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GE Energy Pre Diabetes InterventionA Collaboration withCenters for Disease Control & Prevention and the National Business Group on HealthMarch 16, 2005Business Health AgendaNational Business Group on Health

Click to edit Master title styleWelcomeRon Finch, EdDDirector, Center for Prevention and Health ServicesNational Business Group on Health

David Pratt, MDMedical Director, GE Energy

CDC’s New Goal: Bridging CDC’s New Goal: Bridging Public Health and the Business Public Health and the Business

CommunityCommunity

Business Values vs Community Business Values vs Community Health ValuesHealth Values

Business vs Business vs Community HealthCommunity Health

ROIROI Stay in businessStay in business ProductivityProductivity Profit and lossProfit and loss OverheadOverhead Employees as a Employees as a

capital capital investmentinvestment

Public goodPublic good Healthy peopleHealthy people Public and Public and

private private partnershipspartnerships

Non-profitsNon-profits AdvocacyAdvocacy

Know the LanguageKnow the Language

CoCHisCoCHis DDT, CVDDDT, CVD DNPA, AsthmaDNPA, Asthma OSH, DRHOSH, DRH

ROIROI PresenteeismPresenteeism NBGHNBGH

Community and Public Community and Public HealthHealth

Community health= Community health= primary domain of the primary domain of the public health entities.public health entities.

Models, based on Models, based on epidemiological evidence, epidemiological evidence, target populations with target populations with identified health risk identified health risk factors or conditions.factors or conditions.

Engaging business in Engaging business in such activities is such activities is challenging, and many challenging, and many community health community health development efforts lack development efforts lack effective partnership with effective partnership with local businesses.local businesses.

Opportunity knocks to open Opportunity knocks to open the doors between business the doors between business

and community healthand community health

CDC ReinventionCDC Reinvention Two Overarching Health Two Overarching Health

Protection GoalsProtection Goals Health promotion and prevention Health promotion and prevention

of disease, injury, and disability:of disease, injury, and disability: PreparednessPreparedness

CDC Reinvention: CDC Reinvention: Six Six Strategic ImperativesStrategic Imperatives

Health Impact.Health Impact. CDC will be a customer-centric CDC will be a customer-centric

organization. organization. Public Health Research.Public Health Research. Leadership for the nation’s health Leadership for the nation’s health

system.system. Global Health.Global Health. Effectiveness and Accountability.Effectiveness and Accountability.

CDC New InitiativesCDC New Initiatives Cooperative agreementsCooperative agreements Multiple divisions working together, Multiple divisions working together,

sharing expertise and resourcessharing expertise and resources DDT, CVD, DNPADDT, CVD, DNPA AsthmaAsthma Center for Public and Private Center for Public and Private

PartnershipsPartnerships

We Have an Epidemic of We Have an Epidemic of DiabetesDiabetes ! !

Why pick diabetes for a Why pick diabetes for a health promotion health promotion

intervention?intervention? Costs over $100 billion/year in health Costs over $100 billion/year in health

care expenditurescare expenditures Effective interventions promote Effective interventions promote

multiple good outcomesmultiple good outcomes Leading cause of heart disease and Leading cause of heart disease and

strokestroke Leading cause of blindness in adultsLeading cause of blindness in adults Leading cause of end stage renal Leading cause of end stage renal

disease requiring dialysisdisease requiring dialysis

Consequences of Consequences of uncontrolled diabetesuncontrolled diabetes

Loss of productivityLoss of productivity Increased direct and indirect health Increased direct and indirect health

care expenditurescare expenditures Poorer quality of life for employees Poorer quality of life for employees Possible permanent disability Possible permanent disability

Why Control Diabetes?Why Control Diabetes? Better control translates into fewer Better control translates into fewer

complicationscomplications Fewer complications translate into Fewer complications translate into

fewer days lost to absenteeism fewer days lost to absenteeism and disability, and future savings and disability, and future savings on health care expenditureson health care expenditures

Why the workplace as a site Why the workplace as a site of disease education?of disease education?

Unique opportunity for educationUnique opportunity for education Less time away from workLess time away from work Improves employer-employee Improves employer-employee

relations and shows employer cares relations and shows employer cares about employeesabout employees

Do Any of These Things Do Any of These Things Work?Work?

Bottom Line: Does better glucose Bottom Line: Does better glucose control translate to better outcomes control translate to better outcomes or better health in the individual?or better health in the individual?

Does better glucose control translate Does better glucose control translate into improved productivity in the into improved productivity in the workplace?workplace?

Economic Benefits of Economic Benefits of Improved Glycemic ControlImproved Glycemic Control

Testa et al, JAMA, Nov 1, 1998Testa et al, JAMA, Nov 1, 1998 Workers with better Hba1c had Workers with better Hba1c had

fewer days lost to absenteeismfewer days lost to absenteeism Fewer days of restricted activityFewer days of restricted activity

Strategies for Better Strategies for Better Outcomes: Examples of Outcomes: Examples of

Worksite ProgramsWorksite Programs Canada:worksite physical activity Canada:worksite physical activity

classes:savings of $679/personclasses:savings of $679/person Coca Cola company:worksite wellness Coca Cola company:worksite wellness

>$500 /year/person x 2500 people>$500 /year/person x 2500 people First Chicago:Worksite diabetes First Chicago:Worksite diabetes

education program-improvement of education program-improvement of HbA1c 9.0% to 8.3%HbA1c 9.0% to 8.3%

National Diabetes Education National Diabetes Education Program (NDEP) Goals:Program (NDEP) Goals:

CDC and NIH program formed after CDC and NIH program formed after evidence showed that better glucose evidence showed that better glucose control translated into fewer complicationscontrol translated into fewer complications

Public and private partnerships to improve Public and private partnerships to improve diabetes treatment and outcomes diabetes treatment and outcomes

Increased public awareness of the Increased public awareness of the seriousness of diabetes, its risk factors, seriousness of diabetes, its risk factors, and strategies for preventing diabetic and strategies for preventing diabetic complicationscomplications

NDEP WorkgroupsNDEP Workgroups African American WorkgroupAfrican American Workgroup Latino Hispanic WorkgroupLatino Hispanic Workgroup American Indian – Alaska NativeAmerican Indian – Alaska Native Diabetes in youthDiabetes in youth Older adultsOlder adults PPODPPOD Business and Managed Care WorkgroupBusiness and Managed Care Workgroup

NDEP Business and Managed NDEP Business and Managed Care workgroupCare workgroup

Business and Managed Care Business and Managed Care Work Group (BMC)Work Group (BMC)

To increase awareness of the benefits of quality To increase awareness of the benefits of quality diabetes care among employers, benefits diabetes care among employers, benefits managers and managed care decision makersmanagers and managed care decision makers

To provide employers, health plans and To provide employers, health plans and employees with tools and information for employees with tools and information for incorporating diabetes education programs into incorporating diabetes education programs into the workplacethe workplace

To promote the value of investing in preventionTo promote the value of investing in prevention

NDEP Business/Managed NDEP Business/Managed Care Workgroup: Who are Care Workgroup: Who are

we?we? CDC and NIHCDC and NIH Large and small businessesLarge and small businesses UnionsUnions Occupational health professionalsOccupational health professionals Public health agenciesPublic health agencies Managed care groupsManaged care groups Non-profit organizationsNon-profit organizations

BMC Work GroupBMC Work Group NBGHNBGH GE PowerGE Power GMGM American American

Association of Health Association of Health PlansPlans

United Automobile United Automobile Workers UnionWorkers Union

Wisconsin Wisconsin Diabetes ControlDiabetes Control

ProgramProgram Novo-NordiskNovo-Nordisk Harrington and Harrington and

ChappellChappell National Fed of National Fed of

IndInd BusinessesBusinesses

NDEP TARGET GROUPSNDEP TARGET GROUPS Occupational health professionalsOccupational health professionals Wellness coordinatorsWellness coordinators Benefits personnel and HR managersBenefits personnel and HR managers Large and small businessesLarge and small businesses UnionsUnions Regional and national business groupsRegional and national business groups Managed care organizationsManaged care organizations

BMC Workgroup ProjectsBMC Workgroup Projects Diabetes White Paper : Call to action!Diabetes White Paper : Call to action! Diabetes Needs Assessment ToolDiabetes Needs Assessment Tool Diabetes Worksite Intervention KitDiabetes Worksite Intervention Kit Regional partner conferences: Regional partner conferences:

General Motors, DFWBGH, Federal General Motors, DFWBGH, Federal Reserve, Land’s End Reserve, Land’s End

Diabetesatwork.org

Needs AssessmentNeeds Assessment What is it and why does my company What is it and why does my company

need to address diabetes?need to address diabetes? Helps to see the potential prevalence Helps to see the potential prevalence

of diabetes in the company based on of diabetes in the company based on NHIS data. Each company has a NHIS data. Each company has a unique workforce, based on age, unique workforce, based on age, ethnicityethnicity

Is diabetes Is diabetes relevant at this time?relevant at this time?

Diabetesatwork.org: Diabetesatwork.org: ContentContent

Planning GuidePlanning Guide Assessment ToolAssessment Tool Choosing a Health PlanChoosing a Health Plan Lesson PlansLesson Plans Fact SheetsFact Sheets ResourcesResources Frequently Asked Questions (FAQ's)Frequently Asked Questions (FAQ's)

Diabetesatwork: ContentDiabetesatwork: Content General Diabetes Education General Diabetes Education Managing Diabetes Complications Managing Diabetes Complications Cardiovascular Disease Cardiovascular Disease Emotional Well-Being Emotional Well-Being Nutrition, Weight Control, and Nutrition, Weight Control, and

Physical Activity Physical Activity Dealing With Type 1 Diabetes Dealing With Type 1 Diabetes

Lesson Plans, Lunch & Lesson Plans, Lunch & LearnsLearns

High and Low Blood Glucose High and Low Blood Glucose Symptoms and Causes Symptoms and Causes

Making Your Doctor Visit Count Making Your Doctor Visit Count Cardiovascular risk factorsCardiovascular risk factors FeetFeet

Other TopicsOther Topics Guide to choosing a health plan, Guide to choosing a health plan,

developed with AAHPdeveloped with AAHP Supervisor’s guideSupervisor’s guide Shift workShift work Links to other NDEP sitesLinks to other NDEP sites

What Can My Company Do?What Can My Company Do? Develop a Supportive Work Develop a Supportive Work

EnvironmentEnvironment Seize the moment for educationSeize the moment for education Educate other employees about Educate other employees about

diabetesdiabetes Create a wellness committeeCreate a wellness committee Sponsor health screeningsSponsor health screenings Coordinate All Health EffortsCoordinate All Health Efforts

ResourcesResources National Business Group on Health National Business Group on Health

www.wbgh.comwww.wbgh.com WK Kellogg Foundation, The Business Interest in WK Kellogg Foundation, The Business Interest in

a Community’s Health, pdf on NBGH web site, a Community’s Health, pdf on NBGH web site, National Business Coalition on Health National Business Coalition on Health

www.nbch.orgwww.nbch.org American College of Occupational and American College of Occupational and

Environmental Medicine Environmental Medicine www.acoem.orgwww.acoem.org American Occupational Health Nurses American Occupational Health Nurses

www.aaohn.orgwww.aaohn.org

Resources: American College of Resources: American College of Occupational and Environmental Occupational and Environmental

HealthHealth www.acoem.orgwww.acoem.org Consensus Statement on Health and Consensus Statement on Health and

ProductivityProductivity The Business Case for Managing HealThe Business Case for Managing Heal

th and Productivityth and Productivity

Health and Wellness in the WorkplaceHealth and Wellness in the Workplace Business and Managed Care DiabetesBusiness and Managed Care Diabetes

and Health Resource Kit and Health Resource Kit

RememberRemember New evidence: DPT Diabetes New evidence: DPT Diabetes

Prevention Trial; lifestyle and/or meds Prevention Trial; lifestyle and/or meds can PREVENT type 2 diabetescan PREVENT type 2 diabetes

The lifestyle changes and medical The lifestyle changes and medical care recommended for diabetes care recommended for diabetes control helps prevent and control control helps prevent and control MANY chronic diseases.MANY chronic diseases.

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Diabetes Prevention@ GE Energy

Donna Tomlinson, MD MScHealth Promotions Manager, GE Energy

Tiana Howland, RNCardiovascular Disease Prevention Specialist & Health Coach, Community Care Physicians

GE Energy Risk ManagementOverviewCardiovascular Risk Assessment• CRA input• CRA outputCardiovascular Risk Management• Energy Health Coach• Diabetes Prevention @ GE Energy

– Sample of program– Implementation & Planning– Results

Diabetes Prevention@ GE EnergyCardiovascular Risk Assessment Input• 11 questions• Height, weight, girth• Blood pressure• Lipids & glucose

February 3, 2005 Test Event

Example, Ed Houston, Texas

Your 10-year risk of having a serious heart problem is 18.2 %. The standard risk for a 45-year-

old Male is 5.8 %. Your 10-year risk of stroke is estimated to be 2.9 %. The standard risk for a 45-year-old Male

is <1 %.

You have said that you do not have cardiovascular disease.

You have said that you have diabetes.

Modifiable cardiovascular disease risk factors:

1. Smoking o Quit Smoking – If you did not smoke your 10-year risk of a serious heart problem would be

11.8 %. 2. Blood Pressure

o Your blood pressure is 138/89 mm Hg—Hypertension 3. HDL-cholesterol

o Your HDL “good” cholesterol is 39 mg/dL. Lower HDL predicts higher cardiac risk. Make increasing your HDL a top priority.

Your cardiac risk factors (above) determine your LDL-cholesterol goal.

Your LDL-cholesterol goal is 100 mg/dL or less.

Currently, your LDL "bad" cholesterol is 121 mg/dL.

With careful attention to lifestyle modifications you have an excellent chance of bringing your LDL-cholesterol below goal without medications.

The Metabolic Syndrome is present because: Your fasting glucose is 190 mg/dL Your triglycerides are 282 mg/dL Your HDL Cholesterol level is 39 mg/dL Your blood pressure is 138/89 mm Hg

Fasting glucose 190 mg/dL; see MD before leaving today. Smoker with CAD Equivalent. See MD or nurse practitioner before leaving today.

Cardiov ascular Risk Assessment

GE Energy February 3, 2005

Data QualityMisclassification Bias

xx0xx1xx2xx3xx4xx5xx6xx7xx8xx9

Yea

r One

Yea

r Tw

o

Yea

r Thr

ee

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Systolic BP Ones Digit

Digit bias resulted in 362 false positive diagnoses of hypertension with an unnecessary physician referral.Cost of unnecessary referrals:350 * $70 = $24,500

10 20 30 40 50

0:14

0:21

0:28

0:36

Index

Minutes

AssessmentTime

12 16 20 24 28 32 36

95% Confidence Interval for Mu

18.5 19.5 20.5 21.5 22.5 23.5 24.5 25.5

95% Confidence Interval for Median

Variable: Min

A-Squared:P-Value:

MeanStDevVarianceSkewnessKurtosisN

Minimum1st QuartileMedian3rd QuartileMaximum

20.5326

5.3389

18.6661

0.8270.031

22.2105 6.323839.9906

0.387342-6.5E-01

57

11.000017.000022.000027.000036.0000

23.8885

7.7577

25.0000

Anderson-Darling Normality Test

95% Confidence Interval for Mu

95% Confidence Interval for Sigma

95% Confidence Interval for Median

Descriptive Statistics

• Production time focus• Customer oriented• Efficiently

Cardiovascular Risk Assessment2002 2003 2004 Total

Conference 1,468 1,858 607 3,933Sites w/Cl inic 723 1,190 1,118 3,031Sites w/out Cl inic 98 16 354 468Other 19 21 91 131Grand Total 2,308 3,085 2,170 7,563

CRAs CountPeople with at least 1 CRA 6,205People with at least 2 CRAs 1,173People with at least 3 CRAs 173People with at least 4 CRAs 12Total Number of CRAs 7,563

Cardiovascular Risk Assessment Output• 10 year risk of cardiac event• 10 year risk of stroke• Existing CAD, PAD, CVA• Blood pressure

– Including medication use• Tobacco users• LDL-cholesterol

– Including medication use• Overweight/obese

• Hypertriglyceridemia• Metabolic Syndrome• Diabetes

GE Energy Profile

Under weight1%

Normal29%

Overweight44%

Class III Obesity2%

Class I Obesity18%

Class II Obesity6%

Normal 32%

Stage 115%

Stage 23%

Prehypertension50%

78% malemean age 42.7

2% CVD17% metabolic syndrome

Percent of Population withMetabolic Syndrome Risk Factors

Central Obesity

Trigs at Risk

Impaired Fasting Glucose

HDL at Risk

BP at Risk

0% 5% 10% 15% 20% 25% 30% 35% 40%

Mean Change Between CRA 1 & CRA 2Age (yrs.): 1.2, p = 0.000Total Cholesterol (mg/dl): -3.1, p = 0.000HDL Cholesterol (mg/dl): 1.6, p = 0.000LDL Cholesterol (mg/dl): -4.0, p = 0.000Imputed serum triglycerides: -7.7, p = 0.039Serum glucose (mg/dl): -5.4, p = 0.000Systolic blood pressure (mmHg): -2.5, p = 0.000Diastolic blood pressure: -0.7, p = 0.012BMI (kg/m^2): -0.0, p = 0.507Waist Circumference (cm): -0.1, p = 0.412

Change Between CRA 1 & CRA 2CRA 1

CRA 2

Diabetes

Diabetes

Diabete

s

Diabetes 1,134 5 1,139

Diabetes 12 22 34

1,146 27 1,173

CRA 1

CRA 2Tobacco

Tobacco

Tobacco

Tobacco 1,047 33 1,080

Tobacco 15 78 93

1,062 111 1,173

Incident diabetes = 1.0%Prevalent diabetes = 3.0%“Cured” diabetes ?

Net tobacco quit rate at 1.2 years

= 28.3%

Net Effect of CRA As an Intervention

Per 1000 employees screened, 4 events (in 5 years) are averted24.8 events averted in our screened populationAt $40,000 per event = $992,000

Change in Predicted Risk of Primary Cardiac Event(Cardiac Event = fatal non-fatal MI, sudden death or surgical intervention)

Mean change in Real 5 yr. CHD risk: -0.002, p = 0.001Mean change in Real 10 yr. CHD risk: -0.003, p = 0.003Mean change in 5 yr. CHD risk (age held constant): -0.004, p = 0.000Mean change in 10 yr. CHD risk (age held constant): -0.008, p = 0.000

CRA Intensive Follow UpEnergy Health Coach

0.0

5.1

.15

.2.2

5C

urre

nt 1

0 yr

. Ris

k

0 .05 .1 .15 .2 .25Baseline 10 yr. Risk

Excludes prevalent CAD, N = 116

2nd Quarter 2004Current & Baseline Risks

Our focus is on those with highest modifiable riskNNT to prevent one event (10 year risk) is 20

Current & Baseline RiskOld Recruitment Method

0.1

.2.3

Cur

rent

10

yr. R

isk

0 .1 .2 .3Baseline 10 yr. Risk

Excludes prevalent CAD, N = 59

August 2004Current & Baseline RisksCurrent & Baseline Risk

Old Recruitment Method

CRA Follow UpLess Intensive InterventionCriteria for IntensiveRisk > 10%, modifiableRisk > 7.5%, LDL “med level”Trigs > 1000 mg/dLStage 2 HypertensionNew or poorly controlled diabetes

Criteria considered for less intensive follow-upPrehypertensives Stage 1 hypertensivesLDL-cholesterol at “lifestyle levels”Overweight or obese Metabolic syndromeOther pre-diabetic

They built it. We came.

Complications of Diabetes

#1 Cause of Blindness

90% Preventable

#1 Cause of Kidney Failure

Most is Preventable

#1 Cause of NT Amputation

40% to 50% Preventable

60% to 70% of Diabetes Deaths are Cardiovascular

StrokeHeart Failure

Coronary Heart Disease

Six Sigma Care?In one California HMO:>26% had a documented

eye exam>48% had their blood or

urine examined for signs of kidney failure

>56% had total cholesterol & 31% had LDL cholesterol checked

>8% had a foot exam at every visit

You have got to take an active

role in monitoring & measuring your

health. Waiting for the system to help you just won’t

work.

Counting Saturated Fats

(Sat fat per serving) * (Servings) = Grams of Sat Fat3 g x 2 Servings = 6 g Sat Fat

7 g x 2 tablespoons of butter = 14 g Sat Fat20 g Sat Fat

Some examples of saturated fat content:8 oz glass of whole milk: 5 g Sat Fat

One tablespoon heavy cream: 3 g Sat Fat1 ounce slice cheese: 5 g Sat Fat

3 oz serving skinless white chicken: 1 g Sat Fat3 oz serving dark meat chicken: 2 g Sat Fat

3 oz lean pork: 4 g Sat Fat3 oz marbled steak or roast: 4 to 11 g Sat Fat

Hot dog: 5 to 11 g Sat FatDouble quarter pound cheeseburger: 20g Sat Fat

Script forInstructor

Counting Grams of Saturated FatBreakfast: sausage egg and cheese on a biscuit, 2 hash browns and large coffee with cream Lunch: big bacon classic burger, biggie fries, and a medium frostyDinner: 10 oz steak with mashed potatoes with butter and salad with hidden valley original with baconDessert: 1 pint of Haagen-Dazs ice cream

Counting Grams of Saturated FatSausage egg with cheese2 Hash BrownsLarge Coffee w/6 tablespoons creamBig bacon classicBiggie Fries (5.6 ounce)Frosty medium10 ounce steakMashed potatoesButter 3 tablespoonsLettuceHidden Valley Dressing 4 tablespoons1 pint = 2 cups Haagen-Dazs

140.3g

8 g3 g

13.2 g12 g

3.5 g7 g

18 g0 g

21.6 g0 g

10 g44 g

Diabetes and High Blood PressureAre Like Twins

Create a Blood Pressure Action Plan John’s average blood pressure is 132/85>He should reduce his

systolic blood pressure down below 120

132 -120 = 12 points

Obese

Does not exercise

Eats fast food daily

Does not drink alcohol

Create a Blood Pressure Action Plan Harry’s average blood pressure is 124/81>He should reduce his

systolic blood pressure down below 120

124 -120 = 4 points

Healthy weight, but gained 5 pounds last year

Moderately active

Eats typical American diet

Has 1 or 2 drinks on the weekend

You will learn that our nutrition message is more than just 5 A Day . . .

Top 10 Daily HasslesA Survey of Middle-aged Adults:1. Concerns about weight2. Health of a family member3. Rising prices4. Home maintenance5. Too many things to do6. Misplacing or losing things7. Yard work or outside home

maintenance8. Property, investments, or

taxes9. Crime10. Physical appearance

Diabetes Prevention @ GE EnergyProgram SitesHouston

– Pilot program complete (24 employees)Schenectady

– Program in progress (11 employees)Minden

– Program in progress (25 employees)Bangor

– CRA first week in June; program to begin same week

Implementation & PlanningRole:

CRADiabetes

PreventionTop Management

Culture of confidence in Medical directorDigitization drive in 2001; Access prototype

Largely unnoticed as a separate program

HQ Medical Team

Expertise available:SoftwarePublic Health/CVD Prevention; designImplementation

Public Health/CVD PreventionHealth Coach Experience

Site Nurse

Short term intense commitment

Commitment of minimum of 10 hours

Site Leaders

Most familiar with our product Nurses present case, has not been an obstacle

$$$ Major investment from business

Most costs are from site nurse and production time

Planning Upfront, Direct, SimpleEligible Costs to

BusinessPlanning Steps

Group high risk for diabetes.•3 or more metabolic syndrome risk factors

•No direct expenditure for site•Recommend hourly workers participate in the program “on the clock” for ½ of the program•“Giveaways” provided by GEE Health services without charge•Nurse or health educator time to present materials required. Minimal preparation time.

1. View program materials 2. Identify program lead:      3. Obtain site approval

Approved by:      On clock/off clock:   4. Order sample materials and printed script

from Joan. 5. Schedule classes (begin within 30 days of

CRA):1-1     1-2   1-3   1-4 2-1     2-2  3-1   3-2   4-1  4-2  6-1  

6. Prepare invitation (with schedule above) to be distributed at CRA event

7. Identify & invite participants to prevention program at the time of the event.

8. Give pre-program survey to all who are eligible for the program.

Pilot Study Results

n = 23 InitialAfter

program p = Total Cholesterol 191.5 177.6 0.0060

HDL Cholesterol 38.4 37.2 0.5980LDL Cholesterol 109.0 108.6 0.9420

Triglycerides 212.7 159.1 0.0490Glucose* 111.4 97.5 0.0000

Systolic BP 132.0 126.7 0.0370Diastolic BP 82.6 76.9 0.0210

BMI 33.5 32.9 0.2850Waist Circumference 43.1 43.5 0.4370

Number of MS Risk Factors 3.2 2.4 0.0012# MS RF, Excluding Glu** 2.7 2.3 0.0100

*Glucose reduction probably overstated due to assessment method of repeat measure.

**Number of MS risk factors dropped even after excluding IFG as a risk factor.

Business and Public Health: Bridging the Gap in Health Improvement

• Impetus for the project– CEO concerned about health status of employees– Top management wants productive workforce– Management understood link between health status and

productivity

• GE, CDC and NBGH– Cooperative Agreement

• Objectives of the collaboration– Science-to-Service– Link CDC scientist with business

ROI: The Business Case

• Healthcare costs increasing 10% annually• 95% of healthcare costs goes to direct medical

services• 5% is allocated to preventing disease• 50% to 70% of all diseases are associated with

modifiable health risks• CFO want costs justification

Developing the ROI• Identify the populations

– Participants– Control Group

• Monitor healthcare costs and utilization during periods of:– Pre-intervention– Intervention– Post Intervention

GE Energy - CRA (Cardiovascular Risk Assessment Program)D

iabe

tes

Inte

rven

tion

Gro

upEv

ent

Extr

act

Ana

lysi

sSi

te S

cree

ning EE invited to

CRA Screening

EE arrives(fasting)

registers, andcompletesscreening

questionnaire

Metrics Obtainedat Screening(Ht, Wt, Girth,

BP, Blood Drawnfor Glucose, Full

Lipid Panel)

Blood sentfor

processing

Blood results,questionnaireresponses and

metrics enteredinto CRA

Application

CRA Reportgeneratedbased on

FraminghamEquation

MedicalReviewsReports

All Partic ipantsreceive CRAReport and

individualizedcounseling perfindings...and

invited togroup as noted

below

5 High Risk Conditions EE counseled and referred to LMD for followup

EE counseled and invited to join Diabetes Intervention Group

CompletesIntervention

Questionnaire

Attends weeklyDiabetesProgram

(duration = 6months

CompletesIntervention

Questionnaire

PostIntervention

CRA Screening

Analysis of Pre/Post CRAMetrics

In selection locations, EE will be offered:GE Energy Focused Disease Management Program - Susan/Tiana

Metabolic Syndrome

CRA EventExtract Analysis

Yes

Metabolic Syndrome Too?

CRA ExtactGenerated

Or

Costs and Utilization Metrics• Costs

– Health Plan Claims Data– Prescription Medication

Costs– Disability Costs Data

• Utilization Data– Admissions– ER visits– Scripts– Disability Days/Events

Discussion of Pre-Intervention Data

• Data collected– 6, 12, 18 month intervals

• Review of Data– Range: $139,000 to $00 over 18 month period– Breakdown by range and categories

• Included in ROI calculation is costs of:– Spouse– Children

Intervention Participation Rate

• Dose Response– Percent of Activities

Attended– Participant Survey

• Lifestyle changes– Exercise– Healthy Diet– Adherence to

Medications

Program Per Person NNTHealth Coach 200.00$ 20 4,000.00$ CRA 68.00$ 125 8,500.00$ DM Prevention* (Incl Production) 511.56$ DM Prevention* (Incl Production) 99.06$ (class of 15 participants)

Cost to Prevent 1 Predicted Cardiac Event (10 Year)

Program Costs

Item CostFat Facts Card 0.85$ Deck of Cards 2.60$ Sun Block 0.95$ Floss 1.20$ Jump Rope 2.20$ Pedometers 2.50$ Jump Rope Card 0.85$ Almonds Free *Booklet of Sat Fat 4.30$ squeeze fruit 2.00$ BP Card 0.49$ Dash Diet Booklet 2.00$ *1/2 hour of production time 412.50$ Total/EE cost for all sessions 432.44$ per EECost without production time 19.94$ per EE

Admin CostVideo 20.00$ Binder 4.75$ Paper 12.00$ *Nurse Time 1,150.00$ Total Admin Cost 1186.75 per class

ROI (Con’t)

• First: Employee only• Second: Employee and family• Third: Participants compared to control

group

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Integrating Health Promo Programs With Health PlanLynn KohrsHealthcare Manager, GE Energy

Group Health Plan Benefit Design Diabetes care

Insulin and supplies, free or very low cost?

Ease of lab services, free or very low cost?

Diabetic education? Covered?

Partnering with Health Promotions Team

Patient advocacy, benefit clarity, delivery,

referrals to healthcare resources, COEs

Employer Involvement:Bridges to Excellence, Leapfrog, both

important to quality of care in our communities

Group Health Plan Benefit Design Diabetes care

Insulin and supplies, free or very low cost?

Ease of lab services, free or very low cost?

Diabetic education? Covered?

Partnering with Health Promotions Team

Patient advocacy, benefit clarity, delivery,

referrals to healthcare resources, COEs

Employer Involvement:Bridges to Excellence, Leapfrog, both

important to quality of care in our communities

V%/Active EE(3)% (1)% 3% 4% 4% 12% 7% 12% 8% 7% 11%

$/Active EE$6,850 $13,000

$0

$400

$800

$1,200

$1,600

$2,000

$2,400

'95 '96 '97 '98 '99 '00 '01 '02 '03 '04E '05E

($MM)

$982$1,366

$1,792$1,552

$958 $983 $1,026 $1,123Post 65 (Cash)

Disability (Cash)

Pre 65 (Cash)

$2,093

Health Costs (U.S.)

$2,033$2,321

Retiree (Accrual)

Summary

Goals/ObjectivePublic Private PartnershipsLessons Learned – Strength/Weaknesses

Open ForumQ&A