Taking Action: Launching Your Own Asheville Project

Back in the mid-nineties, health care professionalsin North Carolina collaborated to implement theAsheville Project, a proactive approach to healthcare. Instead of fixing patients when they break,as Barry A. Bunting, PharmD, likes to say, the goal is toprevent patients from breaking and manage their conditionsin such a way that they eventually improve. Bunting,one of the project?s founders, is clinical manager of pharmacyand Asheville Project coordinator at the Diabetesand Health Education Center at Mission Hospitals inAsheville. The intended result was 3-fold: not only wouldpatients? health improve, employer health care costs wouldbe reduced, and overall employee productivity wouldincrease.

That idea came to fruition in 1997, when the firstAsheville Project was launched with just a small group ofdiabetes patients employed by the City of Asheville. Now,a decade later, the initiativehas moved beyond diabetesto other chronic conditions,and it is being replicatedacross the country.

One of the main factorsbehind the attractiveness ofthe Asheville model is itsflexibility; the concept can beadapted to coincide with theresources that exist in anygiven community. For example,some Asheville sitesboast pharmacists? networksthat are coordinated throughthe state pharmacy associations;others have moreinformal arrangements thatare handled by the pharmaciststhemselves. At oneAsheville site, a pharmacybenefits manager acts as administrator of the pharmacists?network. Many patients visit their health care coaches/pharmacists at the local pharmacy; however, an increasingnumber of pharmacists visit their patients? workplaces toconduct regular monitoring sessions.

At its core, the Asheville model is extremely simple. Inorder to work, what is required is a willing employer, awilling health care coach (most often a pharmacist), andwilling patients. Physicians and health care educators?-those conducting the seminars that patients are required toattend?-must also be on board.Diabetes Management?a Good Place to Start

Dr. Bunting suggests that the best condition to start with isdiabetes. ?It is just in so much need of improvement, andthe return on investment appears to be very quick and significant,?he says. ?We got into asthma, high blood pressure, and depression as a result of the success of the diabetesprogram.? No matter what condition pharmacistsare monitoring, they must attend training in order toupdate their knowledge of the disease.

The Asheville model is designed for self-insuredemployers, and pharmacists interested in launching theirown Asheville Project should start there. ?If there are severalemployers geographically close to your location whoseemployees are coming into your store, then it?s thoseemployers you should be thinking about contacting,?Dr. Bunting advises.

In Asheville, the pharmacy department at MissionHospitals was the catalyst for recruiting and training interestedpharmacists and matching them with an employer.?I tell a new employer who has expressed an interest tolook at their numbers,? Dr. Bunting relays. ?Every time wehave done that, they have come back with sticker shock: arealization that they are spending, in many cases, morethan $10,000 per person per year in health care costs?-especially on people with diabetes.?A Focus on the Patient

Although the pharmacist?s role is to offer coaching,monitoring, ongoing education, and accountability, thepatient is at the center of the Asheville model. ?They arethe most critical?-more so than their physician or theirpharmacist?-because they deal with this 24 hours a day,?Dr. Bunting notes. ?What the health care community can provide is help, and they are going to do well or not so welllargely depending on the help they get from the healthcare system.? Pharmacists, in turn, can use this as anopportunity to return to the roots of the profession: helpingpatients improve their health while being compensatedin return.

Providing patient care services takes time, and in orderfor this to work, pharmacists need to manage it properly.?Time is money, and if they are being paid to do this, andthey are being compensated comparably to what theywould earn if they were dispensing, that gives the pharmacistan option,? Dr. Bunting says. ?However, with the shortageof pharmacists, the biggest challenge to this model workingbeyond Asheville is the ability of pharmacists to createthe time to see patients. Ultimately, that is going to meanusing technicians more and using automated technologymore. That needs to be embraced rather than feared.?

He adds that pharmacists also should be wary of bitingoff more than they can chew: start with a handful ofpatients rather than a loaded roster. ?It?s best for them tostart out with a manageable number that seems to matchup with the time they have been able to free up.?Bring Everyone on Board

The success of the Asheville model relies upon collaborationamong all parties involved: employers, patients,pharmacists, health care educators, and physicians. One ofthe most significant barriers to the program?s effectivenessis if physicians are not on board well before the model islaunched. ?A common mistake is not gaining the supportof the physician community up front,? Dr. Bunting pointsout. In Asheville, organizers solved this by engaging thephysicians in the pharmacist training. ?They gainedknowledge about what we were trying to do, and theybecame unofficial champions.?

Ultimately, a successful launch is dependent upon thedesire by everyone involved to make it happen. Not onlymust pharmacists have the motivation to make somechanges in their practice, employers, too, must be open tothe potential benefits if the model is implemented properly.?They need to be committed to the idea that preventionis possible,? Dr. Bunting says. ?This model is a reasonablestrategy that can help them reduce their health care costsand improve their employees? health and productivity.?

Senator Burr Touts Asheville Project

Eileen Koutnik-Fotopoulos

Ms. Koutnik-Fotopoulos is a staff writer for Pharmacy Times.

Sen Richard Burr (R, NC) knowsthe state?s health care system needsserious improvement. He supportslegislation in Congress that will makehealth care more accessible and affordablefor all Americans through privateinsurance companies.

?Emergency rooms across NorthCarolina are filled with patients whoaren?t getting preventive care and who don?t have healthinsurance. Unfortunately, not only are these people morelikely to get sick because they aren?t getting good preventivecare, but the cost to treat them affects all of us whoultimately foot the bill through higher health costs,? hesaid. ?We need to find a way to increase the number ofthose who have health care insurance and put a greateremphasis on keeping people healthy in the first place.?

In January 2007, Burr addressed the Senate floorregarding the state of health care. He proposed 2 strategiesto get a handle on the incredible cost of health care:(1) provide coverage and (2) promote prevention andwellness. ?If we can teach people how to control disease,then the number of times they access health care is goingto be less,? he said.

While his statement is common sense, there is a problem.?If we can?t create a relationship between an individualand a health care professional, how in the worldare we ever going to complete the educational process ofwhat disease management is??

He cited the Asheville Project that began 10 years agoin his home state as the prime example of patients workingwith a pharmacist to control their diabetes. The project was, ?clearly out of the box because the communitydecided, with a grant, they were going to reimburse pharmaciststo counsel diabetes patients,? Burr told theSenate.

The Asheville Project, which is being replicatedacross the country, allows patients with certain conditionslike diabetes, hypertension,and asthma toform a relationship withpharmacists through patientcounseling. Thepharmacist will evaluate a patient?s medication to makesure it is correct and there are no interactions with othermedications they may be taking. The pharmacist willprovide education on exercise and diet and monitortheir progress. In a nutshell, patients will learn how tomanage their disease state.

In his address, Burr said the proof is the data, notingthe significant cost savings?approaching $3000 perdiabetes patient/year, according to the most recentdata??because we now provide for every diabetic thisintense relationship with a health care professional.?

?Now what you have to understand is that inAsheville?s case, and these other areas around the country,this is not the traditionalentry point wherewe would choose to educate.This is quite creative.As a matter of fact, we havetalked about it, and it has been rejected in this institutionbefore, that we actually pay pharmacists to do partof the health care education. I hope it is something wewill reexamine because I think there is tremendousmerit to it.?