Expanding the Concept of Preventive CareBruce Lyon-Dugin

Improving Diet and Physical Activity Assessment (R01)

Category of Funding Activity:

Education Food and Nutrition Health Income Security and Social Services

Improving Diet and Physical Activity Assessment (R01

Applications submitted under this Funding Opportunity Announcement (FOA) may include development of: novel assessment approaches and/or better methods to evaluate instruments assessment tools for culturally diverse populations across various age groups including older adults; improved technologies and/or applications of existing technologies; and/or statistical methods to assess or correct for measurement errors or biases.

Health Care in America Today

Claims Dollar Today

0% 20% 40% 60% 80% 100%

0.75 0.1

Chronic Claims

Rx drugs

Preventive Services

Chronic diseases such as asthma, cancer, diabetes, obesity, and heart disease affect the quality of life for 133 million Americans

Chronic diseases account for more than 75 cents of every dollar we spend on health care in this country

Columbia University School of Nursing, Center for Health Policy. The public health workforce: enumeration 2000. Washington (DC): Department of Health and Human Services, Health Resources and Services Administration;

Health Care Reform Intention

Claims

Productivity Gain

0 1 2 3 4 5 6 7 8 9 10

4

5

Preventive CareInpatient/OutPatient ServicesChronic Disease

Increase Pro-ductivity of American Worker through Preven-tive Care Uti-lization

Preventive Medical Services –decrease Absenteeism, Presenteeism, Long Term Chronic disease-More productive and trained workforce –Employer already invested in

Redefine where we spend our Health Dollars: Upstream, not after becoming sick

Pyramid of Claims Health for an Individual

Principal Wellness Company

No Cost Control in an aging workforce in todays health care model

Past this point Individual Productivity diminishes

Age time line fo

r medica

l care

Age Demographics and Eating Habits- 66% of all Adults eat fast food in a seven day work week-Obesity growing statistic-no controls in place to stop trend

Lack Nutrition Education-

BCBSMN –Minnesota Study Department of Health-Human Services 8/2010

Health Care Providers office consultation- Missing Obesity Weight Loss Education

An Average Physical Examination takes about 30 minutes -Patient never gets tools to assist in making a lifestyle change choice

Seidel, Henry M. Mosby's Physical Examination Handbook, 4th edition. St. Louis, MO: Mosby-Year Book, 2003.

Few Health Care Providers ask the right questions related to treatment of obesity

after the physical

BCBSMN –Prevention Minnesota-MN Department Health-Human Services-8/2010 Study

Schematic on Health DeterminantsUW-Wisconsin Population Health Institute

• Health Outcomes

• Heath Factors

• Programs and Policies

• Tobacco use• Diet & exercise• Alcohol use• Unsafe sex

• Access to care• Quality of care

• Education• Employment• Income• Family and social support• Community safety

• Environmental quality• Built environment

Mortality & Morbidity

Health Behavior 30%

Clinic Care 20%

Social & Economic Factors 40%

Physical Environment 10%

Education Conference Finding2010 Minnesota Statewide Health Improvement

Key findings

• Fewer than half patients know their BMI• Majority of patients want to lose weight• Willing to diet and exercise rather than use

medications or surgery• Providers ask about physical activity more than diet• Few providers offer advice and assistance• Preventive testing dollars spent on tests only

Results: Health.State.mn.us/obesity summary:

Employer needs to control health spending-Expense out of Control

• 75 % of an Employer’s health care costs and productivity losses are related to employee lifestyle choices

• Chronic diseases accounts for more than 75 cents of every dollar we spend on health care in this country

• Faced with an aging population, the only hope to control health premiums is catch the disease early and educate on benefits of proper nutrition, exercise and controlling stress (hypertension )

Why to Put your Health Dollarsinto Preventive Care

• Today we take action only on Chronic Disease, which is a Sunken Ship because productivity already has declined in the employees

• Preventive Care focus is a predictable expense• Companies implementing it are driving costs down• Government and health care organizations are

driving the messages the employees see and hear, and are setting the tone

• Corporate social responsibility will drive the movement

Change Focus of Health Care delivery

• Preventive Care Service – Becomes new reserve for controlling health costs. Insurance plan pays for education

• Self-funded or fully funded health insurance contracts need to create ROI on Health Dollar-Make Productivity Gains the ROI (Healthier workforce= More Product )

• Federal and State Government are using financial subsidies to assist in changing health demographics of population

• Government is driving message of ethics in promoting healthier lifestyles with regulations and audits

Employer Must Partner with Wellness Companies to Promote Health

• Know your population by using biometric & preventive screening aggregate results to focus education and incentives

• Spend dollars on controllable health outcomes versus chronic care

• Engage your employees in understanding that the health landscape is changing and they cannot NOT participate

• A productive employee will work to an older age and save training dollars, less turnover

• Utilize your health plan benefits to the fullest under health reform. New law requires 80 % to 85 % medical loss ratio payout from you insurance carrier. Capture those dollars for preventive wellness services

The New Workforce

• PPACA, guidelines state that insurance plans must include preventive consulting and counseling. There will be an IRS penalty for non-compliance

• 32,000,000 additional Americans will get health insurance under the Affordable Care Act. (PPACA. Congressional Budget Office] ( new workforce for hiring)

• Biggest issues related to the 32,000,000 additional insured are increased levels of obesity, diabetes and cardiovascular disease

• Same 32,000,000 are currently most unproductive employees. If not healthy, they will drive up presenteeism and absenteeism

What’s the US Department of Health & Human Services Doing to Change the Health of America?

• Financial & Educational Assistance Federal funding programs– The Affordable Care Act provides $11 billion in funding over the next 5 years for the

operation of health centers. – $9.5 billion is targeted to creating new health center sites in medically underserved

areas and expanding preventive and primary health care services at existing health center sites.

– Establish a National Prevention and Health Promotion Strategy for prevention, wellness and public-health activities was published 12/22/2010 by www.hhs.gov/new/reports

– Provide an Education and Outreach Campaign for preventive benefits, and immunization programs.

– Establish a grant program to support the delivery of prevention and wellness services aimed at strengthening prevention activities, reducing chronic-disease rates and addressing health disparities, especially in rural and urban settings.

– Created the National Prevention, Health Promotion and Public Health Council which will be assisted by a nonfederal advisory group of no more than 25 members.

• Linking Public Health with Care Delivery Through Communication and Collaboration

• SHIP is dedicated to encouraging all medical professionals to be proactive about sharing the facts about obesity and tobacco and offering ways to encourage healthy living.

• SHIP is dedicated to the idea that early referral and intervention allows for a great number of patients to integrate into “preventative mode” care.

• SHIP encourages health care providers and community leaders to develop a structured and well-organized strategy for communication, create an effective system of referral of patients.

Transforming Health Care Through Collaboration ,Melissa Marshall, ICSI (SHIP Grant)

Minnesota Answer to Health Reform Statewide Health Improvement Program (SHIP)

Example of County Actions: Hennepin Cty MN

• Hennepin County is implementing Health Works, a comprehensive employee wellness strategy at all agencies, departments and worksites of the county government system.

• HealthPartners (the county’s health plan) has supported the initiative by enhancing the co-payment structure to encourage greater participation by employees in health and wellness activities. This intervention aims to reach 7,600 employees, 1,349 insured dependents and 1,060 insured retirees

• The Intellectual and Developmental Disabilities (IDD) Stakeholders group is guiding the development of a Healthy Eating in Communities intervention to change the systems and practices that influence nutrition and physical activity

Confusion Around PPACA Guidelines

Issues we have encountered with Questions on Preventive Care Mandates *

• Some of the preventive care lists require plans to cover over- the-counter drugs or vitamins. After health reform, these items can no longer be excluded from income without a prescription. If a plan participant buys these items without a prescription and receives reimbursement from the health plan, does the plan sponsor need to report imputed income to them?

• Counseling services are among the preventive services required, including tobacco counseling, alcohol misuse counseling, obesity counseling, etc., but it is not clear how this will work, since these are not services typically covered by an employer’s major medical plan.

• First dollar preventive care coverage is required for pediatric dental and vision. It is not clear how these requirements will apply to major medical plans, which do not usually cover such services.

• For some services, it will be difficult to draw a line between preventive (covered without cost share) and treatment (cost sharing may apply).

* Maureen M. Maly, Partner Faegre & Benson Attorney at Law Minneapolis, MN Oct 1,2010-Preventive Care News

• Federal health-care reform pins its hopes on shifting the prevailing model of care from treating end-stage disease (chronic care) to preventive care. (Centers for Disease Control and Prevention, Atlanta, GA)

• Federal government will audit insurance companies to ensure compliance with the medical loss ratio-insurance claims to revenue formula

• Need to use those “new” claim payout ratio dollars to pay for policy holders’ preventive services

• US Taskforce for Preventive Care will assist in driving claims payment dollars to cover preventive wellness services

Employers Need Revenue Stream for Preventive Care

Conclusion

• Employers need to incent employees to education themselves and take action on their health

• Insurance companies need to provide the coverage and dollars for preventive wellness education and care under current plan designs

• Employers need to leverage the effectiveness of consultative programs outside of health contracts for higher participation and better results

Preventive Care-Phase II -2011 Objective

• Research alignment of National Prevention Strategy with Minnesota Department of Health-(SHIP) Essential Benefit Set Recommendations-and other State Health Preventive Service Initiatives - look for compliance and consistency (25 nonfederal presidential advisory steering group new 2011)

• Create an evidence-based claims review of five national insurance carriers for USPSTF compliance to topic :- Counseling for a healthy diet-Investigate criteria requirements, type of referral, form needs, network and certification level of instructor, payment level, frequency, length and measurement for success. Possible technology improvements for collection of data

• Research employer sponsored educational training for diet and exercise in areas of nutrition, healthy eat habits, quality of food supply, balanced eating, exercise and stretching programs offered at and around work location along with link to communities expansion of physical activity areas.

• Research link between community based preventive services with clinical care to private companies wellness initiatives-garner joint participation goals, awareness and objectives -