1

Blueprint VA: Industry Council for HealthcareEmployee Wellness

August 12, 2013

Chronic Disease in VA

CHRONIC DISEASE IN RICHMOND CITY HEALTH DISTRICT, 2010

4

13% of Virginians report having fair to poor health in general.The state adult smoking rate is 18%.Two-thirds (62%) of Virginia adults are at an unhealthy weight (i.e., overweight or obese). Current obesity rate is 30%.50% of Virginians do not get enough physical activity. Three-fourths (74%) of Virginians do not meet the daily requirements for eating five or more servings of fruits and vegetables. Cumberland Plateau has the highest age-adjusted rate of death from heart disease (213 per 100,000), which is double the state rate (102 per 100,000). Southside has the highest rate of death from cerebrovascular disease (67 per 100,000), which is 60% greater than the state rate (42 per 100,000).

5

$Diabetes & cardiovascular disease make up

1/3 of health care costs

American Diabetes Association. "Economic Costs of Diabetes in the U.S. in 2007". Diabetes Care. Vol. 31, No. 3, pp. 1-20; American Heart Association. "Heart Disease and Stroke Statistics 2010 Update". Circulation.

6

$The combined cost of the two diseases is more than

$606 billion each year

American Diabetes Association. "Economic Costs of Diabetes in the U.S. in 2007". Diabetes Care. Vol. 31, No. 3, pp. 1-20; American Heart Association. "Heart Disease and Stroke Statistics 2010 Update". Circulation.

7

CVD, Diabetes & Obesity

Diabetes = #1 Risk Factor for Cardiovascular Disease

Obesity = #1 Risk Factor for Developing Diabetes

8

1 in 10 adults in the United States has been diagnosed with diabetes

"Diabetes Basics." Diabetes Statistics. American Diabetes Association, n.d. Web. 11 June 2012.

9

1 in 3 adults is

pre-diabetic

www.cdc.gov/features/diabetesalert/

10

1 in 3 adults has been diagnosedwith cardiovascular disease

Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012: published online before print December 15, 2011, 10.1161/CIR.0b013e31823ac046.

11

Average cost for one person to manage cardiovascular disease for a year

$5,693

Wang G, Pratt M, Macera CA, Zheng ZJ, Heath G. Physical activity, cardiovascular disease, and medical expenditures in U.S. adults. Ann Behav Med 2004;28:88-94.

12

Average cost of a stent procedure

$18,560

Health Care Costs To Top $8,000 Per Person." CBSNews. CBS Interactive, 04 Mar. 2009. Web. 11 June 2012.

13

Average cost of coronary bypass surgery

$63,648

Healthcare Blue Book." Healthcare Blue Book. N.p., n.d. Web. 11 June 2012.

Centers for Disease Control and Prevention. National Diabetes Fact Sheet: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdfMottillo S, et al. The metabolic syndrome and cardiovascular risk. J Am Coll Cardiol 2010;56(14):1113-32.

Relationship between CVD and Diabetes

Adults with diabetes have 2-4x higher death rates due to heart disease and stroke than adults without diabetes.

Centers for Disease Control and Prevention. National Diabetes Fact Sheet: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdfMottillo S, et al. The metabolic syndrome and cardiovascular risk. J Am Coll Cardiol 2010;56(14):1113-32.

2-4xPeople with prediabetes have an increased risk of developing diabetes, heart disease, and stroke.

14

Relationship between CVD and Diabetes

Centers for Disease Control and Prevention. National Diabetes Fact Sheet: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdfMottillo S, et al. The metabolic syndrome and cardiovascular risk. J Am Coll Cardiol 2010;56(14):1113-32.

Just over 1/3 OF U.S. ADULTS meet the criteria for metabolic syndrome (MetS), a cluster of CV risk

factors related to overweight/obesity and IR (abdominal obesity, hypertension, dyslipidemia, dysglycemia)

16

Summary Of VA Employees In Past 2 Years

Sample Size: 68,477 (46,001 with Biometrics)

17

VA Employees (cont)

18

Disease Risk Levels In Employees

Traditional

Lipid Pro

file

Risk fo

r CVD- A

thero

genic L

ipoprote

ins

Inflammati

on

Risk fo

r Diab

etes

Omega-3 In

dex

Vitamin D Deficie

ncy0%

10%20%30%40%50%60%70%80%90%

100%

42%

65%

25%

39%

93%

70%

High Risk Levels

19

Diabetes Risk

Optimal Insulin Resistance Suggestive of Pre-Diabetes Suggestive of Diabetes 0%

10%

20%

30%

40%

50%

60%

70%

61%

28%

7%4%

Risk for Diabetes in Virginia Employees

20

Hidden Risk in VA

55%

45%

Hidden High Risk for CVD

31%

69%

Hidden High Risk for Diabetes

All HbA1c and GLUC was normal All had normal lipid panel

21

Main Drivers of Health Care Costs

0%5%

10%15%20%25%30%35%40%45%

28.6%

21.4%

12.5%

33.9%

14.3%

26.8%

0.0%

7.1%

0.0%

10.7%

41.1%

What were the top 3 contributors to your company's healthcare costs in 2012?

22

Critical Conditions in Employee Populations

Cancer

Diabetes

Obesity

CVD/ Heart D

isease

Hypertensio

n

Musculoskeletal or orth

opedicAsth

ma

Depression and/or A

nxiety

Sleep Disorders

OtherUnsure

0%

10%

20%

30%

40%

50%

27%

41% 43% 45%

32% 29%

16%

25%

5%13%

32%

What conditions are most critical to your employee population?

23

Employee Wellness: Cost

< $100 $100-$250 $251-$500 $501-$1000 >$1000 Unsure0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

15.2%18.2%

12.1%

21.2%

15.2%18.2%

How much does your organization spend per year per employee for your wellness program?

24

Prominent IssuesAging populationIncreased chronic disease (heart disease, diabetes, cancer and obesity)Age adjusted rate for heart disease is decreasing, but events are happening at an earlier age Dissatisfaction with health insurance, continual rising costsBusiness impact of ACAVA is not ranked in top 10 states for any of the health indicators – impact on attracting business and maintaining resources

Under 19 20 to 44 45 to 64 Over 65

Changes in Virginia’s Population by Major Group (Actual and Projected)

25

Primary Recommendations

All out war on disease – • public education on health risks & impact to life• support and promotion of health – all ages

State support of best practices for employer programsInsurance Reform- “value based” health insurance N Engl J Med 2011;365:2088-97

26

Secondary Recommendations

Employers Share what worksBring HC Providers into the loop of Employers InitiativesMeasure, Quantitate