solution
The Asheville Project

   To reduce rising health costs, the City of
    Asheville, NC waived co-pays for diabetic
    drugs and devices for employees with
    diabetes who agreed to meet with specially
    trained pharmacists once a month.
   Pharmacists performed screenings,
    educated patients about the disease, and
    encouraged self-care and healthy behaviors.
   Asheville adopted a value-based benefit
    design for people with diabetes.
       Expanded the model for cardio-vascular
        conditions, asthma and depression.


                               9
Why use pharmacists as
counselors?

   Most diabetics on 7-12 medications for
    their diabetes and other co-morbidities
    (hypertension, cardiac problems,
    depression, etc.)
   Many patients have problems
    understanding proper use of drugs and
    insulin
   Research shows medication compliance is
    greatest barrier to improvement in diabetes
    cases.
Value-Based Benefit Design
   Definition*:
       A plan design that maximizes the clinical
        benefit achieved for the money spent
   Objectives:
       Decrease barriers to care for clinically
        beneficial therapies
       Increase the likelihood of compliance to
        treatment and improved health outcomes
       Reduce growth rates for long-term health
        care costs as employee’s health status
        improves

    *University of Michigan, Center for Value-Based Insurance Design:
    http://www.sph.umich.edu/vbidcenter/pdfs/vbidmoreinformation.pdf


                                      11
Asheville:
Blood Sugar (HbA1c Averages)

    8

                                               7.3
                                      6.9                         7.0
              6.6        6.7                             6.7
                                                                  ADA
                                                                  Goal




 Prior to    1st yr     2nd yr     3rd yr     4th yr     5th yr
Program     Program   Program    Program    Program    Program




                                 12
      Asheville:
      Ave. Annual Diabetic Sick-Leave Usage

            12.6



                                   8.46

                           6                       5.68          5.81
Sick Days                                                                      5.67
                       1




                                                   3



                                                              4



                                                                            5
            e




                                  r2
         lin



                      r




                                             r



                                                             r



                                                                           r
                               ea
                   ea




                                          ea



                                                          ea



                                                                        ea
       se




                               Y
                   Y




                                          Y



                                                          Y



                                                                        Y
     Ba




                                              13
       Asheville:
       Patient Satisfaction – Pharmacist Care
   Overall Satisfaction with                Overall Satisfaction with Pharmacist Provided
    Pharmacist Diabetes Care                          Diabetes Care at 6 Months
      6-month follow-up                                                                155
          188 patients
          96% of responses
           either very satisfied
           or satisfied
                                                                             25
                                         0             2          6

                                         1             2          3           4          5
                                        Very                                            Very
                                        Dissatisfied                                    Satisfied




                                   14
Asheville:
Direct Medical Costs Over Time
                             $8,000
                                                                          Other Rx
                                                                          Diabetes Rx
Mean Cost / Patient / Year




                             $7,000
                                                                          Claims $
                             $6,000

                             $5,000

                             $4,000

                             $3,000

                             $2,000

                             $1,000

                                $0
                                      Baseline   1     2        3     4         5
                                                     Follow-up Year

                                                           15
    Asheville: Return On Investment
    Diabetes: decreased total health care costs avg.
     $2000/patient/yr.
    Diabetes: missed work hours cut 50%
    ROI (calculated by employer) of 4:1
    No diabetes patient has gone on dialysis in 8 years of
     program (1227 patient-years)
    Approximately 10% of employees enrolled in a
     program (diabetes/asthma/hypertension/cholesterol)
    Total health plan costs rose 0.1% from 2004-2005
    Over $6 million in health care cost savings over 8 years




                             16
        Employer A: Actual Costs compared to
        Projected Costs*
                 Average Annual Costs to Employer for Participants
                                                                       Year 3 Projected
   $14,000                                        Year 2 Projected         $13,740
                                 Yr 1 Projected
                 Baseline          $10,390              $11,948
   $12,000
   $10,000       $9,035                                                                Yr 3
    $8,000                                                                             savings
                                                                                       Per Patient
    $6,000                                                                             from Projected
    $4,000                                                                             Costs: $6,250
                                                                                       from Baseline
    $2,000                                                                             Total Costs:
        $0                                                                             $1,545
               Baseline 2002     Year 1 Actual         Year 2 Actual   Year 3 Actual
  Pharmacist        $0               $414                  $268            $240
  Medication      $1,667            $3,045                $3,748          $3,093
  Medical         $7,368            $5,454                $4,786          $4,157

Total costs     $9,035             $8,913                $8,802           $7,490

                  *for 63 patients with baseline,1st, 2nd and 3rd year results

                                                  17
Program Evolution

   Asheville, North Carolina
   American Pharmacist Assoc. (APhA)
    Foundation partnered with the City of
    Asheville to replicate the care model
       2003 - “Patient Self-Management Program”
       2007 - Renamed the Patient Self-Management
        Program, “HealthMapRx”
   Each program has its own name locally and
    uses HealthMapRx infrastructure and
    curriculum
       MBGH named the Chicago-area program
        “Taking Control of Your Health”


                             18
APhA Foundation HealthMapRx
Programs Across the Country
                     Sites 2007:                  18
                     Employers:                   80
                     Patients:                    2,000+



                                                  Manitowoc, WI

                                                Milwaukee, WI Flint, MI Pittsburgh, PA
                                                                            Lancaster, PA
Honolulu, HI                                       Chicago Columbus
                                                                         Cumberland, MD
                              Colorado
                             Springs, CO            Quincy       Asheville Greensboro & Eden NC
                                                                 WNC
                                                               NW GA   Charleston, SC
               Los Angeles, CA                                    Dublin GA
                                                        Monroeville, AL

                                                                Tampa, FL




                                           19
    Select Participating Employers
    Charleston: City of Charleston, Mt. Pleasant,
     North Chas, CPW, Piggly Wiggly, Roper Hospital
    Chicago: City of Naperville, Hospira Inc., Jewish
     Federation, Pactiv Corporation
    Colorado Springs: City of Colorado Springs
    Honolulu: Quality Healthcare Alliance, Time
     Supermarkets, Punahou School, and Outrigger
     Resorts
    Los Angeles: University of Southern California
    Milwaukee: City of Milwaukee
    Pittsburgh: Heinz; Westinghouse, Joy Global,
     Carnegie Mellon, Transtar, DDI, Ellwood City
     Forge, General Nutrition (WV & OH)
    Tampa: Manatee County, & Pinellas Sheriff’s Dept.


                             20
Taking Control of Your Health
The Taking Control of Your Health
Coordination Team

   Midwest Business Group on Health (MBGH)
   Illinois Pharmacists Association (IPhA)
   American Pharmacists Association (APhA)
    Foundation
   Health Plan/TPA/PBM




                     22
Taking Control of Your Health
Program Objectives

   Align incentives to promote motivated, self-
    managed patients, leading to improved
    health outcomes for people with diabetes
   Demonstrate that benefit design can impact
    behavior
   Demonstrate that employer investment in
    pharmacy services, reduced co-pays and
    routine patient education improves
    diabetes control and cuts overall costs for
    workers and retirees with diabetes


                          23
Care Model & Patient Incentives
   Offered to people with diabetes through
    their employers
   Voluntary participation
   Patients choose pharmacist
   Education on controlling diabetes
   Ongoing face-to-face care with a personal
    pharmacist
   HIPAA compliant
   Incentives:
       Diabetes-related meds and supplies with
        reduced or waived co-pays
       Labs without co-pays (optional)
       Free glucose meters (optional)

                              24
    Status of Project
    Three participating employers
        Hospira (Chicago, IL, Kenosha, WI and Rocky Mount, NC)
        Jewish Federation of Metropolitan Chicago
        Pactiv Corporation (Chicago area and Jacksonville, IL)
    200 patients enrolled
    800 number for participants to reach Jessica
    Pharmacy Network
        200 pharmacists trained in diabetes education
        Walgreens and Osco chains participating
        UIC, Midwestern and SIU Pharmacy Schools supporting
    Support received from Institute of Medicine of Chicago
     and IAFP
    First reports on clinical outcomes received summer 2008
    Reports on cost savings due April 2009




                                    25
    Year 1 Initial Results (Illinois)
Prior to Program                         After Year 1
   A1c = 7.1                               A1c = 6.9

   Systolic Blood Pressure = 129           Systolic Blood Pressure = 125

   Diastolic Blood Pressure = 78           Diastolic Blood Pressure = 76

   LDL Cholesterol = 92                    LDL Cholesterol = 87

   Weight = 210.8                          Weight = 203.6

   BMI = 32.3                              BMI = 31.4


      All diabetes clinical results are below
      the American Diabetes Guideline goals

                                    26
Ideal Criteria for Implementing

   Self-insured employers most desirable
       Cost utilization data is necessary
   Strong internal champion with decision
    making authority within each employer
    administration
   Willingness to adopt program and
    aggressively promote participation
   Technical support and consultation
    provided by MBGH, IPhA and the APhA
    Foundation


                                27
    MBGH’s Role
    Recruitment of employers into program
    Implementation coordination for consistency and better
     outcomes
    Development of common materials
    Assistance with enrollment
    Communicating with employers, pharmacy network, physicians
     and APhA
    Negotiated rates with pharmacy network
    Assisting employers in replicating model in other locations
    Identify and acquire funding to support common approaches
    User group of participating employers
    Media relations
    Reporting results to community
    Oversight of all activities

                                28
    Employer’s Role
    Willingness to invest in employees’ health to
     enhance quality of life, reduce sick days and lower
     hospitalization costs
    Promote the program, orient and enroll patients
        Enrollment process determined by each employer.
         MBGH handles enrollment for 2 employers and
         multiple worksites
    Capability to provide reduced/waived co-pays or
     other incentives diabetes-related medications and
     supplies
        Work with health plan/TPA/PBM
    Provide access to data from health plan to track
     total health care costs for enrollees
    HIPAA compliance


                                 29
Program Costs

   Waived co-pays for medications and supplies
       Optional incentives
           Waived co-pays for lab tests
           Waived co-pays for preventative check-ups
            (endocrinologist, nephrologist, podiatrist, optometrist, etc.)
           Reduced premiums for participants
   Pharmacist reimbursements for coaching sessions
   Administrative fees (APhA)
       MBGH receives portion for its administrative expenses
   MBGH membership



                                   30
    Breakdown of Employer Costs
    Annual per participant fee to APhA:
     (assumes 200 patients in the program)
        $160 (1st yr), $120 (2nd yr), $80 (3rd yr.)
        Fees drop as program reaches 500 and 1000 patients
    Pharmacist visit fees per patient:
        $120 for one hour
        $90 for 45 minutes
        $60 for 30 minutes
        $30 for 15 minutes
    First year average per patient pharmacist cost:
     (Note: ROI calculator available)
        7 visits @ $90 (45 minutes each) = $630 per patient
        + $160 per patient (APhA admin fee)
        + reduced/waived co-pay costs




                                  31
    Role of the Physician &
    Diabetes Education Centers (DECs)

    Physicians are responsible for overall care of patient
     and changes in therapy
    Program is complementary to scheduled or referred
     physician and DEC visits
    MBGH notifies physicians about the program when
     patients enroll
    Physicians will receive summary reports after each
     patient session with pharmacist
    DEC is responsible for intensive education when
     indicated
        Employers must determine what is covered for DECs
         through benefit design
    Data from the Asheville project indicate that
     physician outpatient and DEC visits increase


                                32
Pharmacist’s Role

   Pharmacist must:
       Be a Certified Diabetes Educator
       Have completed motivational interviewing training
       Have private consultation areas for patient
        education or visit worksite
           Retail chains participating: Walgreens,
            Osco/Albertson’s
       Administer the knowledge, skills and performance
        assessments
       Collaborate with local physicians and DECs
       Maintain documentation and report outcomes
       Comply with program standards and HIPAA


                                    33
IPhA’s Role

   Pharmacist Network Coordinator
       Pharmacist network administration and
        network staff support
           Dedicated pharmacist to oversee the
            pharmacists
               Creates directory of certified pharmacists
               Matches enrollees with pharmacists
               Monitors pharmacists’ performance and
                reports
               Handles billing
               Coordinates diabetes certificate training for
                new pharmacists who want to join the network


                                 34
    Participant’s Role

    Agrees to meet with a specially trained pharmacist
     on an ongoing basis for education, monitoring and
     setting personal goals for diabetes self-management
    Works with a specially trained pharmacist to
     complete knowledge and skills assessments
    Meets at least quarterly with a specially trained
     pharmacist
        Pharmacist Network Coordinator notifies the employer
         if there are participants that don’t keep appointments




                                   35
Patient Experiences

   Click here to view Asheville patient
    testimonials




                       36
Contact Us

   Jessica Westhoff
    MBGH
    312-372-9090 ext. 103       Taking
    jwesthoff@mbgh.org         Control
                                of Your
   Larry Boress               Health
    MBGH
    312-372-9090 ext. 101
    lboress@mbgh.org
   Visit us at www.mbgh.org

                     37

				
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