Health is an Investment

1. Health is an Investment The Asthma Society of Canada in the workplace

2. Asthma Society of Canada Vision: • to empower every child and adult in Canada with asthma to live an active and symptom-free life. Mission: • We are the balanced voice for asthma in Canada, advancing optimal self-management, prevention, research and health care. • We help patients to take control of their symptoms by providing credible and leading edge information, programs, services and the guidance and education they need to live their lives symptom free. • We lead and advocate for the best interests of Canadians with asthma through effective collaboration with policy-makers, researchers and health care providers.

3. The Problem According to the Ontario Health Quality Council: 1 in 3 Ontarians have > 1 chronic diseases including: diabetes, asthma, congestive heart failure depression . In Ontario, financial burden of chronic diseases consumes 33% of direct health care costs >60% of total health care costs More effective management could lead to: 29,000 ER visits avoided, 67,300 fewer hospitalizations, Estimated annual savings of $200 to $350 million.

4. Chronic Disease in the Workplace Respiratory diseases exert a significant economic impact on the Canadian health care system, and on worker productivity Employer borne costs include: Absenteeism, Lost Productivity, and Health Benefits Traditionally, it was thought that good health arises from high standards of living from economic prosperity, however, it appears that this concept might be backwards; perhaps economic prosperity arises from a healthy population*(*source: Brandt-Rauf P, Burton WN, McCunney RJ. Health, productivity, and occupational medicine. J Occup Environ Med 2001;43:1).

5. Chronic Disease in the Workplace • We might conclude that a healthy population results in a healthy economy • With the prevalence of asthma increasing for about the last three decades in western countries, it is plausible that some of the anaemic performance of the economy has been due to the prevalence in chronic disease in the workplace

6. Allergic Rhinitis • According to one study, allergic rhinitis was the most prevalent chronic condition at a workplace: 55% of employees reported experiencing allergic rhinitis symptoms for an average of 52.5 days, were absent 3.6 days per year due to the condition losing 2.3 hours of productivity each workday while symptomatic at work • 70% of people with asthma suffer from allergic rhinitis. • Prevalence of allergies has increased significantly in the last 20 years and is anticipated to reach up to 75% of the population worldwide by 2015

7. Chronic Disease in the Workplace • More hours are lost to persons who are present but unproductive than people who are absent. • Research concludes that lost productivity from workers who are present but not at peak health (presenteeism) is 7.5 times more costly than absenteeism. (source: Lowe G. Here in body, Absent in productivity. 2-12-2002. Canadian HR Reporter. 25-9-2006). • Lost productivity is greatest in those individuals who have chronic and generally benign conditions, such as asthma and allergies.

8. ASC Asthma Control Programming • Telephone and Email Based Asthma Counseling; • Asthma Control Booklet Series; • National Asthma Patient Alliance; • Advocacy Initiatives directed at driving patient and system behaviour change; • Asthma Care Gap Research; • Adult and Pediatric Guideline Dissemination; • Websites for teens and children with asthma; • Four Seasons of Asthma Trigger Management Website; • Asthma and Allergy Friendly Certification Program;

9. Asthma Society Workplace Programming The ASC has workplace programming directed at: • improving quality of life, disease management and control of asthma • reducing overall medical benefit costs, lowering absenteeism rates and increasing productivity • improving knowledge about asthma and associated allergies and self-management skills • increasing awareness about asthma and its impact on daily/work-related activities among employees Objective measures include: • pulmonary function testing • medication compliance rates • absentee days (both long term and short term).

10. Return on Investment Disease management models, in contrast with traditional benefit programmes, can yield a return on investment of $2.85 for each $1.00 invested (source: Cousins MS, Liu Y. Cost savings for a preferred provider organization population with multi-condition disease management: evaluating program impact using predictive modeling with a control group. Dis Manag 2003;6:207-17).

11. Asthma Society of Canada For further information about ASC workplace programming, contact: Christine Hampson President & CEO champson@asthma.ca direct: 416-787-4050 x 109 4950 Yonge Street, Suite 2306 Toronto ON M2N6K1 Canada

12. Chronic Disease Management (CDM) and Medication Adherence Pilot Project developed by Asthma Society of Canada & Oxford Outcomes Ltd

13. Oxford Outcomes Ltd. • Academic affiliated research consulting company (list academic affiliations) • Expertise in • Health program evaluation • Economics evaluation (cost-effectiveness) • Epidemiology • Burden of illness • Health outcomes evaluation • Reimbursement and government relations • 60 employees worldwide, located inToronto, Vancouver, Bethesda, Oxford UK. • Part of COPERA network of consultancies in six European countries • Services offered (summary): strategic and regulatory consulting, design and analysis of observational studies and randomized trials, cost-effectiveness, patient reported outcomes, utility studies, linguistic translation and validation www.oxfordoutcomes.com

14. The Problem • In Ontario, chronic diseases account for 60% of total health care costs • Employer borne costs include: Absenteeism & Lost Productivity, and Health Benefits (disability). • 60% of prescribed medication is taken incorrectly or not at all leading to poor health outcomes • Forgetfulness is akey reason for non-compliance, and number 1 reason for non-compliance among adolescents and seniors.

15. One Potential Solution • A medication reminder program designed to enhance the management of asthma. • A system which enables automated, telephony-based (voice and text messaging) and email adherence reminders and associated tele-services.

16. Joint Public-Private Pilot Project • Ministry personnel overwhelmed by numerous and disparate pilot projects undertaken by private sector. • ASC promoting a collaborative public-private approach to piloting this concept within primary health care and in an employer setting

17. Adherence Activities forChronic Disease Management (CDM) • Typically involves counseling and/or distribution of pamphlets at time of prescription is written or dispensed. • Currently, limited use of medication reminder services in primary care practices, patient groups (health charities), or large employers.

18. Pilot Objectives • To empower patient self management of chronic disease • To improve adherence through automated reminders • To implement and evaluate an automated medication reminder program

19. Project Mandate • MOHLTC directed the pilot as an “implementation” project • Not “research” • Use existing primary health care infrastructure (FHGs, FHNs, FHTs, LHINs etc.) • At the end of the project • transfer knowledge from pilot to provide evidence-based recommendations on how to integrate reminders systems within health care in a sustainable manner • investigate linkages to ePrescribing

20. Principal Investigators Adrian R. Levy, Ph.D. Department of Health Care and Epidemiology School of Population and Public Health, UBC Director – Oxford Outcomes Ltd. D. Wayne Taylor, Ph.D. Director, Health Leadership Institute, DeGroote School of Business, McMaster U. Christine Hampson Ph.D. President & CEO, Asthma Society of Canada

21. Approach • Develop pilot framework (methodology) • Confirmation of all partners & funding • Technology development • Implementation (pilot sites, patient recruitment etc.) • Patient follow-up • Evaluation and analysis • Recommendations to the Ministry of Health

22. Methodology & Considerations • Multiple Patient Recruitment Sites (3 at the least) • Involvement of Local Health Integration Networks (LHINS)

23. Program Evaluation • MOHLTC supporting access administrative health databases (OHIP/CIHI) to determine: • emergency room visits • hospitalizations • primary care visits • visits to respirologists • prescription refills • Patient reported Symptom Control Measure: baseline and end of program • For employer arm of study: absenteeism and/or presenteeism, medication costs

24. Anticipated Project Deliverables At the end of the project • Evidence-based recommendations and roll-out plan to integrate reminders systems within health care • Recommendations for linking to ePrescribing • Scalable patient reminder system (technology) • Reminder system impact analysis on health care resources and direct medical costs

25. Employer Participation • ASC is seeking to identify a partner to run this pilot within an employer setting.

26. Oxford Outcomes For further information about this pilot project, contact: Robert Bick Oxford Outcomes robert.bick@oxfordoutcomes.com direct: 416-986-2426 235 Yorkland Blvd, Suite 402 Toronto Ontario M2J 4Y8