PREVENTING COSTS & CHANGING LIVESNational Diabetes Prevention Program

(NDPP)

Maine Diabetes Prevention and Control Program (DPCP)

Division of Population Health October 2014

Panelist

Nathan Morse, CHES, TTS-C, Maine CDC, Diabetes and Control Program Coordinator - Moderator

Health System: MaineGeneralBarbara A. Crowley, MD, VP, MaineGeneral HealthLaura Holweger, CHES, Program Mgr., Prevention CenterMichelle Aldrich, RN, MaineGeneral Health

Employers:Susan Tufts, Manager of Occupational Health & Wellness, L.L. Bean, Inc.

Anthony Anderson, Fit for Life Program Manager, General Dynamics – Bath Iron Works

Learning Objectives

• Learners will understand the principals/fidelity standards of the NDPP and how to scale and apply it in Health Systems, Employer settings, and Health Plan design such as ACO/VBID.

• Learners will at the conclusion of the session understand how to apply NDPP in care settings as a population health management strategy.

• Learners can demonstrate knowledge base of NDPP and take next steps within their respective Healthy System/Community/Employer/Payer settings to apply this evidence based lifestyle intervention program to their scope of practice and health plan coverage.

29 million with Diabetes

86 millionwith Prediabetes

NDPP Overview

• If you do have prediabetes, research shows that doing just two things can help you prevent or delay type 2 diabetes: Lose 5% to 7% of your body weight, which would be 10 to 14 pounds for a 200-pound person; and get at least 150 minutes each week of physical activity.

• 16 Core; 6 Post-Core; high touch, group support, facilitated by Certified NDPP Lifestyle Coach

WHAT WERE THE DPP STUDY FINDINGS?

Lifestyle - total Lifestyle - 60+ Metformin0

10

20

30

40

50

60

70

80

90

100

58%71%

31%

• Lifestyle intervention sharply reduced the chances of developing type 2 diabetes (58%)• 71% for aged 60+

• Metformin group reduced their risk but not as much as the lifestyle intervention group (31%)

Reduced chance of developing

diabetes

New England Journal of Medicine, 2002

Source: CDC DPRP Program Data as of 3/19/2013

Our Maine Goal for NDPP

• Sustainability: Multi Payer approach to coverage of NDPP.

• Innovative payment models: VBID, ACO, Population Health approach…

• Community, Provider, Worksites communications that inform and support this evidence based approach to prevent/delay Type 2 diabetes.

• Continue to provide high quality TA for NDPP deployment/sustainability.

National Diabetes Prevention Program in Clinical and Community settings

Why?

90,000 patients in the greater Kennebec and Somerset county are at risk >60% of the population

Prevent disease burden and prevalence Reduce overall cost of care associated with Diabetes

Project Set Up

Single leader of project funded through grant

Centralized HUB Report creation to identify in EMR who is

at risk or diagnosed with pre-diabetes Meetings with leadership at the practice Key stakeholders - community and

clinical One key contact

Statistics From the CTG 2 Year Project

88.6% completion rate for 16 week core class• 67 trained Lifestyle Coaches• 60 programs provided to date• 9 programs associated with practices

Bonnie Tracy, volunteer Lifestyle CoachNDPP class at Hathaway

All

Over

Th

e M

ap

Assessment of Population

Readiness for change assessment by Psychologist

Contact from the practice to initiate conversation

Algorithm Referral coming from practice Team based approach Education from all team members Huddles Second approach – MA calls

Clinical Support

• Improved patient outcomes• Patient engagement• Extension of the practice• EEHR reports

Provider Success StoryI have a stack of risk assessment screening cards in every exam room and read through the risk assessment with all of my patients. I tell them about success from my other patients who have completed the program, it seems to motivate them to take action and register.

I love when patients come to their appointment with improved numbers, they typically comment: “I can’t believe this works, I have tried everything in the book, I’m impressed with the program results!”

I am thankful we have this valuable program to refer patients free of charge, also, there are so many programs starting each month in various communities. Both help diffuse barriers for our patients to take advantage of this wonderful program.

Catherine Nielsen, MD Oakland Family Medicine

Peer Coaches and Success Stories

“ My PCP referred me to NDPP because I was pre diabetic, I completed the

program with great success and LOVED IT! I wanted to give back to my community, help

others and keep myself accountable. NDPP

Master Trainer, Laura trained me to deliver the program, I am working

on delivering my second program as a volunteer & love every minute of it!”

Dorothy Turner, volunteer Lifestyle Coach demonstrating her groups weekly weight

loss goal

Success Stories“ I have found the program to be life changing and helpful. It has greatly helped me to change my lifestyle an adapt to new ways of improving my health and fitness. In making these

changes I now have an understanding of how to make wiser decisions and how to control my portions. I plan to

continue with the new lifestyle changes I have made to continue

being successful.”

Success Stories“I lost 18 lbs. and my blood sugars are down below 100. Now I eat

properly and feel great!”

“I am very pleased with my 42lb weight

loss.”

Social Determinants of Health

Implementing the Framework

Healthy

Chronic

AcutePost-Acute & LTC

End of Life

Anchored on Primary Care

Outpatient Diagnostics &

Surgery

Specialty Care - Outpatient

Acute Care - ED &

Inpatient

Home Health & Hospice

Reimbursement Methodology:

Incentivize Efficiency and Reward Quality

Medicare

Self-Insured

Commercial

Medicaid

Fully Insured

Commercial

Self-Pay

KENNEBEC REGION HEALTH ALLIANCE

Principles

PCMH 2.0 System approach Long term investment MUST have a program leader to work

with practices and community Train the trainer Project time > 2 years to see full

potential

Incorporating Diabetes Prevention into L.L.Bean’s Wellness Efforts

Maine Health Management Coalition

Fall Symposium

October 15, 2014

L.L.Bean - Corporate Information

• 5,000 year round employees (10,000 employees during peak)

• Self-insured

• 30,000,000 annual

health costs

• 2,000,000 workers compensation costs

• Average Age 50

• 66% Female

Employee Wellness at L.L.Bean

A business is in a unique and responsible position to effectively enhance the well-being

of its employees”

- Leon Gorman, 1982

We believe healthy people lead fuller, more productive lives. Our employees and

other stakeholders should feel their association with L.L.Bean contributes to their

health and well-being.

Safe & Healthy Living Core Value

Wellness Program Offerings

• Onsite Fitness Centers

• Health Education Classes

• Activity Classes

• Comprehensive HRA Program

• Tobacco Free Campuses

• Healthy Foods in

Cafeteria and Vending

• Employee Outdoor Club

• Employee Assistance Program

Health RiskLLBean

2013LLBean

2010Benchmark

AverageC.S. N'port C.S. Peck C.S. Bangor C.S. Home OFC Returns Mfg. Facilities

Finance / Security

HR/HSW IS Office Areas Stores

Total Participants 3,756 3,530 1.2 / 1.7 M 302 214 84 182 536 192 262 141 119 115 341 559 648

Average Age 51 49 47 / 43 55 54 54 54 51 53 50 52 50 52 50 47 49

Smoking 5.9 7.3 7.7 5.3 7 2.4 8.1 9.5 8.9 12.4 6.5 8.3 2.5 2.9 3.1 2.8

Tobacco Use 7.1 8.5 9.5 6 8 2.4 9.1 11.2 10.5 13.9 9.4 9.1 2.5 4.3 4 3.4

Hypertension (> or = 140/90)

6.6 21.8 13.2 9.9 9.8 7.1 11.5 7.8 8.3 3.8 8.5 5 8.7 6.8 2.5 4.8

Pre-Hypertension (120/80-139/89) 52.7 51.6 47.1 51.7 51.9 71.4 58.8 56.3 52.1 61.5 56 51.3 47.8 47.8 47.1 51.7

Cholesterol (> or = 240)

13.1 11.3 8.7 12.3 16 12.2 13.2 13.8 12.1 13.1 13.5 17.8 13.9 10.3 11.9 12.8

Cholesterol (200 - 239)

34.1 30.9 27 34.8 35.2 25.6 33.5 32.1 36.3 35.5 34 28.8 34.8 35.1 35.2 32.7

LDL (> or = 160)

8.7 7.1 6.7 8 11.3 11 6.6 10 6.9 10.8 10.6 8.5 9.6 7.1 6.6 9.3

Obese BMI > 30

34.9 34.5 33.5 42.3 48.1 66.6 47.3 36.9 42.2 45.4 37.6 26.9 31.3 28.4 19.7 30.5

Overweight BMI 25 - 30

34.7 35.7 34.9 30.4 29.9 17.9 31.3 37.1 32.3 31.7 39.7 34.5 37.4 40.2 36.7 36.6

Ideal Weight BMI < 25

30.3 29.8 31.4 27.4 22 15.5 21.4 26 25.5 22.9 22.7 38.7 31.3 31.4 43.7 32.9

Exercise (< 90 min./wk)

21.9 22.1 31.7 23.3 28.4 36.5 24.7 23.8 28.4 27.8 21.7 24 18.5 16.2 13.8 20.3

Glucose > 125 (Diabetic)

5.8 4.6 5.2 8.9 4.7 11 10.4 6.8 7.4 6.6 8.5 5.9 3.5 5 2.7 3.3

Glucose 100 - 125 (Impaired) 19.2 15.7 19 19.9 19.7 22 16.5 23.6 27.9 22.8 16.3 23.7 18.3 15.9 13.5 18.4

A1C > or = 6.5 5.8 na 5.6 8.9 7.5 7.3 9.3 7.9 7.9 7 8.5 5.1 2.6 5.6 2.7 3.3

Emotional Health 12.1 12.2 17.6 11.6 10.9 21.2 16.1 12.8 12.6 20.1 4.3 8.3 12.6 9 8.1 11.8

Stress 37.4 43.8 48.9 37.5 40.8 58.8 42.5 37.5 35.3 47.1 31.2 35.5 34.5 33.8 29.5 38.1

Alcohol 4.6 4.9 3.6 3.7 7 1.2 3.2 5.7 4.7 7.7 5.8 0 4.2 4.9 2.9 4.9

Above company average Highest risk in the company2013 Company Average 2010 Company Average

Healthy Lifestyles - 2013 Corporate ResultsL.L.Bean – Area Health Risks

Diabetes Prevention Program

• CDC-DPP

• BIW

• Training

• BIW-L.L.Bean class

• Bangor class

Class Structure

 

• Instructors

• Number of Participants

• Class process

• Lessons

• Learnings

Results BIW/L.L.Bean

1 2 3 4 5 6 7 8 9 10 11 120

5

10

15

20

25

30

35

Pounds Lost/Participant

1 2 3 4 5 6 7 8 9 10 11 120%

2%

4%

6%

8%

10%

12%

14%

16%

% Weight Loss

• 11 participants completed program

• Average pounds lost – 13

• Average % weight lost – 7%

Results - Bangor

 

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 160

5

10

15

20

25

30

35

Pounds Lost/Participant

• 15 participants completed program

• Average pounds lost – 12.4

• Average % weight lost – 3.6%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

-2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

% Weight Lost

Key Learnings

• Program pace

• Participant involvement

• Maintaining the integrity of the program

• Making it your own

• Realistic Results

 

Next Steps

 • Continue pilot effort

• Continue data assessment

• Integrate with Healthy Lifestyles HRA program, Actions/Outcomes

• Clinic referrals

• Explore opportunities to reach home agents

Questions?

Susan TuftsEmployee Health & Wellness Manager

L.L.Bean, Inc.207-552-4538

stufts@llbean.com

Bath Iron Works National Diabetes Prevention Program

Anthony Anderson, Fit for Life Program Manager

Version 9/19/2014

39

55% of BIW employees screened are at risk for developing diabetes within four years.

40

Diabetic patients account for almost 3x the cost and 2x the absences of non-diabetics

Diabetes had the highest total direct costs (medical, pharmacy and short term disability) of any other condition in 2013

In 2013, diabetes was the #1 driver of Pharmacy costs, at over twice the costs of the #2 condition

2013 Average Cost Days Absent (for employees)

Diabetic Patient $14,222 15 days/ year

All BIW employees $4,761 8.7 days/ year

41

Building Community Partnerships

Fall 201

3

• BIW and L.L.Bean met to discuss a potential partnership.

Winter 201

3

• BIW and L.L.Bean offered a NDPP coach training hosted by L.L.Bean.

Spring 201

4

• Joint BIW and L.L.Bean NDPP program began for employees and spouses.

Fall 201

4

• Completed 16 core classes• Participants averaged 7% weight loss

42

NDPP Goals for BIW

2014 Goal to begin 4 classes by end of year Shared Vision with community partners

Mid Coast Medical Group Martin’s Point Bath Area YMCA L.L.Bean MaineGeneral Medical Center

43

44

Bath Iron Works and L.L.Bean NDPP Class

Discussion

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hiring or employment practices. This notice is provided as required by Title II of the Americans with Disabilities Act of 1990 and in accordance with the Civil Rights Act of 1964 as amended, Section 504 of the Rehabilitation Act of 1973, as amended, the Age

Discrimination Act of 1975, Title IX of the Education Amendments of 1972 and the Maine Human Rights Act and Executive Order Regarding State of Maine Contracts for Services. Questions, concerns, complaints or requests for additional information regarding

the ADA may be forwarded to DHHS’ ADA Compliance/EEO Coordinators, 11 State House Station – 221 State Street, Augusta, Maine 04333, 207-287-4289 (V), 207-287-3488 (V), TTY users call Maine relay 711. Individuals who need auxiliary aids for

effective communication in program and services of DHHS are invited to make their needs and preferences known to the ADA Compliance/EEO Coordinators. This notice is available in alternate formats, upon request.

Thank you