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

Perhaps no one is in a better position to assess theimpact of the Asheville Project than the City ofAsheville itself where the program was piloted 10years ago. The potential of this new patient caremodel was clear: improve employee health and productivitywhile controlling health care costs?a concept that was destinedto benefit everyone.The city initially targetedstaff members with diabetes,offering them free medicationand testing equipmentin return for their attendanceat educational seminars(provided by MissionSt. Joseph?s Diabetes andHealth Education Center)designed to teach them howto manage their conditionand take their medicationscorrectly. Employees alsohad regular visits with anassigned case manager?-usually a pharmacist.

The pharmacists who signed on have since built boomingpatient care services practices that assist in improvingpatient health through regular counseling and monitoringsessions, resulting in lower overall costs and fewer sickdays. According to Destiny Mattsson, wellness coordinatorin the City of Asheville?s human resources department,the combined data from the city and Mission Hospitalsshow that the returns on investment are 4 to 1, with annualsavings between $1600 and $3200 per diabeticpatient/year; sick leave among diabetic workers also hasdropped 50%.

Mattsson says that thesuccess of the Asheville Projectcan be attributed to thecooperation among all partiesinvolved. ?The key forthis program has been definitecollaboration amongdifferent community partners?everything from ourrisk management, to physicians,nurses, health educators,pharmacists, and ourstaff,? she says.

Last year, the city addeddepression treatment to itshealth management repertoire.Mattsson explains that becauseof the nature of depression, participation data are kept confidential;none of those records are processed through the city?sworksites. To advise staff of this new health managementmodule, the city conducted an aggressive education campaign.?We did a big marketing push that discussed whatdepression is,? she explains, ?that went out prettymuch on a daily basis?via email, newsletters,and posters over the course of a month?andthat?s how people were informed on how theycould get involved.? Designed for those who arediagnosed with clinical depression, the programcovers medication and counseling.

As wellness coordinator, part of Mattsson?srole is to offer preventive management, such asexercise, diet, and stress management programsaimed at minimizing the risk of contracting diabetes.These programs are open to all city employees, whetherthey are part of the Asheville Project or not, and have metwith success. Mattsson recounts one story of a woman sufferingfrom diabetes who followed the city?s WeightWatchers at Work program and lost 50 pounds. ?She wasable to dramatically reduce the amount of medication shewas taking,? she says. ?It not only saved her; it helped us.?

Mattsson receives regular feedback from those participatingin the Asheville Project, and, she notes, the enthusiasmsurrounding it is encouraging. ?A lot of people haveeven used the phrase, ?this program has saved my life.? It?sa great program for everyone?especially those people inthe workforce who can?t afford to take care of themselvesappropriately. This program has allowed them to bettermanage their condition, learn about it, and take care ofthemselves.? With their medications paid for, patients arefree to take better charge of their health. ?Now that theydo not have to pay for their medications, they are takingbetter care of themselves.?

Program Has Political Support

Asheville Mayor Terry Bellamy has beenable to view first-hand the benefits of theAsheville Project for city employees. ?I havenoticed that employees are managing theirlifestyles better, including impressiveweight loss, which has impacted their self-esteemand job performance. A police officerrecently told me how the program hashelped him to lose weight, become morephysically fit, and handle the stress of hisjob in a better way,? she notes. ?The numbersshow that due to this program,employees miss fewer days of work.?

Mayor Bellamy pointed out that approximately25% of the city?s workforce isenrolled in the Asheville Project and creditsit with helping to keep the city?s health carecost increases down. She also commends theproject?s expansion to include more chronicconditions and wellness programs. ?It helpsour budget, but it has much more to dowith people than dollars and cents. Employeesreceive intensive education throughMission Hospitals and are teamed withcommunity pharmacists who make surethey receive their medications correctly,?she continued.

The mayor attributes the success of theprogram to its flexibility and focus on thepatient: ?The program is not static; itevolves based on the changing needs of theemployees and their current needs. Also,the employees sense that they are more thanjust employees to the city but, in fact, arean integral part of the success of theorganization.?

Keeping Asheville City Employees Healthyand on the Job

Ed Lamb

Mr. Lamb is a freelance pharmacy writer living in VirginiaBeach, Va, and president of Thorough Cursor Inc.

When the Asheville Project launched in 1997,Lynn Hollifield, BSN, RN, COHN-S, was the soleoccupational health nurse for the City of Asheville. ?Iused to be the local ?Ask-a-Nurse,?? recalled Hollifield,who is now the health services manager for cityemployees and oversees a small staff. ?The diseasemanagement programs have shifted diabetes care frommy workload, so we?ve been able to expand in otherareas, like an onsite physician clinic, OSHA compliance,and smoking cessation.?

As much as having pharmacists take over many ofthe tasks of caring for patients with chronic healthconditions has helped Hollifield, she praises theAsheville Project most for improving patients? healthby ?hooking them up with other providers who canprovide the most expertise and targeted care like pharmacists,physicians, specialists, dietitians, and diabeteseducators.?

As the program has expanded, Hollifield has seenbenefits for enrollees, the city, and herself and her colleagues.?I never really see diabetic crises anymore, andit has been many years since kidney transplant wasneeded for a current employee,? she told PharmacyTimes. ?The outcomes of the [1-year-old] depressionprogram are varied, but most participants have shownimprovement. Depression still carries a negative stigma,and people are reluctant to seek help. However,some program participants are comfortable with theirdiagnosis and are peer-marketing the benefits of thedepression program to their coworkers.? Hollifieldalso said that fewer employees are requiring emergencyroom care and hospitalization for their chronicconditions.Facilitating Self-Care

Hollifield pointed to the ?free meds? and suppliesas one of the reasons the Asheville model has been sosuccessful. ?That is so important,? she said. ?I?ve hadpeople tell me they split [blood glucose] test strips inhalf to save money or not test at all.?

Asked to describe notable successes for patientsenrolled in Asheville programs, Hollifield first spokeabout a ?brittle diabetic? who was facing the possibilityof going on disability. ?Through the patient managementprogram, this man was able to get aGlucoWatch [Animas Technology] and continue working.I went to the training session where he learnedhow to use the watch, and he couldn?t be happier,?Hollifield said.

She also told the story ofan employee who frequentlyhad to miss work because of?really bad asthma attacks.?Hollifield said, ?He nevercarried his inhaler until heenrolled in the program,? shecontinued. ?He was scared ofhis asthma because his grandmother had died of asthma,but he just could not remember to keep his inhaleron him. One day after he was in the program, he startedhaving an attack, and he did have his inhaler. ?Hemade a special visit to tell me, ?I didn?t have to go to theemergency 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 diabeticsto start carrying snacks so they don?t crash, or if wecan get an asthma sufferer to always have and use theirrescue inhaler, then the program is working. Everybaby step brings us closer to having a healthieremployee.?

Hollifield summed up her 10 years of involvementwith the Asheville Project by saying, ?This is probablyone of the most revolutionary approaches to chronicdisease care, and it works.?