Causes of and Potential Solutions to the High Cost of Health Care

Asheville Diabetes Disease Management Project

On October 10, 2003, John Miall made a presentation in a Web-Assisted Audioconference at Session 2, which was entitled Reining in the Cost of Chronic Illness.

This is the text version of Mr. Miall's slide presentation. Select to access the PowerPoint® Slides (2.9 MB).

Asheville Diabetes Disease Management Project

John Miall
Risk Manager
City of Asheville, NC

Slide 1

Image of city of Asheville.

Slide 2

Diabetes-Related Comorbidities

• 2-4 times greater risk of heart disease.
• 60-65 percent have hypertension.
• 2-4 times greater risk of stroke.
• 60-70 percent have some degree of nervous system damage.
• Leading cause of adult blindness.
• Leading cause of End Stage Renal Disease (40 percent new cases).
• >50 percent lower limb amputations.

Slide 3

Diabetes-Related Indirect Costs

• 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.

Slide 4

Patient Incentives and Care Model

• Patient selection/recruitment.
• Patient education—Mission + St. Joseph's Diabetes Center.
• Matching patients to pharmacists.
• Incentives:
  • Pharmacy Benefit Manager co-pay waivers.
  • Labs without co-pays.
  • Glucose meters.
• The operative word in pharmaceutical care is "care" (Madge's testimonial).

Slide 5

How They Do It
"Patient making better food choice. Blood glucose much improved. 2 x 1.5 cm wound RLE. Referred to physician for evaluation and therapy.

Slide 6

Clinical Outcomes:
Avg. Glycosylated Hemoglobin.
Bar graph of rates of HbA1c dropping from 7.60 to 6.7 over 60 months.

Slide 7

City of Asheville Medical Costs

Bar graph showing average aggregate medical claims moved from 6127 to 4651 over 60 months, including prescription drugs for diabetes.

Slide 8

City of Asheville Diabetes
Sick-Leave Usage

Bar graph showing 12.60 sick leave days to 5.7 over 5 years.

Sick Leave Usage By Time In Program.

Bar graph showing sick leave days moving from 11 to 3.9 over 5 years.

Slide 9

Sick leave usage by time in program.
Bar graph showing sick days taken from baseline to 5 years.

Baseline= 11 days.
1 year= 6.2.
2= 5.6.
3= 8.4.
4=7.6.
5=3.9.

Slide 10

Quality of Life

Bar graph comparing baseline to 14 months into the program showing modest improvements in quality of life in the following categories:

General health perception.
Energy.
Social function.
Role emotional.
Mental.
Pain.
Role physical.
Physical Function.

Slide 11

Frequency/Severity Matrix

Flowchart moving from to high frequency high severity to low frequency, low severity.

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Current as of July 2003

Internet Citation:

Asheville Diabetes Disease Management Project. Slide Presentation by John Miall, at Web-Assisted Audioconference, "Causes of and Potential Solutions to the High Cost of Health Care." Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/hicosttele/sess2/mialltxt.htm

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