Below are answers to some of the most frequently asked questions about the Asheville Project:

How did it all begin? 
The initial idea came from the Pharmacy Director from Mission Hospitals and a group of pharmacists at UNC Chapel Hill and the North Carolina Pharmacists Association (NCPhA).  The program subsequently developed into a true partnership / collaboration with key physicians, Mission Hospitals system, NCPhA, the North Carolina Center for Pharmaceutical Care (NCCPC); and the City of Asheville. The program was coordinated by the City’s Risk Manager and began in 1997 with approximately 47 participants.

Briefly, how does the program work?
An eligible employee is identified or volunteers to participate in one or more modules of the program. They must complete all enrollment paperwork and surveys and submit to the Human Resources Department.  Once paperwork is complete, they are assigned a certified pharmacist care manager to work with the patient.  Patients are then scheduled to attend the ADA (American Diabetes Association) prescribed educational classes; about 9 hours of class time and their benefit card is activated to waive any co-pays associated with said condition.  From that point, employees are required to attend regular meetings with their care manager; attend regular visits with their treating physician and have labs drawn at regular intervals.  Employees can participate in more than one module of the program and received waived co-pays for medications related to those conditions. 

Is diabetes the only disease this model applies to?No. The program began in Asheville for patients with diabetes, but over time was expanded to include asthma, lipid management and hypertension (CV Health,) and in conjunction with the American Pharmacists Association (APhA) Foundation is currently being studied in two beta sites for application in depression.  Other disease states will follow over time given the success in the current models as the City and its program planners determine the needs of our work force and their families.

Why Pharmacists?
Studies have shown consistently that more people have access to some form of health care via the pharmacy than any other source.  Early, frequent, and preventive care is less costly that “sick care.”  Some doctors were initially very apprehensive of this approach, but they participated in the planning and training process, and very soon realized the benefits of such an arrangement.  Patients were actually seeing their physicians MORE often, but with less SEVERE issues.  Additionally, since pharmacists are specially trained to notice drug interactions or other drug related problems they can better serve our employees by double checking to make sure they aren’t being prescribed potentially interfering medications or work with the physician to resolve medication related problems.  If issues arise, the pharmacist can quickly contact the doctor(s) for an alternate prescription.  Collaboration among educators, pharmacists and physicians has yielded improved care.

How are/were the pharmacists recruited for participation?
Initially, an open call went out to all local pharmacists at both independent and chain pharmacies.  Interested pharmacists were required to attend 32 hours worth of training led and developed by physicians and diabetes educators.  At this point, recruitment is basically done on a word of mouth basis.  Additionally, most schools of pharmacy now teach “The Asheville Model” or some form of it as a means of care that students can expect to encounter in their careers.

Are the pharmacists communicating with the treating physicians?
Absolutely!  Data from every visit is shared with the patient’s physician.  The pharmacist performs patient visits under a prescribed protocol which determines if the findings at a visit require follow-up via email, phone, fax, etc.  If certain indicators are seen in a patient/pharmacist meeting the physician is immediately notified, often in the presence of the patient, in order to help the patient as quickly as possible. 

How much are the pharmacists paid?
They are paid per visit, based on the length of the visit.  Initial visits may last 1 – 1 ½ hours follow up visits last between 30-45 minutes.  As the patient progresses through the program, the visits become shorter and less frequent, assuming their condition is properly managed.  Fees consistent with market rates for pharmacist services were negotiated.  Other communities around the country now replicating the model negotiate their own market rates for services with pharmacists.

What are the actual duties of the pharmacist?

• Counsel patient; reinforce what the doctor has told patient.
• Establish goals for patient self-management
• Check Blood Pressure and Glucose Meters (when applicable)
• Perform basic eye exam
• Perform basic foot exam
• Track data on oral hygiene
• Determine when to send patients to their doctor when problems arise.

** First year data found that with the pharmacists performing these duties patients had over 200 more outpatient visits with treating physicians than they did for the year before the program started.  Physicians agreed that the care under this model was less expensive since their fees for outpatient visits are lower than for seeing the same patients in ER’s or ICU’s.

How were participants initially recruited?
Initially patients were identified through TPA (Third Party Administrator) claims data and PBM (Pharmacy Benefit Management) prescription records.  Patients identified were sent a letter to their homes from the City’s attending physician which asked them to come to a meeting where the program was described.  Over the past 10 years HIPPA (Health Insurance Portability and Accountability Act) has dictated changes to this approach but replicators now are still able to identify patients and recruit them into the model while preserving patient confidentiality.

How are referrals into the program being made / participants recruited on anongoing basis?
All new employees are informed of the program options at their new employee orientation; all employees are reminded of the available programs each year during open enrollment.  Finally, employees may be referred through the City’s Health Services Division, the employee wellness program or their physician.  Physicians in the community have become a primary source of referrals of patients into the program.

How are participants tracked?
Unlike most health care, this model is aggressively tracked and measured.  All clinical, claims, drug, and humanistic data are tracked by clinicians and researchers.  Clinical data was initially collected manually, but is now reported to a data system maintained by the APhA Foundation.  Also, results of programs have been gathered, analyzed, peer reviewed and published in scientific journals before it is shared with the general public.  This rigorous process ensures the integrity of the program and its results.

How are patients assigned to pharmacists?
Patients are assigned to pharmacists based on the employee’s preference.  Their choices are usually based on the geographic location of the pharmacy to make it convenient for the patient, close to work, on the way home, etc.