Evaluating Measures of Success for Worksite Initiatives

1. Evaluating Measures of Success for Worksite Initiatives Dyann Matson Koffman, Division for Heart Disease and Stroke Prevention, CDC Andy Spaulding, Maine CDC/DHHS Cardiovascular Health Program

2. Employers say now more than ever� �Convince me� why should my business invest in worksite health promotion?�

3. Present the Big Picture to Employers Adapted from The Platinum Book, IHPM, 2004 It is important to start with the big pictures which lays the foundation for overall WHP This logic model provide a graphic description of the relationship between a program�s activities and its intended effects. Briefly walk through the logic model So, why should a company assess its overall health status? needs assessment guides employer, especially those with limited resources, in deciding how they should best focus their financial and human resources. For example, assessment may show that hypertension is a big driver so that is where to focus resources. How do employers assess their overall health status? It is important to start with the big pictures which lays the foundation for overall WHP This logic model provide a graphic description of the relationship between a program�s activities and its intended effects. Briefly walk through the logic model So, why should a company assess its overall health status? needs assessment guides employer, especially those with limited resources, in deciding how they should best focus their financial and human resources. For example, assessment may show that hypertension is a big driver so that is where to focus resources. How do employers assess their overall health status?

4. Objectives Highlight integrated evaluation approaches and tools that states and others can use to evaluate efforts in worksites. Identify measures of success for worksite interventions including HDSP indicators.

5. Agenda National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Workplace Workgroup Health and Productivity Management (HPM) Framework Workplace Health Index (WHI) (integrated tool) Division for Heart Disease and Stroke Prevention Business Toolkit and Six-Step Guide State Examples Comprehensive Model for Worksite Health Promotion Examples of Tools and Scorecards HeartStroke Check- (draft integrated tool) Purchaser Guide Audit Health Plan Checklist How can States use these Tools to measure success?

6. Health and Productivity Management (HPM) Framework Three main domains and 25 concepts important for measuring an organization�s health Leadership and Corporate Culture Program Design and Implementation Program Evaluation

7. Workplace Health Index Develop a tool(s) for use by employers of all sizes and types to assess their organization�s health, risk factors, program policies, environment, culture, and other areas important to the success of workplace health programs. See List of Published Scorecards and Tools

8. DHDSP Business Toolkit (updating) Toolkit is designed for states to educate and influence employers to provide: comprehensive worksite programs, policies, environmental supports/culture, and preventive health benefits for heart disease and stroke prevention, and to improve employee health and productivity In order to do this, CDC just published our new Toolkit titled��. The purpose of the Toolkit was designed for States to help them�..READIn order to do this, CDC just published our new Toolkit titled��. The purpose of the Toolkit was designed for States to help them�..READ

9. DHDSP Six-Step Guide (updating)

10. New Additions to Toolkit Comprehensive Model for Worksite Health Promotion  HeartStroke Check and Sampling Frame (draft) Purchasers Guide to Clinical Preventive ServicesAudit of Clinical Preventive Services for Adults Health Plans� Benefits and Services Checklist (revised) Other Scorecards and Tools There are many tools available, which I am providing as a handout. None have them have been deemed as the gold standard for worksite health promotion Comprehensive Model----the steps that you can follow to help employers establish comprehensive WHP HeartSt Six-Step Guide: The major component and slim takeaway brochure of the Toolkit is our Employer�s Six-Step Guidw that we give to employers. I will highlight the information in this Guide. Evaluating Health Plans�: A checklist that helps employers choose and negotiate a health benefits package that fits their business workforce Programs that have demonstrated a positive impact on heart disease, stroke, and related risk factors Promising Practice is an innovative worksite program that has field-based data showing positive outcomes for preventing heart disease, stroke, and related risk factors, but that may not yet have been studied under controlled research conditions. PowerPoint presentation for employers using information in the Employer�s  Six-Step Guide Glossary: Definitions and terms related to heart disease and stroke prevention, cardiovascular health, and business Additional Resources: Web links National guidelines for heart disease and stroke prevention Other toolkits Assessment tools Associations and agencies Selected articles with information describing the link between health benefits, comprehensive workplace health promotion and a healthier work force and lower costs to employers There are many tools available, which I am providing as a handout. None have them have been deemed as the gold standard for worksite health promotion Comprehensive Model----the steps that you can follow to help employers establish comprehensive WHP HeartSt Six-Step Guide: The major component and slim takeaway brochure of the Toolkit is our Employer�s Six-Step Guidw that we give to employers. I will highlight the information in this Guide. Evaluating Health Plans�: A checklist that helps employers choose and negotiate a health benefits package that fits their business workforce Programs that have demonstrated a positive impact on heart disease, stroke, and related risk factors Promising Practice is an innovative worksite program that has field-based data showing positive outcomes for preventing heart disease, stroke, and related risk factors, but that may not yet have been studied under controlled research conditions. PowerPoint presentation for employers using information in the Employer�s Six-Step Guide Glossary: Definitions and terms related to heart disease and stroke prevention, cardiovascular health, and business Additional Resources: Web links National guidelines for heart disease and stroke prevention Other toolkits Assessment tools Associations and agencies Selected articles with information describing the link between health benefits, comprehensive workplace health promotion and a healthier work force and lower costs to employers

11. Comprehensive Model for Worksite Health Promotion Resource READ steps. Leadership support from within the company is key to a program�s success This model shows promise as 70% of state respondents felt the model was �useful� or �very useful The Toolkit provides more of the interventions. This tool is more about the nuts and bolts process to assisting employer groups in establishing effective WHP programs and policies These steps are integrated. Planning: What actions will best reach our goals and objectives Assess needs and measure success: how are we doing- did it work, and why are we doing well or poorly? READ steps. Leadership support from within the company is key to a program�s success This model shows promise as 70% of state respondents felt the model was �useful� or �very useful The Toolkit provides more of the interventions. This tool is more about the nuts and bolts process to assisting employer groups in establishing effective WHP programs and policies These steps are integrated. Planning: What actions will best reach our goals and objectives Assess needs and measure success: how are we doing- did it work, and why are we doing well or poorly?

12. Step #1 Provide Leadership at High Level Macro-marketing an approach for reaching and developing relationships with employers on a large scale through: business coalitions business groups task forces business leaders and champions One of the things I hear a lot is that successful partnerships starts with a good relationship. The goal is to work with these coalitions and business leaders as a partner and consultant to reach individual employers Gain �Grass-Top� champion support (e.g., Chief Executive Officers, Senior Managers, Civic Leaders) Develop partnerships with employer groups, business coalitions, and health associations Focus efforts on employers or geographic regions of the state with high rates of heart disease and stroke Conduct media outreach to raise community awareness for worksite health promotion Conduct a series of presentations, using the Toolkit�s PowerPoint presentations and Six-Step Guide Persuade business leaders and organizations to support heart disease and stroke prevention interventions Gain resources commitment from employers to integrate health promotion into corporate operations One of the things I hear a lot is that successful partnerships starts with a good relationship. The goal is to work with these coalitions and business leaders as a partner and consultant to reach individual employers Gain �Grass-Top� champion support (e.g., Chief Executive Officers, Senior Managers, Civic Leaders) Develop partnerships with employer groups, business coalitions, and health associations Focus efforts on employers or geographic regions of the state with high rates of heart disease and stroke Conduct media outreach to raise community awareness for worksite health promotion Conduct a series of presentations, using the Toolkit�s PowerPoint presentations and Six-Step Guide Persuade business leaders and organizations to support heart disease and stroke prevention interventions Gain resources commitment from employers to integrate health promotion into corporate operations

13. State Example�Maine Maine HDSP Program championed linking health insurance premiums with employer sponsored health improvement programs.� � Small businesses (2-50 employees) and self-employed people who are members of a local or regional chamber of commerce are eligible for a 3% annual premium reduction if they participate in a two-part wellness program. Measures of success: Employer participation in program Through the HDSP program�s work and partnership with the Maine Council for Worksite Wellness, a large health insurer was engaged on this topic on multiple occasions over a two-year period.� Subsequently, in November 2006, the insurance carrier announced a new initiative through the Maine State Chamber of Commerce, in which employers meeting certain criteria are eligible for a premium reduction. This is a specific way of rewarding employers for taking prevention seriously, while also providing a strong message that worksite health management is an effective tool for managing medical costs.� The policy was informed by the HDSP program�s strong partnership with the insurance company and its representatives.��For more information on�Maine's�collaboration with worksites see http://www.chronicdisease.org/files/public/SSS_ME_employer_WEB.pdf Through the HDSP program�s work and partnership with the Maine Council for Worksite Wellness, a large health insurer was engaged on this topic on multiple occasions over a two-year period.� Subsequently, in November 2006, the insurance carrier announced a new initiative through the Maine State Chamber of Commerce, in which employers meeting certain criteria are eligible for a premium reduction. This is a specific way of rewarding employers for taking prevention seriously, while also providing a strong message that worksite health management is an effective tool for managing medical costs.� The policy was informed by the HDSP program�s strong partnership with the insurance company and its representatives.��For more information on�Maine's�collaboration with worksites see http://www.chronicdisease.org/files/public/SSS_ME_employer_WEB.pdf

14. �State Example�.Kansas, Missouri partnered with the CDC and the Kansas and Missouri Heart Disease and Stroke Prevention Programs to reach 17 employers (representing over 400,000 covered lives) to design and conduct The Community Initiative on Cardiovascular Health (CICV) in the Kansas City Region. Measures for success: high blood pressure, high cholesterol, other risk factors, value-based purchasing This is a four-phase project focusing on health, lifestyle and behavior issues of high blood pressure, high blood cholesterol, and related risk factors. This is a four-phase project focusing on health, lifestyle and behavior issues of high blood pressure, high blood cholesterol, and related risk factors.

15. �State Example�.North Carolina Asheville Project began in 1997 to improve employee health and reduce healthcare costs in Ashville, NC. A self-insured employer provided employees with diabetes intensive education through the Mission-St. Joseph�s Diabetes and Health Education Center. Clinically-trained, community pharmacists coached program participants on self-managing their illness, using their medications correctly, and making healthy lifestyle choices Measures for success: healthcare costs, employee morale, overall health, and absenteeism. Model components: Within two years the City of Asheville saw healthcare costs going down for those participants. Among the project participants, employee morale improved, overall health improved and absenteeism declined. The program expanded to include cardiovascular disease (i.e., high blood pressure and high cholesterol). Currently, the Asheville Project covers diabetes, cardiovascular disease, asthma and depression. The project led pharmacists to develop strong patient care services by linking with the patient�s primary care providers and the community pharmacies. The program has been found to be effective in reducing participant blood pressure and cholesterol levels and in decreasing the cardiovascular event rate by almost half. Cardiovascular-related medical expenses among participant decreased by 46.5% primarily because of the substantial decrease in hospitalizations, but also because the mean cost per cardiovascular event decreased from $14,343 to $9,931[1]. The Asheville model is payer-driven and patient-centered.� Employers are adopting this approach as an additional health care benefit to empower their employees to control their chronic diseases, reduce their health risks, and ultimately lower their health care costs.� Specific components include: The employer/health plan notifies employees a wellness program is available to them for diabetes, hypertension, high cholesterol, and asthma; agrees to significantly reduce co-pays for disease related medications for patients who take disease specific classes and meet regularly with their specially trained pharmacist; agrees to pay for the self-care classes and coaching sessions. The patient agrees to attend self-care education classes specific for their disease(s); goes to a pharmacist they choose from a list of participating pharmacies/pharmacists; meets with the pharmacist once a month for 20-30 minutes. The pharmacist receives certificate training and is reimbursed for counseling sessions. The American Pharmacists Association (APhA) Foundation is spearheading a nationwide effort to demonstrate how the Asheville model can be adapted and implemented in diverse geographic regions throughout the country. Model components: Within two years the City of Asheville saw healthcare costs going down for those participants. Among the project participants, employee morale improved, overall health improved and absenteeism declined. The program expanded to include cardiovascular disease (i.e., high blood pressure and high cholesterol). Currently, the Asheville Project covers diabetes, cardiovascular disease, asthma and depression. The project led pharmacists to develop strong patient care services by linking with the patient�s primary care providers and the community pharmacies. The program has been found to be effective in reducing participant blood pressure and cholesterol levels and in decreasing the cardiovascular event rate by almost half. Cardiovascular-related medical expenses among participant decreased by 46.5% primarily because of the substantial decrease in hospitalizations, but also because the mean cost per cardiovascular event decreased from $14,343 to $9,931[1]. The Asheville model is payer-driven and patient-centered.� Employers are adopting this approach as an additional health care benefit to empower their employees to control their chronic diseases, reduce their health risks, and ultimately lower their health care costs.� Specific components include: The employer/health plan notifies employees a wellness program is available to them for diabetes, hypertension, high cholesterol, and asthma; agrees to significantly reduce co-pays for disease related medications for patients who take disease specific classes and meet regularly with their specially trained pharmacist; agrees to pay for the self-care classes and coaching sessions. The patient agrees to attend self-care education classes specific for their disease(s); goes to a pharmacist they choose from a list of participating pharmacies/pharmacists; meets with the pharmacist once a month for 20-30 minutes. The pharmacist receives certificate training and is reimbursed for counseling sessions. The American Pharmacists Association (APhA) Foundation is spearheading a nationwide effort to demonstrate how the Asheville model can be adapted and implemented in diverse geographic regions throughout the country.

16. Step #2: Tools to Assess Individual Health Health Risk Appraisals (HRAs) at the Worksite: Basics for HRA Decision Making (CDC); http://www.nbch.org/documents/HRA_Updated_080303.pdf� Aggregated employee data from: HRAs and other employee surveys Biometric screenings, e.g., HBP, HBC Health care claims data/ pharmaceutical claims data Absenteeism data The Work Life Questionaire WLQ (productivity)http://www.nemc.org/icrhps/resprog/thi/wlq.asp  WLQ: Productivity loss score reflects difference in output compared to benchmark healthy workers Seven Benchmarks of Success- how to gather data from businesses May not use all of these tools. Goal is to help employers decide on the tools to use, and how to use the data and information to determine cost drivers, needs, and interventions. Consider all level of interventions- environmental, health plan, education, health plan system changes�all fit into this socio-ecological model. WLQ Productivity and presenteeism measured in 25 or 8-item versions cover 4 domains- work time, physical, mental-interpersonal, and output demands. WLQ: Productivity loss score reflects difference in output compared to benchmark healthy workers Seven Benchmarks of Success- how to gather data from businesses May not use all of these tools. Goal is to help employers decide on the tools to use, and how to use the data and information to determine cost drivers, needs, and interventions. Consider all level of interventions- environmental, health plan, education, health plan system changes�all fit into this socio-ecological model. WLQ Productivity and presenteeism measured in 25 or 8-item versions cover 4 domains- work time, physical, mental-interpersonal, and output demands.

17. Step #2: Tools to Assess Organizational Health and Step #5: Measure Success HeartStroke Check: draft and sampling frame availablevalidate the tool- next 2 years Purchaser�s Guide to Clinical Preventive Services (CDC/NBGH): Health plan coverage for 46 conditions: http://www.cdc.gov/dhdsp/library/purchasers_guide.htmHealth Action Council- Audit of Clinical Preventive Services Toolkit: Health Plan Benefits and Services Checklist (CDC) http://www.cdc.gov/dhdsp/library/toolkit/index.htm See list for other organizational tools Some of these tools can be used for assessing needs and gaps but also to measure success Some of these tools can be used for assessing needs and gaps but also to measure success

18. HeartStroke Check A tool to assess worksite wellness policy, environmental, educational, and administrative supports for heart disease and stroke prevention  Can be used to plan and evaluate worksite services, programs, and interventions Convened expert workgroup Examined existing worksite inventories and resources Used reliable and valid questions from the Heart Check and Heart Check Lite Identified new domains and questions to add to the new instrument Conducted cognitive tests with 9 employers Revised tool based on feedback The tool was developed by an expert workgroup of federal, state, academic, and private sector representatives. In a collaborative process, the workgroup identified and examined existing worksite inventories and resources3-14 that address heart disease and stroke prevention. The review revealed that a comprehensive health promotion program that includes sustained individual risk reduction counseling for employees and lower-cost policy and environmental interventions is the most effective approach to support healthy lifestyles and prevent heart disease and stroke.10-14 The workgroup used reliable and valid questions from the Heart Check7-8 and Heart Check Lite9 assessment tools, and then identified new domains and questions to add to the new instrument. New questions were derived from both the literature and from worksite surveys that state heart disease and stroke prevention programs had previously used in worksites. The Heart/Stroke Check tool was then pre-tested with nine worksites throughout the country to ensure that it was clear, easy to understand, and simple to complete. The tool was then revised based on feedback from these nine employers. Can be used to plan and evaluate worksite services, programs, and interventions Convened expert workgroup Examined existing worksite inventories and resources Used reliable and valid questions from the Heart Check and Heart Check Lite Identified new domains and questions to add to the new instrument Conducted cognitive tests with 9 employers Revised tool based on feedback The tool was developed by an expert workgroup of federal, state, academic, and private sector representatives. In a collaborative process, the workgroup identified and examined existing worksite inventories and resources3-14 that address heart disease and stroke prevention. The review revealed that a comprehensive health promotion program that includes sustained individual risk reduction counseling for employees and lower-cost policy and environmental interventions is the most effective approach to support healthy lifestyles and prevent heart disease and stroke.10-14 The workgroup used reliable and valid questions from the Heart Check7-8 and Heart Check Lite9 assessment tools, and then identified new domains and questions to add to the new instrument. New questions were derived from both the literature and from worksite surveys that state heart disease and stroke prevention programs had previously used in worksites. The Heart/Stroke Check tool was then pre-tested with nine worksites throughout the country to ensure that it was clear, easy to understand, and simple to complete. The tool was then revised based on feedback from these nine employers.

19. Where do you get the information to complete Heart Check? Employer interviews Corporate health policies Direct observation at the worksite Train business coalitions, task forces, employer health promotion specialists how to use tool Most information is readily available from corporate health policies, and through direct observation at the worksite.Most information is readily available from corporate health policies, and through direct observation at the worksite.

20. What does HeartStroke Check assess? Organizational supports (policies, environmental, services, and education): Tobacco Control Nutrition Physical Activity Stress Management Administrative Supports, e.g., incentives Organizational Foundations, e.g., flexible work policies Signs and Symptoms of Heart Attack and Stroke Emergency Response Screenings, Treatments, and Health Education Used to assess, plan, establish, and improve WHPUsed to assess, plan, establish, and improve WHP

21. How do you score HeartStroke Check? Employers answer 81 �Yes or �No� questions Max. score 94 points. 90 - 100% = Excellent 80 - 89% = Very good 70 - 79% = Good 60 - 69% = Fair 50 - 59% = Average 0 - 49% = Below Average Employers answer each question on the survey by simply checking �yes� or �no�. Most information is readily available from corporate health policies, and through direct observation at the worksite. In general, a high number of boxes checked �yes� indicate that the worksite provides comprehensive interventions and services to promote cardiovascular health. For example, answering 80% or more of the questions as �yes� could be considered a good to excellent score. The tool can also be used in conjunction with health risk assessment findings to prioritize areas for health improvement. States could partner with business coalitions or chambers of commerce to reach and assist employers in using this tool and other resources to develop and improve comprehensive worksite health promotion programs, policies, and services throughout a state. State heart disease and stroke prevention programs could also collaborate with other state chronic disease prevention programs using an integrated approach to collect this information from a selected or random sample of employers, through telephone or in-person visits, and enter the information in a database of companies. States could then compile results and conduct analyses over time to use as a benchmark for monitoring change in worksite health promotion programs. Employers answer each question on the survey by simply checking �yes� or �no�. Most information is readily available from corporate health policies, and through direct observation at the worksite. In general, a high number of boxes checked �yes� indicate that the worksite provides comprehensive interventions and services to promote cardiovascular health. For example, answering 80% or more of the questions as �yes� could be considered a good to excellent score. The tool can also be used in conjunction with health risk assessment findings to prioritize areas for health improvement. States could partner with business coalitions or chambers of commerce to reach and assist employers in using this tool and other resources to develop and improve comprehensive worksite health promotion programs, policies, and services throughout a state. State heart disease and stroke prevention programs could also collaborate with other state chronic disease prevention programs using an integrated approach to collect this information from a selected or random sample of employers, through telephone or in-person visits, and enter the information in a database of companies. States could then compile results and conduct analyses over time to use as a benchmark for monitoring change in worksite health promotion programs.

22. Sample Questions

23. What does HeartStroke Check tell you? Proportion of Workplaces with the following services to control high blood pressure screening health risk assessments environmental supports incentives employer payment for services onsite clinical health services or physician referrals behavioral approaches Used to assess, plan, establish, and improve WHPUsed to assess, plan, establish, and improve WHP

24. The Purchaser�s Guide, which was released in Nov, 2006. It has 7 parts or chapters. Purchaser�s Guide to Clinical Preventive Services (developed by CDC, AHRQ, and the National Business Group on Health) provides guidance to employers on recommended clinical preventive services for health benefits design.The Purchaser�s Guide, which was released in Nov, 2006. It has 7 parts or chapters. Purchaser�s Guide to Clinical Preventive Services (developed by CDC, AHRQ, and the National Business Group on Health) provides guidance to employers on recommended clinical preventive services for health benefits design.

25. Purchaser�s Guide Audit Tool

26. Health Plan Benefits and ServicesChecklist to Promote Cardiovascular Health andPrevent Heart Disease and Stroke Experts in health promotion and disease prevention Resources including: American Heart Association (AHA) guidelines USPSTF Guide to Clinical Preventive Services The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure NHLBI National Cholesterol Education Program�ATP III A literature review 2000�2003 IOM report- confronting racial and ethnic disparities in health care A Purchaser's Guide to Clinical Preventive Services Cognitive testing with 9 employers Tool revised based on feedback Experts in health promotion and disease prevention Resources including: American Heart Association (AHA) guidelines USPSTF Guide to Clinical Preventive Services The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure NHLBI National Cholesterol Education Program�ATP III A literature review 2000�2003 IOM report- confronting racial and ethnic disparities in health care A Purchaser's Guide to Clinical Preventive Services Cognitive testing with 9 employers Tool revised based on feedback

27. What does Health Plan Checklist tell you? Assesses how well health plans have provided �best practice� interventions for HDSP: Risk identification Risk reduction programs National guidelines Health care quality assurance systems Heart disease and stroke risk identification: Strategies to identify employees at risk for heart disease, stroke, and related risk factors and conditions. Heart disease and stroke risk reduction programs: Programs and services to help employees prevent heart disease and stroke and improve overall health. National guidelines: Use of national guidelines for treating and preventing heart disease and stroke. Health care quality assurance systems: Systems to reinforce and evaluate the delivery of quality care. Strategies to eliminate cardiovascular disease (CVD) disparities: Tailored strategies to reach diverse groups who may be at increased risk for heart disease and stroke. Patient satisfaction surveys: Evaluations to ensure a high level of patient satisfaction with heart disease and stroke prevention program and services. Cost savings information: Reports that show cost savings associated with heart disease, stroke, and risk factor prevention over time. Community collaboration: Evidence of collaboration with other health plans and local, state, and national health organizations around heart disease and stroke prevention.Heart disease and stroke risk identification: Strategies to identify employees at risk for heart disease, stroke, and related risk factors and conditions. Heart disease and stroke risk reduction programs: Programs and services to help employees prevent heart disease and stroke and improve overall health. National guidelines: Use of national guidelines for treating and preventing heart disease and stroke. Health care quality assurance systems: Systems to reinforce and evaluate the delivery of quality care. Strategies to eliminate cardiovascular disease (CVD) disparities: Tailored strategies to reach diverse groups who may be at increased risk for heart disease and stroke. Patient satisfaction surveys: Evaluations to ensure a high level of patient satisfaction with heart disease and stroke prevention program and services. Cost savings information: Reports that show cost savings associated with heart disease, stroke, and risk factor prevention over time. Community collaboration: Evidence of collaboration with other health plans and local, state, and national health organizations around heart disease and stroke prevention.

28. What does Health Plan Checklist tell you? Assesses how well health plans have provided �best practice� interventions for HDSP: Strategies to eliminate CVD disparities Patient satisfaction surveys Cost savings information Community collaboration Heart disease and stroke risk identification: Strategies to identify employees at risk for heart disease, stroke, and related risk factors and conditions. Heart disease and stroke risk reduction programs: Programs and services to help employees prevent heart disease and stroke and improve overall health. National guidelines: Use of national guidelines for treating and preventing heart disease and stroke. Health care quality assurance systems: Systems to reinforce and evaluate the delivery of quality care. Strategies to eliminate cardiovascular disease (CVD) disparities: Tailored strategies to reach diverse groups who may be at increased risk for heart disease and stroke. Patient satisfaction surveys: Evaluations to ensure a high level of patient satisfaction with heart disease and stroke prevention program and services. Cost savings information: Reports that show cost savings associated with heart disease, stroke, and risk factor prevention over time. Community collaboration: Evidence of collaboration with other health plans and local, state, and national health organizations around heart disease and stroke prevention.Heart disease and stroke risk identification: Strategies to identify employees at risk for heart disease, stroke, and related risk factors and conditions. Heart disease and stroke risk reduction programs: Programs and services to help employees prevent heart disease and stroke and improve overall health. National guidelines: Use of national guidelines for treating and preventing heart disease and stroke. Health care quality assurance systems: Systems to reinforce and evaluate the delivery of quality care. Strategies to eliminate cardiovascular disease (CVD) disparities: Tailored strategies to reach diverse groups who may be at increased risk for heart disease and stroke. Patient satisfaction surveys: Evaluations to ensure a high level of patient satisfaction with heart disease and stroke prevention program and services. Cost savings information: Reports that show cost savings associated with heart disease, stroke, and risk factor prevention over time. Community collaboration: Evidence of collaboration with other health plans and local, state, and national health organizations around heart disease and stroke prevention.

29. Sample Questions

30. How do you score Health Plan Checklist? Employers answer 25 �Yes� or �No� questions Max. score 60 points 90 - 100% = Excellent 80 - 89% = Very good 70 - 79% = Good 60 - 69% = Fair 50 - 59% = Average 0 - 49% = Below Average Employers answer each question on the survey by simply checking �yes� or �no�. The Health Plan Checklist can be used by employers to examine the benefits that health plans provide in heart disease and stroke prevention coverage and services and identify where there may be gaps in these services. The checklist can also be used to compare health plans based on these aspects. Employers can negotiate with health plans to ensure these services get covered. In general, a high number of checked boxes indicates that the plan will provide sufficient comprehensive and high-quality services to promote cardiovascular health and prevent and manage heart disease and stroke. Health benefits managers can also consider other programs and services that address other conditions and their associated costs when selecting a health plan or benefits package. If the employer is self-insured, the checklist can be used to design an employees� benefits package that includes all the fundamental services needed to support cardiovascular health and prevent heart disease and stroke. Employers answer each question on the survey by simply checking �yes� or �no�. The Health Plan Checklist can be used by employers to examine the benefits that health plans provide in heart disease and stroke prevention coverage and services and identify where there may be gaps in these services. The checklist can also be used to compare health plans based on these aspects. Employers can negotiate with health plans to ensure these services get covered. In general, a high number of checked boxes indicates that the plan will provide sufficient comprehensive and high-quality services to promote cardiovascular health and prevent and manage heart disease and stroke. Health benefits managers can also consider other programs and services that address other conditions and their associated costs when selecting a health plan or benefits package. If the employer is self-insured, the checklist can be used to design an employees� benefits package that includes all the fundamental services needed to support cardiovascular health and prevent heart disease and stroke.

31. Where do you get the information to complete the Health Plan Checklist? Health plan, contract, or materials distributed by health plan/health insurance provider  Health plan representative or third party administrator Check a company�s health plan contract Contact the health plan rep.Check a company�s health plan contract Contact the health plan rep.

32. What other resources can be used with Heath Plan Checklist? Purchasers Guide to Clinical Preventive Services- recommendations for coverage of clinical preventive services for 46 conditionshttp://www.businessgrouphealth.org Health Action Council: Audit of Clinical Preventive Services for Adults eValu8- a web-based tool to help organizations evaluate their health benefits and services for many diseases and conditionshttp://www.evalue8.org The Purchaser�s Guide to Clinical Preventive Services provides employers with information to ensure health benefits meet the needs of the employee population. It presents key preventive services and programs based on cost and clinical effectiveness as well as employees� demographic and health characteristics. The Purchaser�s Guide to Clinical Preventive Services can be found at the National Business Group on Health, www.businessgrouphealth.org. eValue8 is a Web-based tool to help organizations evaluate their health benefits and improve health care services. eValue8 uses standardized questions to gather vendor-specific health care information. In combination with the Health Plan Checklist, eValue8 can be used to assess health plans on heart disease and stroke and other health-related topics. Information on the eValue8 assessment tool can be found at www.evalue8.org. The Purchaser�s Guide to Clinical Preventive Services provides employers with information to ensure health benefits meet the needs of the employee population. It presents key preventive services and programs based on cost and clinical effectiveness as well as employees� demographic and health characteristics. The Purchaser�s Guide to Clinical Preventive Services can be found at the National Business Group on Health, www.businessgrouphealth.org. eValue8 is a Web-based tool to help organizations evaluate their health benefits and improve health care services. eValue8 uses standardized questions to gather vendor-specific health care information. In combination with the Health Plan Checklist, eValue8 can be used to assess health plans on heart disease and stroke and other health-related topics. Information on the eValue8 assessment tool can be found at www.evalue8.org.

33. Who should use these Tools? Employers human resource managers health benefit managers health education staff occupational nurses State and local health departments Researchers Practitioners

34. Step #5: �.Tools to Measure Success HeartStroke Check- compare results over time with aggregated individual data, preventive services, and DHDSP Worksite Indicators, e.g, �proportion of worksites with environmental supports for high blood pressure control� WELCOA Seven Benchmarks of Successhttp://www.welcoa.org/freeresources/index.php?category=8 Program Evaluation: A Key to Wellness Program Survivalhttp://www.welcoa.org/wellworkplace/index.php?category=2 CDC Framework for Program Evaluationhttp://www.cdc.gov/DHDSP/state_program/evaluation_guides/index.htm

35. This slide shows how Fieldale has kept their health care costs down over a 12-year period. The dotted line is Fieldale compared the U.S. trend, the red line. The pyramids represent the risk profile of their employees. For example, the red top bar shows the proportion of high risk employees at Fieldale and the green are those at ideal or no risk. You can see the decrease of high risk employees and increase of those at ideal risk since the start of their program. This slide shows how Fieldale has kept their health care costs down over a 12-year period. The dotted line is Fieldale compared the U.S. trend, the red line. The pyramids represent the risk profile of their employees. For example, the red top bar shows the proportion of high risk employees at Fieldale and the green are those at ideal or no risk. You can see the decrease of high risk employees and increase of those at ideal risk since the start of their program.

36. DiscussionHow can States use these Tools? Collaborate with other state chronic disease prevention programs to show trends and measures of success Partner with and provide TA to business coalitions, chambers of commerce, etc. Provide tools on a state web-portal Surveillance to get a snapshot of workplace initiatives and �best practices� and to track improvement in workplace and health plan benefits and services Conduct a random or select sample of employers and health plans (see sampling frame on HeartStroke Check) Compile data and conduct analyses to benchmark How would you guide employers to use these tools to measure success for high blood pressure control and other chronic disease risk factors? States could partner with business coalitions or chambers of commerce to reach and assist employers in using this tool and other resources to develop and improve comprehensive worksite health promotion programs, policies, and services throughout a state. State heart disease and stroke prevention programs could also collaborate with other state chronic disease prevention programs using an integrated approach to collect this information from a selected or random sample of employers, through telephone or in-person visits, and enter the information in a database of companies. States could then compile results and conduct analyses over time to use as a benchmark for monitoring change in worksite health promotion programs. How would you guide employers to use these tools to measure success for high blood pressure control and other chronic disease risk factors? States could partner with business coalitions or chambers of commerce to reach and assist employers in using this tool and other resources to develop and improve comprehensive worksite health promotion programs, policies, and services throughout a state. State heart disease and stroke prevention programs could also collaborate with other state chronic disease prevention programs using an integrated approach to collect this information from a selected or random sample of employers, through telephone or in-person visits, and enter the information in a database of companies. States could then compile results and conduct analyses over time to use as a benchmark for monitoring change in worksite health promotion programs.