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GE Energy Pre Diabetes Intervention A Collaboration with Centers for Disease Control & Prevention and the National Business Group on Health. March 16, 2005 Business Health Agenda National Business Group on Health. Welcome. Ron Finch, EdD Director, Center for Prevention and Health Services

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GE Energy Pre Diabetes InterventionA Collaboration withCenters for Disease Control & Prevention and the National Business Group on Health

March 16, 2005

Business Health Agenda

National Business Group on Health

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Ron Finch, EdD

Director, Center for Prevention and Health Services

National Business Group on Health

David Pratt, MD

Medical Director, GE Energy

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ROI Community

Stay in business


Profit and loss


Employees as a capital investment

Public good

Healthy people

Public and private partnerships



Business vs Community Health

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CoCHis Community


DNPA, Asthma





Know the Language

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Community and Public Health Community

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

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

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

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CDC Reinvention community health

  • Two Overarching Health Protection Goals

  • Health promotion and prevention of disease, injury, and disability:

  • Preparedness

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CDC Reinvention: community healthSix Strategic Imperatives

  • Health Impact.

  • CDC will be a customer-centric organization.

  • Public Health Research.

  • Leadership for the nation’s health system.Global Health.

  • Effectiveness and Accountability.

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CDC New Initiatives community health

  • Cooperative agreements

  • Multiple divisions working together, sharing expertise and resources


  • Asthma

  • Center for Public and Private Partnerships

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We Have an Epidemic of community healthDiabetes !

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Why pick diabetes for a health promotion intervention? community health

  • Costs over $100 billion/year in health care expenditures

  • Effective interventions promote multiple good outcomes

  • Leading cause of heart disease and stroke

  • Leading cause of blindness in adults

  • Leading cause of end stage renal disease requiring dialysis

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Consequences of community healthuncontrolled diabetes

  • Loss of productivity

  • Increased direct and indirect health care expenditures

  • Poorer quality of life for employees

  • Possible permanent disability

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Why Control Diabetes? community health

  • Better control translates into fewer complications

  • Fewer complications translate into fewer days lost to absenteeism and disability, and future savings on health care expenditures

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

  • Unique opportunity for education

  • Less time away from work

  • Improves employer-employee relations and shows employer cares about employees

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Do Any of These Things Work? community health

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

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

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Economic Benefits of Improved Glycemic Control community health

  • Testa et al, JAMA, Nov 1, 1998

  • Workers with better Hba1c had fewer days lost to absenteeism

  • Fewer days of restricted activity

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Strategies for Better Outcomes: Examples of Worksite Programs

  • Canada:worksite physical activity classes:savings of $679/person

  • Coca Cola company:worksite wellness >$500 /year/person x 2500 people

  • First Chicago:Worksite diabetes education program-improvement of HbA1c 9.0% to 8.3%

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National Diabetes Education Program (NDEP) Goals: Programs

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

  • Public and private partnerships to improve diabetes treatment and outcomes

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

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NDEP Workgroups Programs

  • African American Workgroup

  • Latino Hispanic Workgroup

  • American Indian – Alaska Native

  • Diabetes in youth

  • Older adults

  • PPOD

  • Business and Managed Care Workgroup

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Business and Managed Care Work Group (BMC) Programs

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

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

  • To promote the value of investing in prevention

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NDEP Business/Managed Care Workgroup: Who are we? Programs

  • CDC and NIH

  • Large and small businesses

  • Unions

  • Occupational health professionals

  • Public health agencies

  • Managed care groups

  • Non-profit organizations

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NBGH Programs

GE Power


American Association of Health Plans

United Automobile Workers Union

Wisconsin Diabetes Control



Harrington and Chappell

National Fed of Ind


BMC Work Group

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  • Occupational health professionals

  • Wellness coordinators

  • Benefits personnel and HR managers

  • Large and small businesses

  • Unions

  • Regional and national business groups

  • Managed care organizations

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BMC Workgroup Projects Programs

  • Diabetes White Paper : Call to action!

  • Diabetes Needs Assessment Tool

  • Diabetes Worksite Intervention Kit

  • Regional partner conferences: General Motors, DFWBGH, Federal Reserve, Land’s End

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Needs Assessment Programs

  • What is it and why does my company need to address diabetes?

  • Helps to see the potential prevalence of diabetes in the company based on NHIS data. Each company has a unique workforce, based on age, ethnicity

  • Is diabetes relevant at this time?

Diabetesatwork org content l.jpg Content Programs

  • Planning Guide

  • Assessment Tool

  • Choosing a Health Plan

  • Lesson Plans

  • Fact Sheets

  • Resources

  • Frequently Asked Questions (FAQ's)

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Diabetesatwork: Content Programs

  • General Diabetes Education

  • Managing Diabetes Complications

  • Cardiovascular Disease

  • Emotional Well-Being

  • Nutrition, Weight Control, and Physical Activity

  • Dealing With Type 1 Diabetes

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Lesson Plans, Lunch & Learns Programs

  • High and Low Blood Glucose Symptoms and Causes

  • Making Your Doctor Visit Count

  • Cardiovascular risk factors

  • Feet

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Other Topics Programs

  • Guide to choosing a health plan, developed with AAHP

  • Supervisor’s guide

  • Shift work

  • Links to other NDEP sites

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What Can My Company Do? Programs

  • Develop a Supportive Work Environment

    • Seize the moment for education

    • Educate other employees about diabetes

    • Create a wellness committee

    • Sponsor health screenings

    • Coordinate All Health Efforts

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Resources Programs

  • National Business Group on Health

  • WK Kellogg Foundation, The Business Interest in a Community’s Health, pdf on NBGH web site,

  • National Business Coalition on Health

  • American College of Occupational and Environmental Medicine

  • American Occupational Health Nurses

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Resources: American College of Occupational and Environmental Health


  • Consensus Statement on Health and Productivity

  • The Business Case for Managing Health and Productivity

  • Health and Wellness in the Workplace

  • Business and Managed Care Diabetes and Health Resource Kit

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Remember Environmental Health

  • New evidence: DPT Diabetes Prevention Trial; lifestyle and/or meds can PREVENT type 2 diabetes

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

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Diabetes Prevention Environmental Health@ GE Energy

Donna Tomlinson, MD MSc

Health Promotions Manager, GE Energy

Tiana Howland, RN

Cardiovascular Disease Prevention Specialist & Health Coach, Community Care Physicians

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GE Energy Risk Management Environmental HealthOverview

  • Cardiovascular Risk Assessment

  • CRA input

  • CRA output

  • Cardiovascular Risk Management

  • Energy Health Coach

  • Diabetes Prevention @ GE Energy

    • Sample of program

    • Implementation & Planning

    • Results

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Diabetes Prevention Environmental Health@ GE Energy

  • Cardiovascular Risk Assessment Input

  • 11 questions

  • Height, weight, girth

  • Blood pressure

  • Lipids & glucose

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Data Quality Environmental HealthMisclassification Bias

Digit bias resulted in 362 false positive diagnoses of hypertension with an unnecessary physician referral.

Cost of unnecessary referrals:

350 * $70 = $24,500


Systolic BP Ones Digit

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Assessment Environmental HealthTime

  • Production time focus

  • Customer oriented

  • Efficiently

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Cardiovascular Risk Assessment Environmental Health

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10 year risk of cardiac event Environmental Health

10 year risk of stroke

Existing CAD, PAD, CVA

Blood pressure

Including medication use

Tobacco users


Including medication use



Metabolic Syndrome


Cardiovascular Risk Assessment Output

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GE Energy Profile Environmental Health

78% male

mean age 42.7

2% CVD

17% metabolic syndrome

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Percent of Population with Environmental HealthMetabolic Syndrome Risk Factors

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Mean Change Between Environmental HealthCRA 1 & CRA 2

  • Age (yrs.): 1.2, p = 0.000

  • Total Cholesterol (mg/dl): -3.1, p = 0.000

  • HDL Cholesterol (mg/dl): 1.6, p = 0.000

  • LDL Cholesterol (mg/dl): -4.0, p = 0.000

  • Imputed serum triglycerides: -7.7, p = 0.039

  • Serum glucose (mg/dl): -5.4, p = 0.000

  • Systolic blood pressure (mmHg): -2.5, p = 0.000

  • Diastolic blood pressure: -0.7, p = 0.012

  • BMI (kg/m^2): -0.0, p = 0.507

  • Waist Circumference (cm): -0.1, p = 0.412

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Change Between CRA 1 & CRA 2 Environmental Health

Incident diabetes = 1.0%

Prevalent diabetes = 3.0%

“Cured” diabetes ?

Net tobacco quit rate at 1.2 years = 28.3%

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Net Effect of CRA As an Intervention Environmental Health

  • 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 = 0.001

  • Mean change in Real 10 yr. CHD risk: -0.003, p = 0.003

  • Mean change in 5 yr. CHD risk (age held constant): -0.004, p = 0.000

  • Mean change in 10 yr. CHD risk (age held constant): -0.008, p = 0.000

  • Per 1000 employees screened, 4 events (in 5 years) are averted

  • 24.8 events averted in our screened population

  • At $40,000 per event = $992,000

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Current & Baseline Risk Environmental Health

Old Recruitment Method

CRA Intensive Follow UpEnergy Health Coach

Current & Baseline Risk

Old Recruitment Method

  • Our focus is on those with highest modifiable risk

  • NNT to prevent one event (10 year risk) is 20

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Criteria for Intensive Environmental Health

Risk > 10%, modifiable

Risk > 7.5%, LDL “med level”

Trigs > 1000 mg/dL

Stage 2 Hypertension

New or poorly controlled diabetes

Criteria considered for less intensive follow-up


Stage 1 hypertensives

LDL-cholesterol at “lifestyle levels”

Overweight or obese

Metabolic syndrome

Other pre-diabetic

CRA Follow UpLess Intensive Intervention

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They built it. Environmental Health

We came.

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Complications of Diabetes Environmental Health

#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


Heart Failure

Coronary Heart Disease

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Six Sigma Care? Environmental Health

  • 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.

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Counting Saturated Fats Environmental Health

(Sat fat per serving) * (Servings) = Grams of Sat Fat

3 g x 2 Servings = 6 g Sat Fat

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

20 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 Fat

1 ounce slice cheese: 5 g Sat Fat

3 oz serving skinless white chicken: 1 g Sat Fat

3 oz serving dark meat chicken: 2 g Sat Fat

3 oz lean pork: 4 g Sat Fat

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

Hot dog: 5 to 11 g Sat Fat

Double quarter pound cheeseburger: 20g Sat Fat

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Script for Environmental HealthInstructor

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Counting Grams of Saturated Fat Environmental Health

  • Breakfast: 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 frosty

  • Dinner: 10 oz steak with mashed potatoes with butter and salad with hidden valley original with bacon

  • Dessert: 1 pint of Haagen-Dazs ice cream

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Counting Grams of Saturated Fat Environmental Health

8 g

3 g

13.2 g

12 g

3.5 g

7 g

18 g

0 g


21.6 g

0 g

10 g

44 g

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Diabetes and High Blood Pressure Environmental HealthAre Like Twins

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Create a Blood Pressure Action Plan Environmental Health

  • John’s average blood pressure is 132/85

    • He should reduce his systolic blood pressure down below 120

  • 132 -120 = 12 points


Does not exercise

Eats fast food daily

Does not drink alcohol

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Create a Blood Pressure Action Plan Environmental Health

  • 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

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Top 10 Daily Hassles 5 A Day . . .A Survey of Middle-aged Adults:

  • Concerns about weight

  • Health of a family member

  • Rising prices

  • Home maintenance

  • Too many things to do

  • Misplacing or losing things

  • Yard work or outside home maintenance

  • Property, investments, or taxes

  • Crime

  • Physical appearance

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Diabetes Prevention @ GE Energy 5 A Day . . .Program Sites

  • Houston

    • 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

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    Planning 5 A Day . . .Upfront,Direct, Simple

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    Pilot Study Results 5 A Day . . .

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    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

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    ROI: The Business Case Improvement

    • 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

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    Developing the ROI Improvement

    • Identify the populations

      • Participants

      • Control Group

    • Monitor healthcare costs and utilization during periods of:

      • Pre-intervention

      • Intervention

      • Post Intervention

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    Costs and Utilization Metrics Improvement

    • Costs

      • Health Plan Claims Data

      • Prescription Medication Costs

      • Disability Costs Data

    • Utilization Data

      • Admissions

      • ER visits

      • Scripts

      • Disability Days/Events

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    Discussion of Pre-Intervention Data Improvement

    • 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

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    Intervention Participation Rate Improvement

    • Dose Response

      • Percent of Activities Attended

      • Participant Survey

        • Lifestyle changes

          • Exercise

          • Healthy Diet

          • Adherence to Medications

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    Program Costs Improvement

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    ROI (Con’t) Improvement

    First: Employee only

    Second: Employee and family

    Third: Participants compared to control group

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    Integrating Health Promo Programs With Health Plan Improvement

    Lynn Kohrs

    Healthcare Manager,

    GE Energy

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    Group Health Plan Benefit Design Improvement

    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

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    Group Health Plan Benefit Design Improvement

    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

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    Health Costs (U.S.) Improvement





    Retiree (Accrual)




    Post 65 (Cash)






    Disability (Cash)

    Pre 65 (Cash)

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

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

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    Summary Improvement

    • Goals/Objective

    • Public Private Partnerships

    • Lessons Learned – Strength/Weaknesses

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    Open Forum ImprovementQ&A