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Nothing is as powerful as an idea whose time has come, said Victor Hugo. He was talking about a revolution, and that is what the Diabetes Ten-City Challenge represents. It is a significant and potentially powerful transformation in the delivery of pharmacist care to employees with diabetes.
This progressive program-based on established protocols for improving employee health and lowering employer healthcare cost-is spreading quickly across the country. The Ten-City Challenge, which began last October, is founded on the experience of the Asheville Project, in Asheville, N.C., which began nearly a decade ago.
A number of employers are participating at each of the seven sites where the program is currently running. Organizers say the final three sites could be announced by the end of the year. "Our pilot project last year went very well," noted Garrett. "We know the idea is scalable and that we can reproduce our results. And the results have been shown to be impressive."
The Asheville experience, perhaps the most progressive pharmacist care program ever initiated, supports his contention. That program hooked up pharmacists and employers to fight diabetes. It began in 1997 with 47 city employees. Soon several other employers joined, as did hundreds of workers. One employer, the Associated Financial Group, reported that after only 18 months of pharmacist care, they experienced an average savings of $1,000 per participant in medical plan costs.
The savings result from educating employees about the dangers of diabetes, explained Garrett. It is the complications of the disease that make it so economically devastating. In fact, for newly diagnosed patients without medical complications like heart and kidney disease, overall costs are more than 50% lower than for the average patient with diabetes, according to a study published in the March 2006 issue of the Journal of Managed Care Pharmacy.
To fight complications, the American Diabetes Association recommends that patients maintain hemoglobin A1c of less than 7% (A1c is a measure of average blood glucose levels over a three-month period). But that is not what is happening nationwide: The ADA reports that only about 43% of Americans who have been diagnosed with and are being treated for diabetes are actually achieving the A1c target.
Pharmacists who completed the Diabetes Certified Training Program, available through state pharmacist organizations, learn to inform people with diabetes about these numbers and their risk. And that information makes a difference.
"I've seen significant improvements in HbA1c levels," said Chris Green, Pharm.D., a clinical pharmacist at Ohio State University who is participating in the project. "But we've also seen personal improvement in how people feel about themselves and how much harder they work to meet their goals with some extra support."
That attitude change translates well for employers. The Asheville Project reported that absenteeism fell 50%, and workers compensation claims related to diabetes were virtually eliminated for several employers who participated for just a couple of years. Astonishingly, after nine years, participating employers reported that they were paying less to insure program participants than they were paying to insure their employees without diabetes.