Diabetes Ten City Challenge

The Diabetes Ten City Challenge was modeled after other highly successful programs, including the Asheville Project in North Carolina, a diabetes self-management program started in 1997 that has proven to improve overall health, reduce absenteeism, shorten hospital stays and reduce health care costs.  The Diabetes Ten City Challenge was the first-ever national pilot seeking to prove this model can be used effectively anywhere in the country.

Key Objectives:

1. Assess the economic and clinical outcomes for of a multisite community pharmacy health management program for patients with diabetes.

2. Implement an employer-funded, collaborative health management program using community-based pharmacist coaching, evidenced-based diabetes care guidelines, and self-management strategies designed to keep patients with diabetes healthy and productive.

3. Implement the patient self-management training and assessment credential that equips patients with the knowledge, skills, and performance monitoring priorities needed to actively participate in managing their diabetes.

4. Assess patient satisfaction with overall diabetes care and pharmacist care provided in the program. 

More than 30 employers representing a variety of industries joined forces with local pharmacists in 10 different cities to help their employees with diabetes improve their health through the DTCC. 

Cities and employers were chosen based on the following criteria:

• Individual or group of employers with self-insured health care plans have a combined minimum of 5,000 employees and/or beneficiaries;

• Employers agreed to provide incentives, i.e., waive co-pays for diabetes-related medications and supplies for participants in the program;

• There was a strong internal champion with decision-making authority within the employer administration;

• Willingness to adopt and implement the Asheville Project model; and

• Willingness to speak about the program with local and national media.

About the Ten Cities
The DTCC was implemented in 10 different cities. The program was offered in community independent pharmacies, community chain pharmacies, ambulatory care clinics, and at on-site workplace locations if designated by the employer. 

About the Experts
Six experts affiliated with the APhA Foundation oversaw the implementation of DTCC.
APhA Foundation executives traveled throughout the country to speak about the Diabetes Ten City Challenge in an effort to educate audiences about the problems facing our health care system and how the DTCC model is an investment in health rather than an expense for sickness.

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Diabetes Ten City Challenge expanded upon the success of the process of care model from Patient Self-Management Program for Diabetes. Interdisciplinary care teams, innovative payers, and aligned incentives were brought together in 10 different cities across the U.S. to improve health outcomes, enhance the quality of care, and reduce costs. 
 

Pharmacists' Patient Care Services

All ten cities participating in DTCC included pharmacists as an integral part of their diabetes care teams. More than 100 specially trained community pharmacists used the Patient Self-Management Credential to “coach” people on how to manage their diabetes, including setting goals, using medications properly, and tracking their condition consistently with indicators such as cholesterol tests, blood pressure, foot exams and eye exams.

 

Interdisciplinary Health Care Teams

Interdisciplinary Health Care Teams including pharmacists, diabetes educators and physicians were assembled in the community, educated about the program and compensated for their involvement. Team members communicated regularly to optimize patient care.

 

Innovative Payers and Sustainability

Self-insured employers invested in pharmacists' patient care services to help their employees manage all chronic conditions. Resources were allocated to prevention and monitoring, allowing for a reduction in treatment costs for complications of chronic disease. Positive health outcomes and cost savings justified the sustainability of the model.

 

Aligned Incentives

Employers contracted with the APhA Foundation to establish the program in their community, and align employee benefit incentives to encourage success. Co-payments for diabetes medications and related supplies typically were waived for patients who participated. Other incentives included counting participation toward wellness points and waiving copayments for education classes and/or laboratory tests.

Results of the DTCC showed favorable economic and clinical results for employers and participants. The reduction in total healthcare costs is a “net” value, meaning that payers save $1,079 per year after paying the pharmacist for their services and providing waived copay incentives for beneficiaries.  

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Clinical Results

Participants improved in all of the recognized standards for diabetes care, including decreases in A1C, LDL cholesterol and blood pressure; and increases in current flu vaccinations and foot and eye exams.

• A1C blood sugar and lipid panel screening rates increased to 97% and 92%, respectively

• 91% of patients achieved an A1C within the HEDIS goal and 63% achieved HEDIS-defined lipid control

Statistically significant improvements were observed for key clinical measures, including:

• mean glycosylated hemoglobin decrease from 7.5% to 7.1%

• mean low-density lipoprotein cholesterol decrease from 98 to 94 mg/dL

• mean systolic blood pressure decrease from 133 to 130 mm Hg 

• Influenza vaccination rate increased from 32% to 65%, eye examination rate increased from 57% to 81%, and foot examination rate increased from 34% to 74%.

 

Patient Satisfaction Outcomes

• Patients ranked overall diabetes care as very good to excellent increased from 39% to 87%.

• Overall, 97.5% reported being very satisfied or satisfied with the diabetes care provided by pharmacists 

 

View the full fact sheet of the final results.