The Asheville Project
Through The Asheville Project, pharmacists developed thriving patient care services in their community pharmacies. Employees, retirees and dependents with diabetes experienced improved A1C levels, lower total health care costs, fewer sick days, and increased satisfaction with their pharmacist’s services. Unlike other experiments, the Asheville model was payer-driven and patient-centered. The APhA Foundation has implemented and expanded upon this model throughout our research work.
The Background
-
The Asheville Project came from the Pharmacy Director from Mission Hospitals and a group of pharmacists at UNC Chapel Hill and the North Carolina Pharmacists Association (currently the North Carolina Pharmacists Association, or NCAP). The program developed into a true partnership and collaboration with key physicians, Mission Hospitals system, NCAP, the North Carolina Center for Pharmaceutical Care (NCCPC); and the City of Asheville. The program was coordinated by the City’s Risk Manager.
-
The project was initially designed for patients with diabetes, but over time the Asheville Project was expanded to include asthma, lipid management and hypertension (CV Health,) and later depression.
Key Objective:
-
To assess clinical, humanistic, and economic outcomes of a community-based medication therapy management (MTM) program for chronic disease patients over a 5 year period.
The Participants
-
Approximately 400 eligible employees were enrolled in the program (employees could participate in more than one module:
-
Diabetes: 134
-
High Cholesterol / Hypertension: 266
-
Asthma: 95
-
Depression: 51
-
Certificate-trained community and hospital pharmacists from 12 locations were also involved.
The Methods
-
An eligible employee is identified to participate as a patient in one or more modules of the program.
-
After enrollment with their Human Resources Department, patients are assigned to work with a certified pharmacist care manager.
-
Patients are then scheduled to attend the American Diabetes Association (ADA) prescribed educational classes which includes about 9 hours of class time, and their benefit card is activated to waive any co-pays associated with their condition.
-
From that point, patients are required to attend regular meetings with their pharmacist, attend regular visits with their treating physician and have labs drawn at regular intervals.
-
Employees can participate in more than one module of the program and received waived co-pays for medications related to those conditions.
-
All clinical, claims, drug, and humanistic data were tracked by clinicians and researchers.
The Results
With the initial roll out of the program which strictly served diabetics, positive results were realized after 6 months and remained fairly consistent from that point forward. Positive returns were seen by the end of year one with every program. Replications have seen similar results. Results of published data indicate that the City saves about $4.00 for every $1.00 they invest in the program.
Specifically for the diabetes program, both clinical and economic improvements were made.
Clinical Results
-
Mean A1c decreased at all follow-ups, with more than 50% of patients demonstrating improvements each time.
-
The number of patients with optimal A1c values (< 7 %) also increased at each follow-up.
-
More than 50% of patients showed improvements in lipid levels at every measurement.
-
Results suggested that patients with higher baseline A1c values or higher baseline costs were most likely to improve or have lower costs, respectively.
Economic Results
-
Costs shifted from inpatient and outpatient physician services to prescriptions, which increased significantly at every follow-up.
-
Total mean direct medical costs decreased by $1,200 to $1,872 per patient per year compared with baseline.