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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

welcome

Welcome

Ron Finch, EdD

Director, Center for Prevention and Health Services

National Business Group on Health

David Pratt, MD

Medical Director, GE Energy

business vs community health
ROI

Stay in business

Productivity

Profit and loss

Overhead

Employees as a capital investment

Public good

Healthy people

Public and private partnerships

Non-profits

Advocacy

Business vs Community Health
know the language
CoCHis

DDT, CVD

DNPA, Asthma

OSH, DRH

ROI

Presenteeism

NBGH

Know the Language
community and public health
Community and Public Health
  • 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.
cdc reinvention
CDC Reinvention
  • Two Overarching Health Protection Goals
  • Health promotion and prevention of disease, injury, and disability:
  • Preparedness
cdc reinvention six strategic imperatives
CDC Reinvention: Six 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.
cdc new initiatives
CDC New Initiatives
  • Cooperative agreements
  • Multiple divisions working together, sharing expertise and resources
  • DDT, CVD, DNPA
  • Asthma
  • Center for Public and Private Partnerships
why pick diabetes for a health promotion intervention
Why pick diabetes for a health promotion intervention?
  • 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
consequences of uncontrolled diabetes
Consequences of uncontrolled diabetes
  • Loss of productivity
  • Increased direct and indirect health care expenditures
  • Poorer quality of life for employees
  • Possible permanent disability
why control diabetes
Why Control Diabetes?
  • Better control translates into fewer complications
  • Fewer complications translate into fewer days lost to absenteeism and disability, and future savings on health care expenditures
why the workplace as a site of disease education
Why the workplace as a site of disease education?
  • Unique opportunity for education
  • Less time away from work
  • Improves employer-employee relations and shows employer cares about employees
do any of these things work
Do Any of These Things Work?
  • 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?
economic benefits of improved glycemic control
Economic Benefits of Improved Glycemic Control
  • Testa et al, JAMA, Nov 1, 1998
  • Workers with better Hba1c had fewer days lost to absenteeism
  • Fewer days of restricted activity
strategies for better outcomes examples of worksite programs
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%
national diabetes education program ndep goals
National Diabetes Education Program (NDEP) Goals:
  • 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
ndep workgroups
NDEP Workgroups
  • African American Workgroup
  • Latino Hispanic Workgroup
  • American Indian – Alaska Native
  • Diabetes in youth
  • Older adults
  • PPOD
  • Business and Managed Care Workgroup
business and managed care work group bmc
Business and Managed Care Work Group (BMC)
  • 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
ndep business managed care workgroup who are we
NDEP Business/Managed Care Workgroup: Who are we?
  • CDC and NIH
  • Large and small businesses
  • Unions
  • Occupational health professionals
  • Public health agencies
  • Managed care groups
  • Non-profit organizations
bmc work group
NBGH

GE Power

GM

American Association of Health Plans

United Automobile Workers Union

Wisconsin Diabetes Control

Program

Novo-Nordisk

Harrington and Chappell

National Fed of Ind

Businesses

BMC Work Group
ndep target groups
NDEP TARGET GROUPS
  • Occupational health professionals
  • Wellness coordinators
  • Benefits personnel and HR managers
  • Large and small businesses
  • Unions
  • Regional and national business groups
  • Managed care organizations
bmc workgroup projects
BMC Workgroup Projects
  • 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
needs assessment
Needs Assessment
  • 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
Diabetesatwork.org: Content
  • Planning Guide
  • Assessment Tool
  • Choosing a Health Plan
  • Lesson Plans
  • Fact Sheets
  • Resources
  • Frequently Asked Questions (FAQ's)
diabetesatwork content
Diabetesatwork: Content
  • General Diabetes Education
  • Managing Diabetes Complications
  • Cardiovascular Disease
  • Emotional Well-Being
  • Nutrition, Weight Control, and Physical Activity
  • Dealing With Type 1 Diabetes
lesson plans lunch learns
Lesson Plans, Lunch & Learns
  • High and Low Blood Glucose Symptoms and Causes
  • Making Your Doctor Visit Count
  • Cardiovascular risk factors
  • Feet
other topics
Other Topics
  • Guide to choosing a health plan, developed with AAHP
  • Supervisor’s guide
  • Shift work
  • Links to other NDEP sites
what can my company do
What Can My Company Do?
  • 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
resources
Resources
  • National Business Group on Health www.wbgh.com
  • WK Kellogg Foundation, The Business Interest in a Community’s Health, pdf on NBGH web site,
  • National Business Coalition on Health www.nbch.org
  • American College of Occupational and Environmental Medicine www.acoem.org
  • American Occupational Health Nurses www.aaohn.org
resources american college of occupational and environmental health
Resources: American College of Occupational and Environmental Health
  • www.acoem.org
  • 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
remember
Remember
  • 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.
diabetes prevention @ ge energy

Diabetes Prevention@ GE Energy

Donna Tomlinson, MD MSc

Health Promotions Manager, GE Energy

Tiana Howland, RN

Cardiovascular Disease Prevention Specialist & Health Coach, Community Care Physicians

ge energy risk management overview
GE Energy Risk ManagementOverview
  • Cardiovascular Risk Assessment
  • CRA input
  • CRA output
  • Cardiovascular Risk Management
  • Energy Health Coach
  • Diabetes Prevention @ GE Energy
      • Sample of program
      • Implementation & Planning
      • Results
diabetes prevention @ ge energy44
Diabetes Prevention@ GE Energy
  • Cardiovascular Risk Assessment Input
  • 11 questions
  • Height, weight, girth
  • Blood pressure
  • Lipids & glucose
data quality misclassification bias
Data QualityMisclassification Bias

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

Cost of unnecessary referrals:

350 * $70 = $24,500

Frequency

Systolic BP Ones Digit

assessment time
AssessmentTime
  • Production time focus
  • Customer oriented
  • Efficiently
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

Cardiovascular Risk Assessment Output
ge energy profile
GE Energy Profile

78% male

mean age 42.7

2% CVD

17% metabolic syndrome

mean change between cra 1 cra 2
Mean Change Between CRA 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
change between cra 1 cra 2
Change Between CRA 1 & CRA 2

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
Net Effect of CRA As an Intervention
  • 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
cra intensive follow up energy health coach

Current & Baseline Risk

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
cra follow up less intensive intervention
Criteria for Intensive

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

Prehypertensives

Stage 1 hypertensives

LDL-cholesterol at “lifestyle levels”

Overweight or obese

Metabolic syndrome

Other pre-diabetic

CRA Follow UpLess Intensive Intervention
complications of diabetes
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

Stroke

Heart Failure

Coronary Heart Disease

six sigma care
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
Counting Saturated Fats

(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

counting grams of saturated fat
Counting Grams of Saturated Fat
  • 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
counting grams of saturated fat62
Counting Grams of Saturated Fat

8 g

3 g

13.2 g

12 g

3.5 g

7 g

18 g

0 g

140.3g

21.6 g

0 g

10 g

44 g

create a blood pressure action plan
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 plan65
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

top 10 daily hassles a survey of middle aged adults
Top 10 Daily HasslesA 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
diabetes prevention @ ge energy program sites
Diabetes Prevention @ GE EnergyProgram 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
business and public health bridging the gap in health improvement
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
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
Developing the ROI
  • Identify the populations
    • Participants
    • Control Group
  • Monitor healthcare costs and utilization during periods of:
    • Pre-intervention
    • Intervention
    • Post Intervention
costs and utilization metrics
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
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
Intervention Participation Rate
  • Dose Response
    • Percent of Activities Attended
    • Participant Survey
      • Lifestyle changes
        • Exercise
        • Healthy Diet
        • Adherence to Medications
roi con t
ROI (Con’t)

First: Employee only

Second: Employee and family

Third: Participants compared to control group

integrating health promo programs with health plan

Integrating Health Promo Programs With Health Plan

Lynn Kohrs

Healthcare Manager,

GE Energy

group health plan benefit design
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 design86
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

slide87

Health Costs (U.S.)

$2,321

($MM)

$2,093

$2,033

Retiree (Accrual)

$1,792

$1,552

$1,366

Post 65 (Cash)

$1,123

$1,026

$983

$982

$958

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

summary
Summary
  • Goals/Objective
  • Public Private Partnerships
  • Lessons Learned – Strength/Weaknesses