neil f. gordon, interxvent

MaRSBusiness of Aging Conference

April 30, 2012

Agenda

Dr. Neil Gordon, Founder INTERVENT INTERVENT Overview Global vs Canadian

Corporate Wellness / Disease Management Program Uptake Outcomes / Science

Dr. Dorian Lo, EVP, Pharmacy and Healthcare at Shoppers Drug Mart Case Study:

Why Shoppers Drug Mart Implemented a Health / Wellness Program Shoppers Drug Mart Employee Program Overview Results Challenges

Conclusion

Founded INTERVENT in 1997 Used evidence-based research and clinical guidelines from

nationally recognized organizations and led INTERVENT’s national/international expansion

Past director of exercise physiology at the world renowned Cooper Research Institute in Dallas, TX

Former clinical professor of medicine at the Emory University School of Medicine in Atlanta, GA

Past Chairman of the American Heart Association Committee on Exercise, Cardiac Rehabilitation and Prevention

Devoted over 30 years to the prevention of cardiovascular disease and other chronic illnesses

Published over 100 scientific manuscripts and 8 books on prevention/disease management

INTERVENT Founder

Dr. Neil GordonFounder

INTERVENT Overview

INTERVENT is a global lifestyle management and chronic disease risk reduction company based in Toronto, Canada and Savannah, GA, USA.

INTERVENT develops, licenses and provides evidence-based programs for the prevention and management of multiple chronic diseases.

Mission: To help significantly improve individual and population-based measures of health while simultaneously reducing health care costs and enhancing productivity

The Evolution of INTERVENT

Programs originally based on research available in the early 1990s, especially the Stanford Coronary Risk Intervention Project (SCRIP).

After completion of original research study in Dallas, TX, INTERVENT USA, Inc. was founded in 1997; INTERVENT Canada was subsequently launched in 2007.

Since 1997, considerable time and effort has been spent developing, testing and successfully implementing INTERVENT’s evidence-based, technology-enabled, outcomes-oriented, comprehensive lifestyle management and chronic disease risk reduction programs.

Risk Assessment

• Nutrition• Weight Management• Physical Activity• Stress Management• Tobacco Cessation• Diabetes

• High touch• Integrated with web-

based program• Formal, structured,

systematic approach• Personalized support

InterventionOptions

Self-helpIntervention

(web/mail)

Health CoachAssisted Intervention(telephonic/web/on-site/mail)

Management Areas

•Stratification•Health Risk Assessment

Numerous

Program

Modules

Evalu

atio

n a

nd F

ollo

w-u

p

A Treatment Platform that builds…

Gamma-Dynacare PartnershipIntegrated Biometric Module

HRAHRA Population stratificationPopulation

stratification

Lower Risk 0-2 Risk Factors

59%

Lower Risk 0-2 Risk Factors

59%

Moderate Risk

3-4 Risk Factors

32%

Moderate Risk

3-4 Risk Factors

32%

Individual stratification


Higher Risk 5 + Risk Factors

9%


9%

Lower Intensity

Intervention35%

Lower Intensity

Intervention35%

Moderate Intensity

Intervention30%

Moderate Intensity

Intervention30%

Higher Intensity

Intervention35%

Higher Intensity

Intervention35%

1st Levelof Stratification

(Industry Standard)

2nd Levelof Stratification(INTERVENT)

Level 1 = risk for future direct and indirect health care-related expenditure (“health risk stratification”);

Level 2 = intensity of lifestyle health coaching required to facilitate risk reduction in moderate/higher-risk individuals and to keep

apparently healthy individuals healthy (“intervention intensity stratification”)

Key: BOB Data

Consent to have EAP make an outbound call

Referrals to Allied Healthcare Providers

Physician Summary Report

Partnering with C-CHANGE to ensure concordance with Canadian guidelinesPartnering with C-CHANGE to ensure concordance with Canadian guidelines

Lifestyle Management Programs:Key Steps

Be sure that the Lifestyle Management Program that you select incorporates all of the following essential components:1. Identification of At-Risk Individuals

2. Risk Factor Determination

3. Goal Setting

4. Action Plan Formulation (guideline-based)

5. Action Plan Implementation

6. Referrals to Allied Health Care Providers (MD; Pharmacist; CDE; EAP)

7. Follow-up Evaluation and Progress Reports

8. Compliance Enhancement/Tracking

9. Aggregate Outcomes Assessment

10. All of the above should all be evidence-based…

Coaching Methodology

• Dedicated health coaches assigned to participants; pull in specialists as needed

• Wellness Vision• Focus is on the individual

• Incorporates multiple behavior-change techniques: e.g., stages of change, motivational interviewing, single concept learning theory

• Educational kits, audios, eating and exercise diaries and on-line materials support the foundation for behavioral change

• Comprehensive goals and action plan linked to health risk factors

• Evidence-based medicine approach• Formal, structured, systematic approach • Nature and intensity of intervention individualized based on

multiple factors, including risk status and readiness to change

• System supports tracking of qualitative and quantitative results• Follow-up reports utilized during the program allow the participant to

track their progress along the way

Coaching Philosophy

Emotional Support

Interventions

Progress Tracking

Quality• Quality audits help ensure delivery of a high-quality program• Calls tracked and recorded

Better Health for Life℠16

Better Health for Life℠17

Approximately 100 published scientific abstracts or manuscripts documenting benefits in terms of multiple risk factors, clinical variables, self-reported health status and ROI

(Including numerous publications in peer-reviewed medical journals and independent third-party research)

Key scientific manuscripts include:1. Comparison of single versus multiple lifestyle interventions: Are the antihypertensive effects

of exercise training and diet-induced weight loss additive? American Journal of Cardiology 1997;79:763-7672. Comprehensive cardiovascular disease risk reduction in a cardiac rehabilitation setting. American Journal of Cardiology

1997;80(8B):69H-73H3. Comprehensive cardiovascular disease risk reduction in the clinical setting. Coronary Artery Disease 1998; 9:731-735.4. Innovative approaches to comprehensive cardiovascular disease risk reduction in clinical and community-based

settings. Current Atherosclerosis Reports 2001; 3:498-5065. Effects of a contemporary, exercise-based rehabilitation and cardiovascular risk reduction program on coronary patients

with abnormal baseline risk factors. CHEST 2002; 122:338-3436. Effectiveness of 3 models for comprehensive cardiovascular disease risk reduction. American Journal of Cardiology

2002;89:1263-12687. Effectiveness of therapeutic lifestyle changes in patients with hypertension, hyperlipidemia, and/or hyperglycemia.

American Journal of Cardiology 2004; 94: 1558-15618. Effect of comprehensive therapeutic lifestyle changes on pre-hypertension. American Journal of Cardiology 2008; 102;

1677-1680.9. Health-risk appraisal with or without disease management for worksite cardiovascular risk reduction. Journal of

Cardiovascular Nursing 2008; 23: 513-518.10. Clinical effectiveness of lifestyle health coaching: Case study of an evidence-based, technology-enabled, outcomes

oriented, comprehensive program. 2012 (In Review).

Interventions Driven by Hard Science (with documented outcomes)

Scientific Evidence

Percent change in 10-year Framingham CHD Risk Score in higher-risk employees

Source: Published in Journal of Cardiovascular Nursing, November 2008

INTERVENT INTERVENT U.S.A.U.S.A.

Scientific ValidationINTERVENT INTERVENT U.S.A.U.S.A.

Percentage of participants who achieved goal levels in classic CVD risk factors without medications within three months of initiating the program

Source: Published in American Journal of Cardiology, December 2004

*No statistically significant differences between baseline vs. follow-up rates. Follow-up assessed at 12 weeksGordon NF; Am J Cardiol 2002; 89:1263-68

Drug use amongINTERVENT compliers*

Publications

INTERVENT Participants

Notes: INTERVENT Program was implemented in January 2003. Participants enrolled in the INTERVENT Program in 2003 and completed a full year of service and evaluations. Analysis performed, in part, by Milliman Consultants and Actuaries.

Notes: INTERVENT Program was implemented in January 2003. Participants enrolled in the INTERVENT Program in 2003 and completed a full year of service and evaluations. Analysis performed, in part, by Milliman Consultants and Actuaries.

Non-INTERVENT Participants

State of Oklahoma Pilot: Average Health Care Claims Per Employee in 2002 vs. 2003

$2.30 savings for every $1 spent$2.30 savings for every $1 spent

INTERVENT INTERVENT U.S.A.U.S.A.

Return On Investment

Return On InvestmentINTERVENT INTERVENT CanadaCanada

Gamma-Dynacare Medical Laboratories Employee Case-studyGamma-Dynacare Medical Laboratories Employee Case-study

138.4 minutes per week gain in exercise among sedentary employees

35.7% improved medication compliance

ROIpresenteeism $4.42 for every $1 spent

Meta-Evaluation of Worksite HealthPromotion Economic Return Studies: 2012 UpdateChapman LS. Am J Health Promo 2012; 26: TAHP-1-TAHP-12

• Meta-evaluation of 62 economic return on investment studies of multi-component worksite wellness/health promotion

• Average duration of follow-up = 3.83 years• Number of study subjects = 546,971• Key findings:

% Change in sick leave absenteeism = -25.1% % Change in workers’compensation costs = -40.4% % Change in disability management costs = -24.2% % Change in health costs = -24.5% Cost:Benefit Ratio = 1:5.56 (i.e., ROI = 556%)

US Companies Use of Disease Management Programs

Shoppers Drug Mart

Select Data from HRA and Lifestyle Health Coaching Summary Analyses

Shoppers Drug Mart

Dr. Dorian Lo, Executive Vice President, Pharmacy and Healthcare at Shoppers Drug Mart

Previous positions include:

• President, Shoppers Drug Mart Health Solutions

• Medco Health Solutions, Chief Medical Officer, Health Plans

• McKinsey & Company

• Boards: Society of Aging of New York, Chilton Memorial Hospital Foundation

• MBA (Wharton) and MD (University of Western Ontario)

Why did Shoppers Drug Mart Implement a Program?

The program allowed us to further invest into our employees’ health.

• “Walk-the-Walk”of promoting good health and counseling• Supports our culture of Caring• Demonstrate SDM as a Top Employer• Use health information to stratify patients for disease management

and holistic employee care

What Did We Hope to Achieve?

Shoppers had the following goals:

• Improve productivity through decreased absenteeism and better employee health

• Improve intermediate outcomes and select clinical end-points• Improve employee satisfaction

Description of the Program

• First Step: Health Risk Assessment (HRA)• Phase 1 – offered to Corporate Head Office ~ 1200 employees• Phase 2 – rolled out to Allied Business Units ~ 500 employees• Integrated with flex benefits insurance program• Integrated Lab Results

• Second Step: Referrals• Referrals to Certified Diabetes Educators and Employee Assistance Program• Coached programs for higher risk employees• On-line lifestyle management programs

• Encouraging Success• Optimum points and other incentives• 76% of employees started an HRA• 96% completion rate

Our Workforce: Mainly Women

BU 1 BU 2 BU 3 ALL BOB

Completed

HRA (Number)832 110 261 1,203 --

Male

(n & %)

373

(44.8%)33 (30.0%) 73 (28.0%)

479

(39.8%) (49.6%)

Female

(n & % )459 (55.2%) 77 (70.0%) 188 (72.0%)

724

(60.2%) (50.4%)

(BU = Business Unit; ALL = All BUs combined; BOB = Book of Business)

Our Workforce:Average Age of 40 y.o.

BU 1 BU 2 BU 3 ALL BOB

Age

(Years)

42.3 M

40.5 F

37.1 M

41.8 F

39.1 M

37.7 F

41.5 M

39.9 F

43.4 M

42.9 F

Males –

Age 45 or Older18.4% 7.3% 8.0% 15.1% 23.4%

Females –

Age 55 or Older3.8% 10.9% 5.0% 4.7% 8.3%

SDM Employees were at lower risk than INTERVENT’s book of business

Level 1 = risk for future direct and indirect health care-related expenditure (“health risk stratification”);

Level 2 = intensity of lifestyle health coaching required to facilitate risk reduction in moderate/higher-risk individuals and to keep

apparently healthy individuals healthy (“intervention intensity stratification”)

HRAHRA Population stratificationPopulation

stratification

Lower Risk 0-2 Risk Factors 59% / 79%

Lower Risk 0-2 Risk Factors 59% / 79%

Moderate Risk

3-4 Risk Factors

32% / 18%

Moderate Risk

3-4 Risk Factors

32% / 18%




9% / 3%


9% / 3%

Lower Intensity

Intervention35% / 59%

Lower Intensity


Moderate Intensity


Moderate Intensity


Higher Intensity


Higher Intensity


1st Levelof Stratification

(Industry Standard)

2nd Levelof Stratification(INTERVENT)

Key: BOB; Shoppers Drug Mart

Our various business units had similar Wellness Scores

77.6

76.4

7877.6

73

74

75

76

77

78

79

80

Wel

lnes

s S

core

BU 1 BU 2 BU 3 ALL

78.3% of Participants are at a higher than desirable risk for CVD

Only 21.7% of participants are at a desirable risk for cardiovascular disease. This is a concern but this is not a surprising observation.

BU 1 BU 2 BU 3 ALL

Known CVD, Heart Failure, and/or Diabetes

4.1% 2.7% 3.4% 3.8%

One or More Potentially Modifiable CVD Risk Factors

73.6% 78.2% 75.9% 74.5%

Total at Higher Than Desirable Risk for CVD

77.7% 80.9% 79.3% 78.3%

Mean 10-Yr Risk for Coronary Heart Disease

4.3% 2.0% 3.2% 4.0%

10% or Higher 10-Yr Risk for Coronary Heart Disease

7.7% 0% 0% 6.6%

Weight remains the main risk factor

Prevalence (%) of Six Major Modifiable Risk Factors Among HRA Participants by Business Sectors

BusinessSector

CurrentCigaretteSmoker

Prehypertensionor Hypertension

AbnormalCholesterol

and/orTriglycerides

Prediabetesor Diabetes

Overweight

orObese

PhysicalInactivity

BU1 8.2% 25.5% 12.6% 5.0% 54.6% 39.3%

BU2 14.5% 36.4% 10.9% 2.7% 58.2% 41.8%

BU3 8.0% 23.4% 7.7% 2.3% 42.9% 48.3

ALL 8.7% 26.0% 11.4% 4.2% 52.4% 41.5%

Stress is another main risk factor

Prevalence (%) of Other Select Risk Factors, Chronic Conditions or Negative Health Behaviors

Business Sectors

Great Deal of Stress(Home/Work)

Poor EatingHabits

Sleep Apnea orEvidence of

Another Sleep Disorder

Medications for Anxiety

Medications

for Depression

Asthma

BU1

41.3%

32.7%

31.0%

3.5

3.4

6.9

BU2

44.5%

45.5%

32.7%

3.6%

5.5%

12.7%

BU3

39.1%

43.7%

28.3%

3.8%

4.2%

10.0%

ALL

41.1%

36.2%

30.6%

3.6%

3.7%

8.1%

High interest from our employees

Weight Management (%)

25.5 26.3

35.930.9

0

10

20

30

40

50

60

70

Per

cen

tag

e

Somewhat Interested Very Interested

Shoppers Drug Mart Book of Business


Exercise Training (%)

29.4 29.1

48.3

34.9

0

10

20

30

40

50

60

70

Per

cen

tag

e




Smoking Cessation (%)

23.9 26.8

47.7

36.2

0

10

20

30

40

50

60

70

Per

cen

tag

e




Nutrition (%)

29.6 29.9

49.0

35.2

0

10

20

30

40

50

60

70

Per

cen

tag

e




Stress Management (%)

32.828.1

30.8

22

0

10

20

30

40

50

60

70

Per

cen

tag

e



Lifestyle Health Coaching:Demographics

Intermediate outcomes have improved for participants

% of at risk participants has decreased through coaching

78.6

53.7

22.7

41.9

12.0

37

55.759.5

41.5

18.2

33.8

12.0

36.8

45.9

0

10

20

30

40

50

60

70

80

ElevatedSystolic BP

ElevatedDiastolic BP

Elevated LDLCholesterol

Obesity CigaretteSmokers

ElevatedBlood

Glucose

Stress

Pe

rce

nta

ge

Prevalence atProgram Entry

Prevalence atFollow-upEvaluation

Participants at Baseline + Follow-up (n=75; average follow-up=~20 weeks)Prevalence of Potentially Modifiable Risk Factors

Shoppers Drug Mart Considerations

Employers need to balance investments vs the importance of qualitative employee health & wellness.

• HR and CFOs are reluctant to pay for programs until ROI is proven in Canada HRA and disease management reinvestment is typically

combined with a restructuring of benefits offering Canadian studies are needed to establish ROI for employers

• Should Government subsidize DM since these activities can reduce their medical expenditures US studies show that most of the impact from DM relates to

hospitalization and overall burden from chronic care• Incentives and convenience are required to drive strong

participation (including on-site health clinics to collect lab results)

Conclusion

• HRA is a key enabling step in managing health and wellness since it provides health data

• HRA’s use is in deriving positive ROI from interventions• Employers can utilize existing research and their own data to

judge overall benefits of DM initiatives and to ensure programs are targeted and customized to their employees’ needs