Innovative Plan Unites Pharmacists and Employers Against Diabetes

Published March 1, 2007

An employee of the City of Charleston, South Carolina left work early one day last spring because he didn’t feel well. On his way home, he blacked out at the wheel and had a car accident. When questioned about it at the hospital, he explained he was a diabetic and had not been taking his medicine. When asked why, he said it’s so expensive he sometimes goes without his medications altogether.

Approximately 21 million Americans, or 7 percent of the U.S. population, live with diabetes, making it one of the nation’s biggest health problems. Even more disturbing is that 6.2 million of them are unaware of their condition and go untreated.

Through a program called the Diabetes Ten City Challenge (DTCC), the American Pharmacists Association Foundation (APhA) is hoping to address that problem by teaming pharmacists with employers in a patient-centered, self-care program that offers employees incentives for managing their diabetes in a proactive way, thereby reducing and possibly eliminating the need for catastrophic care.

Communicating with Patients

“We know how to treat diabetes effectively,” explained APhA Foundation Executive Director William Ellis. “We have drugs that work, and [we] know what diet and exercise can do.

“Now we have to put a system in place that reinforces that knowledge,” Ellis continued. “And we believe it is important to do it on a collaborative level. With this program, pharmacists are communicating with the employees, their physicians, and diabetes education centers, which the patients are also referred to for extra training if they need it.”

Launching Campaigns

Charleston launched its campaign in May 2006. The other nine cities–Chicago, Illinois; Colorado Springs, Colorado; Cumberland, Maryland; Dalton, Georgia; Honolulu, Hawaii; Los Angeles, California; Milwaukee, Wisconsin; Pittsburgh, Pennsylvania; and Tampa Bay, Florida–are following suit.

Thanks to the innovative, patient-centered program, the Charleston employee who had the car accident now has access to the care he needs every month.

“We got him started one month earlier than the scheduled kickoff date,” said Kay Cross, assistant director of human resources for the City of Charleston. “We have a good insurance plan, but even paying 30 percent of medication costs can be a lot for some employees.

“We feel the Diabetes Ten City Challenge fits our current benefit programs,” Cross continued. “We believe that if we can help our employees stay healthy, it is good for them and for us. Being proactive is the way to go in health care, and I believe it is where the country is headed in terms of getting rid of some diseases.”

Teaming Up

The DTCC is fashioned after North Carolina’s Ashville Project. Ten years ago, the City of Ashville–a self-insured employer–began teaching employees with chronic conditions such as asthma, high cholesterol, and diabetes how to control their diseases.

In addition, employees were teamed with pharmacists, who stressed the importance of taking medication as prescribed.

A pharmacist works directly with the patient but informs the patient’s doctor of any red flags that might be raised. The doctor then decides whether to change the patient’s medication or dosage or call the person in for an office visit, explained John Miall, one of the Ashville Project’s founders and a consultant to the APhA Foundation.

Saving Money

In addition to disease-management education and pharmacist coaching, the DTCC offers employees and their dependents financial incentives, such as waivers of co-payments on prescription drugs and diabetes-related supplies.

Though employers are sometimes leery of the program, Ellis said, it has proven to save them money in the long run.

According to the APhA Foundation, the program reduces employee absenteeism by 50 percent. That, in turn, leads to fewer workers’ compensation claims, saving about $918 in the first year and more in subsequent years, yielding a 400 percent return on investment in the second year.

“After the first year of the program’s trial, people actually saw their doctors more frequently,” said Miall. “There ended up being 200 more outpatient visits that year. Although the model added more frequent doctor’s visits, there were fewer visits to the emergency room. We took the severe catastrophic cost of care and exchanged it with frequent lower-cost care.

“In the current system,” Miall continued, “doctors and insurance companies seem to only get paid when there are catastrophic events. But it’s better to pay them for keeping people healthy rather than when people are severely sick.”

Expanding Availability

If the program continues to be successful, the APhA Foundation plans to expand it to more communities.

“Our overall goal is to try and make this program as widely available as possible,” Ellis said. “As we expand in the future, we want to reach other kinds of populations, like the underserved, and find the best way to connect with those communities. There is so much that needs to be done in the whole area of diabetes–it’s almost an epidemic.”

Aricka Flowers ([email protected]) writes from Chicago.

For more information …

American Pharmacists Association Foundation,