To reduce the risk of cardiovascular disease and diabetes among … mentoring-Nancy... ·...
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E Benefits Council M PL YE O ES Nancy A. Haller, MPH, CHES, Manager, State Wellness Program To reduce the risk of cardiovascular disease and diabetes among Oklahoma state employees. To suspend or decrease the rising costs of healthcare premiums paid by state government. To improve our risk as a group and attract additional health care companies. E Benefits Council M PL YE O ES Use of a scientific web-based interactive program with one-on-one telephone health education mentoring using behavior change techniques. A 12-month comprehensive program that includes: ◦ exercise training, ◦ proper nutrition, ◦ weight management, ◦ stress management, and ◦ smoking cessation. E Benefits Council M PL YE O ES
Transcript of To reduce the risk of cardiovascular disease and diabetes among … mentoring-Nancy... ·...
EBenefits Council
M PL YEO ES
Nancy A. Haller, MPH, CHES, Manager, State Wellness Program
To reduce the risk of cardiovascular disease and diabetes among Oklahoma state employees.
To suspend or decrease the rising costs of healthcare premiums paid by state government.
To improve our risk as a group and attract additional health care companies.
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Use of a scientific web-based interactive program with one-on-one telephone health education mentoring using behavior change techniques.
A 12-month comprehensive program that includes:◦ exercise training, ◦ proper nutrition, ◦ weight management, ◦ stress management, and ◦ smoking cessation.
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Initial Health History Questionnaire (HHQ)
Creation of short and long-term goals
Individualized action plan
One-on-one telephone mentoring
Web-based health educational modules and audios
Ongoing support through e-mail and telephone
Strict tracking adherence
12-week and 1-year follow-up evaluations with physician-based clinical assessments
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Cash incentives offered through state agencies choosing one of the following incentive programs:
Gold $500Silver $300Bronze $100
A waived visit to Primary Care Physician with waived lab work for fasting lipid profile and fasting glucose
Discount to fitness center membership
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Participants are evaluated on clinical effectiveness at baseline, at 12-weeks, and at 1-year.
Participants are referred to their personal physician for:◦ fasting lipid profile ◦ fasting glucose◦ blood pressure ◦ resting pulse rate ◦ height and weight measurements◦ hip and waist measurements
Participants that are directed back to their PCP at 12-weeks and at 1-year incur some costs.
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Participants completing Health History
2983
Average Age (years) 47
Males (%) 18.9
Females (%) 81.1
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African American (%) 11.1
Asian (%) 2.0
Hispanic (%) 2.6
Caucasian (%) 82.0
American Indian (%) 2.5
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15.6 14.9
43.3
22.3
8.5
25.5
80.2
56.7
0
20
40
60
80
100
Elevated Systolic Blood Pressure
Elevated Diastolic Blood
Pressure
Elevated Cholesterol
Elevated LDL Cholesterol
Cigarette Smokers
Elevated Blood Glucose
Overweight Not Exercising
Percen
t
Prevalence at Program Entry
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15.1 14.3
58.9
45.149.8
7.9
43.2
10.3 9.2
43.1
30.4
44.3
7.2
40.9
0
20
40
60
80
100
Elevated Systolic Blood Pressure
Elevated Diastolic Blood Pressure
Elevated Cholesterol
Elevated LDL Cholesterol
Obesity Cigarette Smokers Elevated Blood Glucose
Percen
t
Prevalence at Program Entry Prevalence at Follow‐up Evaluation
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15.514.3
46.4
23.2
47.1
7
25.9
9.3 9
39.4
19.1
41.5
6.1
25.4
0
20
40
60
80
100
Elevated Systolic Blood Pressure
Elevated Diastolic Blood Pressure
Elevated Cholesterol Elevated LDL Cholesterol
Obesity Cigarette Smokers Elevated Blood Glucose
Percent
Prevalence at Program Entry Prevalence at Follow‐up Evaluation
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20.9 18.2
54.4
30.7
60.4
4
36.4
11.1 10.7
35.9
22.2
55.1
3.1
33.2
0
20
40
60
80
100
Elevated Systolic Blood Pressure
Elevated Diastolic Blood Pressure
Elevated Cholesterol
Elevated LDL Cholesterol
Obesity Cigarette Smokers Elevated Blood Glucose
Percent
Prevalence at Program Entry Prevalence at Follow‐up Evaluation
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CVD Risk Factors
Initial 12 Months 2005 2006 2007
Systolic BP (mmHG)
138 118 Medical
Diastolic BP (mmHG)
80 72Annual Plan Paid ($)
7,260.87 284.05 35.55
Cholesterol (mg/dl)
202 160Annual Charge ($)
14,089.85 592.25 496.85
Triglycerides (mg/dl)
118 71 Dr. Visit 9 3 1
Weight (lb) 219 159 Hospitalization 4 0 0
BMI (kg/m2 37.8 27.4 Outpatient 4 3 1
Blood Glucose (mg/dl)
93 85 ER visit 0 0 0
HbA1c (%) Pharmacy
Annual Plan Paid ($)
286.79 181.36 158.22
Annual Charge ($)
2,634.97 1,886.54 745.64
Claims
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CVD Risk Factors
Initial 12 Months 2005 2006 2007
Systolic BP (mmHG)
120 120 Medical
Diastolic BP (mmHG)
80 76Annual Plan Paid ($)
209.00 559.65 1,741.67
Cholesterol (mg/dl)
225 194Annual Charge ($)
285.00 1,049.15 2,995.72
Triglycerides (mg/dl)
103 97 Dr. Visit 2 6 25
Weight (lb) 215 115 Hospitalization 0 0 0
BMI (kg/m2 38.2 20.4 Outpatient 0 0 1
Blood Glucose (mg/dl)
110 111 ER visit 0 0 0
HbA1c (%) 6.3 6.0 Pharmacy
Annual Plan Paid ($)
10.00 15.50 271.36
Annual Charge ($)
19.52 68.60 628.18
Claims
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All Participants Without CHD:◦ Relative risk reduction = 13.0%
Participants Without CHD and baseline 10-Year Risk >10%:◦ Relative risk reduction = 24.8%
Participants Without CHD and baseline 10-Year Risk >20%:◦ Relative risk reduction = 39.1%
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10.7
20.5
48
19.2
1.7
19.2
39.5
33.6
7.20.6
21.4
42.9
28.9
6.50.3
0
20
40
60
80
100
Much Better Somewhat Better About the Same Somewhat Worse Much Worse
Percen
t
Prevalence at Program Entry Prevalence at 12 Week Follow‐up Evaluation Prevalence at 12 Month Follow‐up Evaluation
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Data Sources◦ Benefits Administration System (BAS) for verification of
employee health plan.◦ Medical and pharmacy claims data from largest healthcare
plan (Indemnity plan) for state employees.
Analysis◦ Compare monthly average claims of participants with state
employees.◦ Compare monthly average claims of participants before and
after enrollment in OK Health program.◦ Compare monthly average claims of participants by risk
factors.
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OK Health program participants◦ Active state employees from 1/1/05 – 6/30/07◦ Enrolled in Indemnity Plan from 1/1/05 – 6/30/07◦ Completed 12-months in OK Health program◦ 331 participants were included
State employees◦ Active state employees from 1/1/05 – 6/30/07◦ Enrolled in Indemnity Plan from 1/1/05 – 6/30/07◦ 17,089 state employees were included
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$143
$208
$224
$258
$0
$50
$100
$150
$200
$250
$300
2005 2006/2007
Participants State Employees
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$66
$90
$60
$77
$0
$25
$50
$75
$100
2005 2006/2007
Participants State Employees
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Anti-lipidemic Drugs 15.6% Increase
Anti-hypertensive Drugs 9.0% Increase
Anti-diabetic Drugs 7.0% Decrease
Change in Use of Anti-lipidemic, Antihypertensive and Anti-diabetic Drugs (~12 Months)
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$209
$158
$105$124
$373
$211
$168 $173
$0
$50
$100
$150
$200
$250
$300
$350
$400
A B C D
2005 2006/2007
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$113
$75
$29
$62
$146
$109
$33
$80
$0
$50
$100
$150
$200
A B C D
2005 2006/2007
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Each risk factor increased or decreased was associated with a commensurate change in 1.9% productivity loss over time and estimated to be $950/year/risk changed.OK Health program participants (~12 months; n=1,580):
Productivity-related savings = $32.27/employee/mo
Physical inactivity -363 risksBlood pressure -118 risks BMI -88 risksTotal cholesterol -61 risksCigarette smoking -14 risksTotal -644 risks
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Degreed Professional
Trained and Certified [ACSM and/or CHES]
Continuing Education
Background ranges from RN, Dietitian, Exercise Physiologist, Health Psychologist, or generalist Health Educator
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OK Health participants significantly decreased their cardiovascular risk during one year in the program.
Participants utilized more pharmacy claims due to more appropriate medication use and enhanced compliance.
Savings from medical utilization will need data analysis for greater than two years.
Our goal as a mentor is to help prevent or manage CVD and other chronic diseases.
By partnering with participants in setting goals and integrating healthy lifestyles, participants can achieve optimal health and well-being.
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Our website: www.ebc.state.ok.us/okhealth
Contact: Nancy A. Haller Our phone number:
405 – 232-1190 ext. 120 & 125
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