Asheville Worksite Project Replication

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Submission Date: December 2012

Entry Type: Case Study

State/Territory Submitted on the Behalf of: South Carolina

States/Territories Involved: South Carolina

Domain Addressed:

Environmental Approaches

Public Health Issue:

The importance of addressing the environment that surrounds individual decision-making and promotes healthful behaviors is recognized as an important obesity prevention strategy.

Individuals are viewed within the larger context of community, family, and society. Worksites, from that perspective, are significant targets for chronic disease prevention in general and vascular disease prevention in particular, since a significant part of an employee’s day is spent at work. Additionally, health care costs in the United States doubled from 1990 to 2001 and are expected to double again by 2012. Chronic illnesses affect more than a third of working-age Americans and the costs associated with chronic diseases account for approximately 75 percent of the nation’s annual health care costs. Rising health care costs have a huge financial impact on employers. Nearly 60 percent of employers’ after-tax profits are spent on corporate health benefits. An estimated 25-30 percent of companies’ medical costs per year are spent on employees with excess health risk. That contrasts to three decades ago when only 7 percent of corporate profits paid for health costs.

Project Objectives:

The primary objective is to increase the percentage of worksites in South Carolina adopting policies that promote chronic disease prevention, lower health care costs for employers and increase control of blood pressure and cholesterol levels among individuals with high blood pressure and high blood cholesterol. Our strategy is based on the successful Asheville Project.

Program Action:

Through the Asheville Project, employees with chronic disease conditions are provided with intensive education through coaches or care managers. These health coaches or care managers are usually local area pharmacists that ensure participants are medically compliant and making lifestyle changes. It has inspired a new health care model for individuals with chronic conditions.

Unlike other experiments, the Asheville model is payer-driven and patient-centered. Employers are adopting this approach as an additional health care benefit to empower their employees to control their chronic diseases, reduce their health risks, and ultimately lower their health care costs. This program is unique because:

  1. It waives co-pays which increases adherence by taking away a financial barrier
  2. It educates people on the need to take the medicatio for prevention of stroke and heart attack
  3. It provides routine meetings with a ‘coach’ on the site where people’s blood pressure is measured, promoting personal accountability because people know their numbers and goals
  4. Coaching also helps people determine their own goals for nutrition and activity, both of which also help reduce BP
  5. It provides positive reinforcement from a coach which helps people feel good about their health and achievement of goals

Data/Other Information Collected:

Data on the following is colledted:

  • Improved health outcomes
  • Return on investment

Quarterly data reports will include, but are not limited to:

  •   Blood pressure control
  •   Cholesterol
  •   A1C, foot exams, blood glucose, eye exams and physical activity (for diabetes)
  •  smoking status
  •  financial impact

Other strategies monitored will include low dose aspirin therapy, smoking cessation and tobacco Quitline referrals

Impact/Accomplishments:

South Carolina’s statewide results demonstrate the reductions in overall plan cost for the managed population, as compared to the non-managed population. Other key indicators include utilization comparisons of various care categories, such as emergency room visits and in-patient hospitalizations. The project has been successfully implemented across the state, including City of Aiken, Piggly Wiggly, Inc. (multi-city), and Tuomey Healthcare System. Statewide results show reductions in visits related to places of service (emergency rooms) which are most often the most expensive for health plans. These reductions can be attributed to American Health Care (AHC) care managers educating and helping patients choose healthier lifestyle options, which leads to greater control of their disease, and, thus, reduces emergency room visits and in-patient hospitalizations. The clinical care results are favorable, and demonstrate the efficacy of this program in controlling high blood pressure and high blood cholesterol levels of employees enrolled in these worksites.

Our participating worksites achieved the following return on investment (ROI) averages over a 2-year period:

Diabetes Program: $9.41:$1

Hyperlipidemia Program (cholesterol): $2.94:$1

Hypertension Program: $2.15:$1

Challenges/Lessons Learned:

Recruitment of new worksites and amount of funding remains a challenge to enrollment of employees in recruited worksites with severe chronic disease risk factors.

Next Steps:

Recruitment of new sites, monitoring of enrollees

Program Areas:

Worksite Health

State Contact Information:

SC
Joy F. Brooks, MHA
South Carolina Department of Health and Environmental Control
803-545-4497
brooksjf@dhec.sc.gov

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