Employer Case Studies

Diabetes Management in the Workplace

Benefit Plan Design Approaches: Employer Case Studies

Taking Control of Your Health (TCOYH)

In 2006, MBGH received a grant to replicate one of the most well-known and successful diabetes self-management programs in the country, The Asheville Project. The MBGH initiative, part of the “Diabetes Ten City Challenge,” took place in 10 communities across the country. Employer pilot programs were designed to determine if a value-based model of diabetes treatment, using waived copays for incentives and required visits to a specially trained pharmacist, could be replicated. Today, the Taking Control of Your Health (TCOYH) program has emerged as a leading example of employer best practices and provides significant value to participating employers and employees. It contains many of the original features of the Asheville model, but has been enhanced to include behavior modification and lifestyle change support while addressing the triggers and barriers that prevent people from changing their behavior. 

Program details:

  • Employer-sponsored patient self-management program utilizing specially trained, diabetes certified pharmacists to participate in regular face-to-face meetings with an employee to help educate, motivate and empower them to better manage their condition. Meetings take place at least once per quarter either at home, at work or near work. For being engaged in their care, participants receive incentives, such as reduced or waived copays for diabetic drugs, with some employers offering participants testing strips at little or no cost.
  • Pharmacists are compensated to provide coaching support and encourage the participants to receive regular screenings. They also provide feedback to the patient’s physician to keep them engaged in the process.
  • Employer determines which segments of their covered population (actives, dependents, retirees) are eligible to participate in the program.
  • Program outcomes include: Reductions in A1c levels, BP and LDL cholesterol measurements, weight and BMI; increases in medication compliance; reduced medical costs.
  • The program has consistently provided participating employers with value from the outcomes achieved.
    • Employer A - Clinical Outcomes:
      • Hemoglobin A1c(A1c): 82 % improved from the baseline, 52% now have an A1c of 7 or below and 86% have an A1c of 8 or below
      • Body Mass Index (BMI): 10% improved from baseline
      • Waist Circumference: on average 21% of females reached goal of 35 inches or less while 29% of males reached goal of 40 inches or less
      • LDL (low-density lipoprotein or “bad cholesterol”): 94% reach the goal or below from baseline
      • Blood Pressure: 83% are at goal or below for systolic and 52.25% are at goal for diastolic measurements
    • Employer B - Clinical Outcomes:
      • Hemoglobin A1c (A1c): 80% improved from baseline, 76% now have an A1c of 7% or below
      • Body Mass Index (BMI): 23% improved from baseline
      • Waist Circumference: on average 24% of females reached goal of 35 inches or less while 37% males reached goal of 40 inches or less
      • LDL (low-density lipoprotein or “bad cholesterol”): 96% reached the goal or below from baseline
      • Blood Pressure: 78% are at goal or below for systolic and 100% are at goal for diastolic measurements

The Asheville Project

The City of Asheville, NC developed this program for employees, retirees and dependents with diabetes. Each person was teamed with a community pharmacist who made sure they were using their medications correctly. The program outcomes included: improved A1C levels, lower total health care costs, fewer sick days and increased patient satisfaction with their pharmacist’s services. Pharmacists developed thriving patient care services within their community pharmacies. Unlike other experiments, the Asheville model was payer-driven and patient-centered. Today, it serves as a well-known and well-respected model for employer’s who are seeking effective ways to manage the health and wellbeing of people with diabetes in the workplace.

Other Employer Case Studies

Procter & Gamble

  • Raised employee coinsurance from 30% with a $50 maximum out-of-pocket to 50% with no maximum for classes of medications primarily providing value only to members (nail fungus treatments, acne drugs, hormone replacement therapy, infertility medications, etc.)
  • This resulted in significant decreases in utilization of these medications and provided funding of additional value-based design for medications with shared member/company value.
  • Following analysis of chronic disease medical, prescription, and disability claims to determine top drivers of employee productivity losses and benefits costs; the employee coinsurance for drugs used to treat Diabetes, Asthma, Hypertension, and Hyperlipidemia was reduced by 50%, resulting in a 15% employee co-insurance with a maximum out-of-pocket limit/85% employer co-insurance and amounts above the employee OOP max.
  • Design outcomes included progressive increases in medication possession ratios and reductions in disability, hospitalizations, urgent care and emergency room visits related to these conditions.

State of Minnesota – State Employee Group Insurance Program (SEGIP)

Advantage Value for Diabetes

  • New VBID program launched as pilot on 1/1/2018 and replaced prior Medication Management Therapy Program
  • Eligibility: Adults (age18+) with Type 1 or Type 2 diabetes
  • Fully integrated into the Minnesota Advantage Health Plan – no enrollment required
  • Copays eliminated* for qualifying medical services & qualifying prescription drugs when paired with diabetes diagnosis or fill of antidiabetic medication
  • View slides from October 2018 VBID program
*90% of employees enrolled in plans where copays are eliminated; 10% enrolled in plans where copays are significantly reduced

Florida Health Care Coalition

Diabetes Prevention Lifestyle Change Program

  • This sister coalition worked with the State of Florida to develop, implement and evaluate a program to increase inclusion of the CDC's Diabetes Prevention Lifestyle Change Program (DPLCP) as a covered benefit for employees in the State of FL
  • Program objectives included making the DPLCP accessible to employees who currently have or are at risk for prediabetes; increase the number of at-risk employees who participate in the program; and lower diabetes-related health care costs

Pitney Bowes

Project Living

  • One of the first companies in the U.S. to fully implement a value-based benefit design program for diabetes (2002); and an early innovator using value-based insurance design (VBID)
  • Program dramatically reduced the copayments for some chronic disease medications, such as diabetes drugs
  • Since the company changed the plan, it has seen reductions in medical costs for employees with those diseases