2007_NLO_United Against Diabetes - Randy Defrehn - Slide 1

www.unitedagainstdiabetes.orgwww.unitedagainstdiabetes.org 11

United Against DiabetesUnited Against Diabetes

Presentation to BC/BSPresentation to BC/BSHollywood, Florida – February 22, 2007Hollywood, Florida – February 22, 2007


Our ObjectiveOur Objective

To launch a national campaign focusing To launch a national campaign focusing on preventing and managing diabetes and on preventing and managing diabetes and related risks, including obesity, related risks, including obesity, cholesterol, hypertension and smokingcholesterol, hypertension and smoking Primarily in Multiemployer FundsPrimarily in Multiemployer Funds Secondarily in other union populationsSecondarily in other union populations


An Initiative ofAn Initiative of Center To Protect Workers RightsCenter To Protect Workers Rights Diabetes Research Institute FoundationDiabetes Research Institute Foundation Dad’s Day/Dollars Against DiabetesDad’s Day/Dollars Against Diabetes National Coordinating Committee For National Coordinating Committee For

Multiemployer PlansMultiemployer Plans


What is NCCMP?What is NCCMP?

Founded 1974Founded 1974 Non-profit membership organizationNon-profit membership organization Members:Members:

Pension and health & welfare fundsPension and health & welfare funds Both employers and unionsBoth employers and unions

To ensure members a minimum of To ensure members a minimum of regulatory or other interference. regulatory or other interference.

www.NCCMP.Org


What is CPWR?What is CPWR?

Non-profit organizationNon-profit organization Research and training arm of BCTDResearch and training arm of BCTD Special focus on safety and healthSpecial focus on safety and health 25 million annual budget25 million annual budget Research consortium with 32 universities Research consortium with 32 universities Recognized world-wideRecognized world-wide

www.cpwr.com


What is DRIWhat is DRI Leading center of excellenceLeading center of excellence Basic, pre-clinical, clinical and public Basic, pre-clinical, clinical and public

health researchhealth research Leads federation of 11 research centers Leads federation of 11 research centers

world-wideworld-wide Type 1 diabetes: Pioneer in islet cell Type 1 diabetes: Pioneer in islet cell

transplantstransplants Type 2 diabetes: Participant in the Type 2 diabetes: Participant in the

Diabetes Prevention Program (DPP)Diabetes Prevention Program (DPP)www.dri.org


What is Dad’s DayWhat is Dad’s Day

Founded by Building Trades unions in Founded by Building Trades unions in 1987 to raise money for DRI1987 to raise money for DRI

Annual Dad’s Day nationwide fundraisingAnnual Dad’s Day nationwide fundraising Golf tournaments and other fundraising Golf tournaments and other fundraising

eventsevents More than $35 million raised to dateMore than $35 million raised to date Goal for 2007: raise 5 millionGoal for 2007: raise 5 million

www.dadsday.org


Our Message Our Message # 1# 1

Diabetes is epidemicDiabetes is epidemic 2006: 15% of population over age 40 has 2006: 15% of population over age 40 has

diabetesdiabetes 2/3rds know it2/3rds know it Already 10-15% of health and welfare costsAlready 10-15% of health and welfare costs


Our Message Our Message # 2# 2

Diabetes can be managedDiabetes can be managed To do so, health and welfare funds must To do so, health and welfare funds must

become proactivebecome proactive Each fund can do it alone, or we can do it Each fund can do it alone, or we can do it

togethertogether We think a We think a common approachcommon approach is best is best


Our Message Our Message # 3# 3The Costs of Doing NothingThe Costs of Doing Nothing

By 2015By 2015 25%25% of adult population will have diabetes of adult population will have diabetes They will consume They will consume 25-30%25-30% of all health and of all health and

welfare costswelfare costs By 2020By 2020

30-40%30-40% of adult population will have diabetes of adult population will have diabetes They will consume They will consume 30+%30+% of all health and of all health and

welfare costswelfare costs


The Union Market– 59 Million LivesThe Union Market– 59 Million Lives

SectorSector UnitsUnits LivesLivesMultiemployer Multiemployer FundsFunds

1760 Funds1760 Funds 25+ million lives25+ million lives

Of these 1100 Of these 1100 building trades building trades

FundsFunds

10 million lives10 million lives

Single employer Single employer union families union families

25 million25 million

TotalTotal 50+ Million Lives50+ Million Lives


The Union Market– DollarsThe Union Market– Dollars

SourceSource LivesLives Annual Health Costs Annual Health Costs (2003)(2003)

MultiemployerMultiemployer 25 million25 million $200 billion*$200 billion*

Single Single EmployerEmployer

25 million25 million $150 billion$150 billion

TotalTotal $350 billion$350 billion

*Of this approx. $18 Billion is for Rx


Patient Support ProgramPatient Support Program Awareness, Screening and Early DetectionAwareness, Screening and Early Detection. .

Screening individuals at risk for diabetes, obesity, hypertension, Screening individuals at risk for diabetes, obesity, hypertension, cholesterol and smoking, and providing them with help to cholesterol and smoking, and providing them with help to change life style, delays the onset of diabetes and other change life style, delays the onset of diabetes and other risks/diseasesrisks/diseases

Disease ManagementDisease Management. . Disease progression is slowed and average medical costs are Disease progression is slowed and average medical costs are

reduced for patients who are part of disease management reduced for patients who are part of disease management programs.programs.

Case Management.Case Management. Patients with advanced diabetes have fewer complications, Patients with advanced diabetes have fewer complications,

fewer emergency room visits and hospital admissions, and fewer emergency room visits and hospital admissions, and shorter lengths of stay per hospital admission if they are enrolled shorter lengths of stay per hospital admission if they are enrolled in active case management programsin active case management programs


0

5

10

15

20

25

30

35

40

Percent

Healthy Overweight Obese

Weight (BMI) of Trust Fund Adult (>40) Population

Source: CPWR DOE Medical Screening program


0

2

4

6

8

Percent

<40 40-54 55-64

One Trust Fund's Experience:Prevalence of Diagnosed Diabetes,

Construction Trades Members

1990199520002005

Source: Duke University


One Trust Fund’s ExperienceOne Trust Fund’s Experience 7,500 active members7,500 active members 341 (4.5%) members with diabetes341 (4.5%) members with diabetes Cost of treating these 341 with diabetesCost of treating these 341 with diabetes

5 years (1999-2005): 5 years (1999-2005): • Total $11.01 MillionTotal $11.01 Million• Per Patient: $32,300Per Patient: $32,300

Average Cost Per Patient Per Year: $6,500.Average Cost Per Patient Per Year: $6,500. Percent of Total Fund Costs/Members: 11.2% Percent of Total Fund Costs/Members: 11.2%

Source: Duke University


The Challenge of Imposing The Challenge of Imposing Disease Management in Disease Management in

Indemnity Plan EnvironmentIndemnity Plan Environment Health plansHealth plans

Not involved in careNot involved in care Lacking clinical guidelines or rulesLacking clinical guidelines or rules Too few participants in any medical practice to Too few participants in any medical practice to

influence the practiceinfluence the practice Deficient data systems and program monitoringDeficient data systems and program monitoring

ProvidersProviders Practice traditional reactive medicinePractice traditional reactive medicine Resentful of health plan intrusionResentful of health plan intrusion Are measured on process rather than outcomesAre measured on process rather than outcomes


SolutionSolution

Encourage use of incentives and penaltiesEncourage use of incentives and penalties To participate in screeningTo participate in screening To comply with treatment guidelinesTo comply with treatment guidelines

Access to evidence-based patient support Access to evidence-based patient support program designed for the multiemployer program designed for the multiemployer fund environmentfund environment

Continuous evaluation and improvementContinuous evaluation and improvement


Population at Risk For DiabetesPopulation at Risk For DiabetesTotal

Multiemployer pop25,000,000

Generally Not at Risk17 Mill

At Risk (32%)8 Million

No diabetes5.3 Mill

Diabetes2.7 Mill (10.8%)


How this Campaign Will be FundedHow this Campaign Will be Funded

Development Phase (5 years):Development Phase (5 years): Support from health care industry partners, Support from health care industry partners,

government and foundationsgovernment and foundations Ongoing CampaignOngoing Campaign

Contributions from participating health and Contributions from participating health and welfare funds which in return receive all benefits welfare funds which in return receive all benefits of campaign including of campaign including Patient Support ProgramPatient Support Program

Contribution rate(s) to be defined by Fund Contribution rate(s) to be defined by Fund Advisory CommitteeAdvisory Committee


Goals for Year 1Goals for Year 1

Get up and runningGet up and running Recruit at least 25 FundsRecruit at least 25 Funds Start up to 5 pilot studiesStart up to 5 pilot studies Work out bugs in patient support programWork out bugs in patient support program Finalize plan for public health program Finalize plan for public health program

activitiesactivities Prepare plans to go nationwide by 2008Prepare plans to go nationwide by 2008


Goals for EnrollmentGoals for Enrollment

YearYear Funds Funds EnrolledEnrolled

LivesLives DiabeticsDiabetics ContributionsContributionsTo UADTo UAD

11 2525 300,000300,000 32,40032,400 $1-1.7 mill$1-1.7 mill22 9090 1,800,0001,800,000 195,000195,000 $7-10 mill$7-10 mill33 300300 5,000,0005,000,000 540,000540,000 $20-28 mill$20-28 mill44 800800 12,000,00012,000,000 1,300,0001,300,000 $48-68 mill$48-68 mill55 12001200 15,000,00015,000,000 1,620,0001,620,000 $55-85 mill$55-85 mill

Contribution = 1 cent per member per hour worked = $13-18 per year


What’s the Probability of SuccessWhat’s the Probability of Success

Highly experienced teamHighly experienced team Excellent access to target populationExcellent access to target population Great reception for concept in target Great reception for concept in target

populationpopulation Past experiencePast experience

DiabetesDiabetes Smoking prevention and cessationSmoking prevention and cessation Construction safety and healthConstruction safety and health

2007_NLO_United Against Diabetes - Randy Defrehn - Slide 1

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