Critical Path Network

Hospital provides DM to employee groups

Reduces hospital stays, ED visits, and absenteeism

Mission Hospital in Asheville, NC, has teamed up with seven employers in the community to provide face-to-face disease management for chronically ill employees.

The program helps participants stay healthy, reduces hospital stays and emergency department visits, cuts down on absenteeism, and saves money for the self-funded employee health plans, according to Anna Garrett, PharmD, manager of outpatient clinical pharmacy programs for Mission Hospital.

The program grew out of the Asheville Project, which started as a pilot project conducted by the North Carolina Association of Pharmacists to help people with diabetes adhere to their treatment plan.

"The program has morphed into a broader model of care that is offered by the hospital to employers with self-funded employee health plans," Garrett says.

Hospital-based care managers, usually either pharmacists or RN-certified diabetes educators, work one on one with employees with chronic conditions that include diabetes, hypertension, high cholesterol, asthma, and depression.

The program is voluntary. The health plans agree to pay for medication and supplies and any copay the employees are responsible for as long as they are in the program. The hospital bills for the care manager visits through the employer's third-party administrator.

People who enroll in the program agree to attend self-management classes covered by their company's health plan and meet face to face on a regular basis with their care manager.

In the first five years of the program, the overall cost of care for participants with diabetes and asthma dropped by $2,000 a year, and costs for participants with cardiovascular disease decreased by about $900 a year, Garrett says.

At the same time, absenteeism decreased dramatically among employees receiving disease management, she adds. In the original pilot project, the 48 people with diabetes employed by the City of Asheville cut their sick days in half, reducing them from an average of 12 days a year to six.

Identifying eligible members

The hospital arranges with the employer's pharmacy benefit management to run a report determining which employees are taking medication for the chronic conditions covered by the program. Once they are identified as eligible for the program, the hospital sends them an enrollment package with information about the program.

"We don't want to violate HIPAA regulations by making the employer aware of an employee's health condition without permission from the employee," she says.

Employees who enroll are assigned a care manager based on their diagnosis and the complexity of their needs.

For instance, those who are taking multiple medications are assigned to a pharmacist care manager. Employees with diabetes work with the nurse care managers who are certified diabetes educators. A physician assistant coordinates care for the depression patients if depression is their only diagnosis.

Participants meet face to face with their care manager a minimum of once a month or as often as four times a month, depending on their clinical situation.

The majority of participants meet with their care manager at the hospital. Some are given paid time off to participate. Other employers give their employees unpaid time off to see the case manager. Still others require the employees to see their care manager when they aren't scheduled to work.

"We have almost zero no-shows among employees who come during working hours and get paid for it," she says.

A care manager goes to one worksite two days a week to work with the employees.

"At this site, the employees work 12-hour shifts, which make it difficult for them to come to the hospital during business hours. This arrangement has worked out well, and we are working with other employees to provide more on-site disease management. Some of the participants are reluctant because they would have to change care managers and end a long-standing relationship," Garrett says.

The care managers notify the participants' physicians about the program and their patients' participation and work with them to ensure that the treatment plan is being followed. They contact the physician if there is a change in the patient's condition or if they think a change in medication could be beneficial.

"The care managers do a lot of education and coaching and work with the employees to set goals and develop strategies for managing their condition," Garrett says.

They monitor medication adherence and side effects, helping patients understand their treatment plan, and helping them set goals, which may include exercise, diet, or smoking cessation.

The program is open-ended, and employees may participate for as long as they like.

"Some people have been in the program for as long as 12 years. They love it. It's a great benefit for them, and the cost reduction to the employers has been sustained over the long term," Garrett says.

The care managers are employed by the hospital and have undergone training to learn how to work with patients with chronic diseases. The hospital has offered depression management training as part of continuing education.

In addition to being a care manager for the patients in the program, the nurses conduct diabetes education classes and work with patients referred by the hospital who need regular diabetes care.

The pharmacists also conduct medication consultations for senior citizens and medication reconciliation for surgical patients.

Garrett attributes the success of the program to the personal working relationship that develops between the care managers and the employees.

"We always see the patients in person. We find that face-to-face contact makes a huge difference in the outcomes," she says.

(For more information, contact: Anna Garrett, PharmD, manager, outpatient clinical pharmacy programs, Mission Hospital, Asheville, NC, e-mail: