Staying well lowers costs

For many communities, wellness programs also provide the added benefit of cost savings in a tight fiscal environment. One of the most highly regarded of those programs, the Asheville Project, has developed an international reputation for its documented savings, despite the recent cost increase.

The project began in 1997 with 47 employees with diabetes, according to Walker. Today, the program includes 350 of the city's 1,300 active and retired employees, who are diagnosed with diabetes, high blood pressure or high cholesterol, asthma, depression or a combination of conditions.

The program is voluntary. Employees who decide to participate must take classes about their chronic condition and meet regularly with a care manager, who is a licensed pharmacist.

In exchange for meeting those requirements, the city pays for all of the participants' laboratory work for their medical tests and co-pays on drugs. For workers with diabetes, the city also pays for related materials, such as needles and test strips, for as long as they follow the requirements of the program. Additional incentives include special tests related to a condition and vision tests for those with diabetes.

The Asheville Project's savings in health care costs have been impressive, according to a five-year study of the program. For patients with diabetes, the health care costs declined from $6,127 per person during the baseline year to $3,554 per person after one year. For those with diabetes who participated through the first five years of the project, the mean cost was $4,561, which was 58 percent below the national average of $7,248. Diabetic patients reduced their total sick leave time from an average of 12.6 days per year during the baseline year to 6.01 days per year in the first year, which also was sustained through the next six years.

For asthma patients, emergency room visits fell from 9.9 percent to 1.3 percent and resulted in savings of more than $584,000 in direct and indirect costs over the five-year study. For those with cardiovascular disease, the rates of related medical events fell by 53 percent during the study period, and medical costs decreased from 30.6 percent to 19 percent of total health care costs. "We see health care costs going down in the long run," Walker says. "There are ups and downs, but we see huge savings in decreased hospital costs, fewer emergency room visits, [and] fewer cases of end-stage renal [kidney] disease."

Walker says that the success and expansion of the program may be the cause of the recent increases in the costs, as staff has had less time to closely monitor the larger volume of new participants. New software that will track patient behavior will help the staff ensure that participants are following the program's requirements. "We need to make sure they are visiting the health clinics so they know what to do to take care of themselves," she says.