title: The hickory project: controlling healthcare costs and improving outcomes for diabetes using the asheville project model.
abstract: BACKGROUND
  The results of the Asheville Project have shown the success of a community-based, chronic disease management model in improving clinical outcomes in patients with chronic disease while reducing annual costs of care per participant. The question arose whether other programs using a similar management model and implemented in other communities could replicate the success of the Asheville Project in improving clinical outcomes and reducing costs for patients with a chronic disease.
  
  
  OBJECTIVE
  To assess the long-term clinical and financial outcomes of a chronic care management model for patients with diabetes, using the Asheville care management model that was successful in the management of several chronic diseases.
  
  
  METHODS
  Longitudinal, 3-year (2007-2009), quasi-experimental, multisite, pre-/postenrollment study.
  
  
  METHODS
  Self-insured health plan members with diabetes agreed to meet on a regular basis (ie, an average of every 3 months) with a healthcare professional. Participants received reduced copayments on diabetes-related medications and supplies as an incentive for participating in the study. Providers utilized a web-based electronic medical record system that provided updated medical and prescription data and highlighted gaps in care based on national standards. Program providers included community pharmacists, population health management company pharmacists, and nurses at on-site clinics, trained in use of evidence-based guidelines of care. Providers assessed patients' medications, knowledge level, and lifestyle; provided patient education and goal setting; and referred patients for physician follow-up and recommendations to physicians. The majority of the encounters were face-to-face.
  
  
  RESULTS
  The study included 95 plan members in the clinical cohort participating for 1 year or more, and 54 members in the financial cohort who have been participating in the program for 3 years. At the end of 3 years, the percentages of those achieving guideline goals increased from baseline to the latest follow-up included, respectively, reaching target hemoglobin A1c levels, 38% to 53%; low-density lipoprotein cholesterol, 46% to 67%; systolic blood pressure (BP), 55% to 72%; diastolic BP, 60% to 71%; annual eye examination, 37% to 61%; and self-testing blood glucose, 79% to 97%. Total healthcare costs decreased by an average of $2704 per participant per year. The program's return on investment was $4.89 to every $1 spent (including program costs).
  
  
  CONCLUSIONS
  The Hickory Project shows that it is possible to produce sustained improvements in clinical outcomes and reductions in healthcare costs for patients with diabetes using a chronic care model that provides frequent patient follow-up, a focus on appropriate medication therapy, adherence to clinical practice guidelines, and a reduction in prescription copayments for antidiabetes medications as an incentive for patients to participate in the program.
authors.affiliation: Vice President, Clinical Services, American Health Care, Rocklin, CA.
authors.forename: Barry A
authors.initials: BA
authors.lastname: Bunting
authors.affiliation: Chief Executive Officer, American Health Care, Rocklin, CA.
authors.forename: Grover
authors.initials: G
authors.lastname: Lee
authors.affiliation: Senior Clinical Manager, American Health Care, Rocklin, CA.
authors.forename: Grant
authors.initials: G
authors.lastname: Knowles
authors.affiliation: Chief Clinical Officer, American Health Care, Rocklin, CA.
authors.forename: Christine
authors.initials: C
authors.lastname: Lee
authors.affiliation: Chief Operating Office, American Health Care, Rocklin, CA.
authors.forename: Paul
authors.initials: P
authors.lastname: Allen