It took regular trips down the aisles of the local supermarket for Peter Benz, a 62-year old retiree in suburban Syracuse, N.Y., to finally get his diabetes under control.
But learning how to fight and win the battle of blood sugar at the grocery store, the site of so many dietary downfalls for diabetics, struck some, including his regular physician, as a little odd.
"My doctor joked about it," Benz said. "He said it's like going to an Alcoholics Anonymous meeting in a bar."
But 490-bed Crouse Hospital in Syracuse and Wegmans, a Rochester, N.Y.-based grocery chain, couldn't disagree more. Together with E2M, a Dallas-based disease management company, they have put together an innovative program for delivering diabetes education, counseling and medical care in a convenient super-market setting.
By making it easier for patients to live with their disease, Crouse expects that the diabetes program, launched in August 1997, will reduce treatment costs as it improves patients' health. So far about 200 patients, including Benz, have enrolled, and the preliminary results are encouraging.
A disruption of metabolism that has no cure, diabetes requires diligent attention to diet and lifestyle to avoid such serious complications as blind-ness, kidney failure and loss of limbs. Diabetes takes an expensive financial hit on providers and a heavy personal toll on patients. Nearly 11 million people have been diagnosed as having diabetes, according to the American Diabetes Association. And based on a study using data from 1992, the association said spending on the direct costs of diabetes care was $45 billion-more than $37 billion on hospital care alone.
By taking the diabetes message to the streets, or at least the checkout counter, Crouse, which administers the novel program, and its partners expect to have better luck in getting patients to understand and stick to a healthy regimen. Dietary advice, for instance, is tailored to seasonal variations in eating habits. And pharmacists at drug-store departments of the Wegmans stores are an integral part of the team that works with patients.
Based on data from a two-year pilot that E2M managed in Corpus Christi, Texas, Crouse should reduce diabetes-related emergency-room visits, cut admissions and shorten length of stay. Annual cost of care per patient in the Texas program dropped to $2,382 from $7,421 before participation.
In the process of changing how it delivers diabetic care, Crouse also is test-driving a future approach to treating chronic disease.
"This is one of our entry forays into disease management," said Edward Wenzke, president and chief executive officer at Crouse. "We are learning as we do this. For us, it's a strategic program that we're happy operationally also works well."
Crouse drew praise by taking health-care outside the four walls of the hospital and putting it where people actually want to spend their time.
"It's exactly on target," said David Shulkin, M.D., a disease management expert at University of Pennsylvania Health System in Philadelphia. "You have to get to people where they are. Everyone's too busy these days, but everyone goes to the supermarket." In fact, E2M estimates the average person makes 80 trips to the grocery story a year.
Besides location, the Crouse program offers a much more intensive approach than the usual diabetes clinic. For instance, the diabetics in the Crouse program get a customized health plan with monthly goals and follow-up visits with dietitians and diabetes educators typically spread out over a year. The supermarket health center-complete with a private classroom and office-is tucked away in one corner of the Wegmans store. (The program is operational in just one store now; a second program is being readied in another store.) It also features an on-site certified clinical laboratory so that patients know how they're doing on key disease indicators before they go home. A status report is faxed to each patient's referring physician as well to close the clinical loop.
By contrast, in the typical diabetes education mode, a dietitian meets with a patient once or twice and sends him on his way.
"I'll teach you everything you need to know for a lifetime in the next hour, and you're expected to remember it forever," said Lawrence Kohn, M.D., co-medical director of the diabetes program, of the usual approach. "It just doesn't work."
For now the emphasis at Crouse is on education, Kohn said, because Syracuse has relatively low managed-care penetration. But, in a few years, when the hospital has greater direct financial responsibility, he's confident that today's investment will pay handsome dividends.
"At the time when we could be asked to assume financial burden for these patients, we'll be handling a better bunch of patients," he said.
The reluctance of some insurers to pay for the program has slowed its rollout. Crouse, which plans to extend the program to other grocery stores, would like to have 500 patients enrolled at the first site after one year. The supermarket health center can serve up to 1,200 patients.
"Lack of insurance coverage is our number one reason for turning patients down," Kohn said. But he is undeterred. "We're aggressively working on that, and the evidence is rock-solid that patients benefit."