Nearly 20 years ago, a group of researchers at the University of North Carolina School of Pharmacy had a theory for an improved model of healthcare delivery. Specifically, they were interested in studying the financial impact to employer medical plan costs which could be obtained if medical plan participants would remain compliant with their prescribed medications. With their premise in hand, the next step was to find an employer partner who would be willing to experiment with them. This partnership was eventually forged with the City of Asheville in Asheville, North Carolina.
The Asheville Project, as it was later named, began with a narrow focus on their diabetic population of employees. Diabetic patients were chosen specifically due to the comorbidities (multiple other chronic health conditions) that are generally present in diabetics. Numerous studies by The American Diabetes Association and others have documented the following in diabetic patients:
• 2 to 4 times greater risk of heart disease
• 60% to 65% have hypertension
• 2 to 4 times greater risk of stroke
• 60% to 70% have some degree of nervous system damage
• Leading cause of adult blindness
• Leading cause of end-stage renal disease (ESRD), and accounts for 40% of all new cases
• Accounts for 50% of lower limb amputations
The program implementation involved a nurse or pharmacist to meeting one-on-one with each identified high risk diabetic on the medical plan. The goal of these ongoing meetings was to ensure the patients actually complied with the prescribed overall medical standard for their condition. In addition, the copays and other associated costs for diabetic testing and disease specific medications / supplies were waived, thus removing any financial barrier to compliance.
At the time there existed published research showing that if the hemoglobin A1C (90 day measure of blood sugar) of diabetic patients were to reduce just 1 point, you could expect to see all of the comorbid conditions to reduce by 50%. This meant that even a small improvement in these health plan member’s A1C levels would see all of the associated health conditions cut in half. Obviously achieving this goal was worth the effort, and thus the programs was implemented and communicated to the employees.