Ms. Heinze is a freelance writer/editor based in Vancouver, British
Columbia.
Perhaps no one is in a better position to assess the
impact of the Asheville Project than the City of
Asheville itself where the program was piloted 10
years ago. The potential of this new patient care
model was clear: improve employee health and productivity
while controlling health care costs—a concept that was destined
to benefit everyone.
The city initially targeted
staff members with diabetes,
offering them free medication
and testing equipment
in return for their attendance
at educational seminars
(provided by Mission
St. Joseph’s Diabetes and
Health Education Center)
designed to teach them how
to manage their condition
and take their medications
correctly. Employees also
had regular visits with an
assigned case manager—-
usually a pharmacist.
The pharmacists who signed on have since built booming
patient care services practices that assist in improving
patient health through regular counseling and monitoring
sessions, resulting in lower overall costs and fewer sick
days. According to Destiny Mattsson, wellness coordinator
in the City of Asheville’s human resources department,
the combined data from the city and Mission Hospitals
show that the returns on investment are 4 to 1, with annual
savings between $1600 and $3200 per diabetic
patient/year; sick leave among diabetic workers also has
dropped 50%.
Mattsson says that the
success of the Asheville Project
can be attributed to the
cooperation among all parties
involved. “The key for
this program has been definite
collaboration among
different community partners—
everything from our
risk management, to physicians,
nurses, health educators,
pharmacists, and our
staff,” she says.
Last year, the city added
depression treatment to its
health management repertoire.
Mattsson explains that because
of the nature of depression, participation data are kept confidential;
none of those records are processed through the city’s
worksites. To advise staff of this new health management
module, the city conducted an aggressive education campaign.
“We did a big marketing push that discussed what
depression is,” she explains, “that went out pretty
much on a daily basis—via email, newsletters,
and posters over the course of a month—and
that’s how people were informed on how they
could get involved.” Designed for those who are
diagnosed with clinical depression, the program
covers medication and counseling.
As wellness coordinator, part of Mattsson’s
role is to offer preventive management, such as
exercise, diet, and stress management programs
aimed at minimizing the risk of contracting diabetes.
These programs are open to all city employees, whether
they are part of the Asheville Project or not, and have met
with success. Mattsson recounts one story of a woman suffering
from diabetes who followed the city’s Weight
Watchers at Work program and lost 50 pounds. “She was
able to dramatically reduce the amount of medication she
was taking,” she says. “It not only saved her; it helped us.”
Mattsson receives regular feedback from those participating
in the Asheville Project, and, she notes, the enthusiasm
surrounding it is encouraging. “A lot of people have
even used the phrase, ‘this program has saved my life.’ It’s
a great program for everyone—especially those people in
the workforce who can’t afford to take care of themselves
appropriately. This program has allowed them to better
manage their condition, learn about it, and take care of
themselves.” With their medications paid for, patients are
free to take better charge of their health. “Now that they
do not have to pay for their medications, they are taking
better care of themselves.”
Program Has Political Support
Asheville Mayor Terry Bellamy has been
able to view first-hand the benefits of the
Asheville Project for city employees. “I have
noticed that employees are managing their
lifestyles better, including impressive
weight loss, which has impacted their self-esteem
and job performance. A police officer
recently told me how the program has
helped him to lose weight, become more
physically fit, and handle the stress of his
job in a better way,” she notes. “The numbers
show that due to this program,
employees miss fewer days of work.”
Mayor Bellamy pointed out that approximately
25% of the city’s workforce is
enrolled in the Asheville Project and credits
it with helping to keep the city’s health care
cost increases down. She also commends the
project’s expansion to include more chronic
conditions and wellness programs. “It helps
our budget, but it has much more to do
with people than dollars and cents. Employees
receive intensive education through
Mission Hospitals and are teamed with
community pharmacists who make sure
they receive their medications correctly,”
she continued.
The mayor attributes the success of the
program to its flexibility and focus on the
patient: “The program is not static; it
evolves based on the changing needs of the
employees and their current needs. Also,
the employees sense that they are more than
just employees to the city but, in fact, are
an integral part of the success of the
organization.”
Keeping Asheville City Employees Healthy
and on the Job
Ed Lamb
Mr. Lamb is a freelance pharmacy writer living in Virginia
Beach, Va, and president of Thorough Cursor Inc.
When the Asheville Project launched in 1997,
Lynn Hollifield, BSN, RN, COHN-S, was the sole
occupational health nurse for the City of Asheville. “I
used to be the local ‘Ask-a-Nurse,’” recalled Hollifield,
who is now the health services manager for city
employees and oversees a small staff. “The disease
management programs have shifted diabetes care from
my workload, so we’ve been able to expand in other
areas, like an onsite physician clinic, OSHA compliance,
and smoking cessation.”
As much as having pharmacists take over many of
the tasks of caring for patients with chronic health
conditions has helped Hollifield, she praises the
Asheville Project most for improving patients’ health
by “hooking them up with other providers who can
provide the most expertise and targeted care like pharmacists,
physicians, specialists, dietitians, and diabetes
educators.”
As the program has expanded, Hollifield has seen
benefits for enrollees, the city, and herself and her colleagues.
“I never really see diabetic crises anymore, and
it has been many years since kidney transplant was
needed for a current employee,” she told Pharmacy
Times. “The outcomes of the [1-year-old] depression
program are varied, but most participants have shown
improvement. Depression still carries a negative stigma,
and people are reluctant to seek help. However,
some program participants are comfortable with their
diagnosis and are peer-marketing the benefits of the
depression program to their coworkers.” Hollifield
also said that fewer employees are requiring emergency
room care and hospitalization for their chronic
conditions.
Facilitating Self-Care
Hollifield pointed to the “free meds” and supplies
as one of the reasons the Asheville model has been so
successful. “That is so important,” she said. “I’ve had
people tell me they split [blood glucose] test strips in
half to save money or not test at all.”
Asked to describe notable successes for patients
enrolled in Asheville programs, Hollifield first spoke
about a “brittle diabetic” who was facing the possibility
of going on disability. “Through the patient management
program, this man was able to get a
GlucoWatch [Animas Technology] and continue working.
I went to the training session where he learned
how to use the watch, and he couldn’t be happier,”
Hollifield said.
She also told the story of
an employee who frequently
had to miss work because of
“really bad asthma attacks.”
Hollifield said, “He never
carried his inhaler until he
enrolled in the program,” she
continued. “He was scared of
his asthma because his grandmother had died of asthma,
but he just could not remember to keep his inhaler
on him. One day after he was in the program, he started
having an attack, and he did have his inhaler. “He
made a special visit to tell me, ‘I didn’t have to go to the
emergency room like before,’” she said.
Baby Steps = Big Successes
Reflecting on these success stories, Hollifield said,
“Even a baby step is a big success. If we can get diabetics
to start carrying snacks so they don’t crash, or if we
can get an asthma sufferer to always have and use their
rescue inhaler, then the program is working. Every
baby step brings us closer to having a healthier
employee.”
Hollifield summed up her 10 years of involvement
with the Asheville Project by saying, “This is probably
one of the most revolutionary approaches to chronic
disease care, and it works.”
