Prevention for Everyone: City of Asheville Extends Health Management Even to the Healthy

OCTOBER 01, 2007
Carolyn Heinze

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.?

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