Title: GE Energy Pre Diabetes Intervention A Collaboration with Centers for Disease Control
1GE 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
2Welcome
- Ron Finch, EdD
- Director, Center for Prevention and Health
Services - National Business Group on Health
- David Pratt, MD
- Medical Director, GE Energy
3CDCs New Goal Bridging Public Health and the
Business Community
4Business Values vs Community Health Values
5 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
6Know the Language
- CoCHis
- DDT, CVD
- DNPA, Asthma
- OSH, DRH
- ROI
- Presenteeism
- NBGH
7Community 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.
8Opportunity knocks to open the doors between
business and community health
9CDC Reinvention
- Two Overarching Health Protection Goals
- Health promotion and prevention of disease,
injury, and disability - Preparedness
10CDC Reinvention Six Strategic Imperatives
- Health Impact.
- CDC will be a customer-centric organization.
- Public Health Research.
- Leadership for the nations health system. Global
Health. - Effectiveness and Accountability.
11CDC New Initiatives
- Cooperative agreements
- Multiple divisions working together, sharing
expertise and resources - DDT, CVD, DNPA
- Asthma
- Center for Public and Private Partnerships
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13We Have an Epidemic of Diabetes !
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15Why 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
16Consequences of uncontrolled diabetes
- Loss of productivity
- Increased direct and indirect health care
expenditures - Poorer quality of life for employees
- Possible permanent disability
17Why 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
18Why 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
19Do 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?
20Economic 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
21Strategies for Better Outcomes Examples of
Worksite Programs
- Canadaworksite physical activity classessavings
of 679/person - Coca Cola companyworksite wellness gt500
/year/person x 2500 people - First ChicagoWorksite diabetes education
program-improvement of HbA1c 9.0 to 8.3
22National 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
23NDEP Workgroups
- African American Workgroup
- Latino Hispanic Workgroup
- American Indian Alaska Native
- Diabetes in youth
- Older adults
- PPOD
- Business and Managed Care Workgroup
24NDEP Business and Managed Care workgroup
25Business 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
26NDEP 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
27BMC 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
28NDEP 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
29BMC Workgroup Projects
- Diabetes White Paper Call to action!
- Diabetes Needs Assessment Tool
- Diabetes Worksite Intervention Kit
- Regional partner conferences General
Motors, DFWBGH, Federal Reserve, Lands End
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31Needs 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?
32Diabetesatwork.org Content
- Planning Guide
- Assessment Tool
- Choosing a Health Plan
- Lesson Plans
- Fact Sheets
- Resources
- Frequently Asked Questions (FAQ's)
33Diabetesatwork Content
- General Diabetes Education
- Managing Diabetes Complications
- Cardiovascular Disease
- Emotional Well-Being
- Nutrition, Weight Control, and Physical Activity
- Dealing With Type 1 Diabetes
34Lesson Plans, Lunch Learns
- High and Low Blood Glucose Symptoms and Causes
- Making Your Doctor Visit Count
- Cardiovascular risk factors
- Feet
35Other Topics
- Guide to choosing a health plan, developed with
AAHP - Supervisors guide
- Shift work
- Links to other NDEP sites
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38What 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
39Resources
- National Business Group on Health www.wbgh.com
- WK Kellogg Foundation, The Business Interest in a
Communitys 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
40Resources 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
41Remember
- 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.
42Diabetes Prevention_at_ GE Energy
- Donna Tomlinson, MD MSc
- Health Promotions Manager, GE Energy
- Tiana Howland, RN
- Cardiovascular Disease Prevention Specialist
Health Coach, Community Care Physicians
43GE Energy Risk ManagementOverview
- Cardiovascular Risk Assessment
- CRA input
- CRA output
- Cardiovascular Risk Management
- Energy Health Coach
- Diabetes Prevention _at_ GE Energy
- Sample of program
- Implementation Planning
- Results
44Diabetes Prevention_at_ GE Energy
- Cardiovascular Risk Assessment Input
- 11 questions
- Height, weight, girth
- Blood pressure
- Lipids glucose
45Data 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
46AssessmentTime
- Production time focus
- Customer oriented
- Efficiently
47Cardiovascular Risk Assessment
48Cardiovascular 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
49GE Energy Profile
78 male mean age 42.7 2 CVD 17 metabolic
syndrome
50Percent of Population withMetabolic Syndrome
Risk Factors
51Mean 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/m2) -0.0, p 0.507
- Waist Circumference (cm) -0.1, p 0.412
52Change Between CRA 1 CRA 2
CRA 1 CRA 1 CRA 1 CRA 1
CRA 2 Diabetes ? Diabetes ? Diabetes
CRA 2 ? Diabetes 1,134 5 1,139
CRA 2 ? Diabetes 12 22 34
CRA 2 1,146 27 1,173
Incident diabetes 1.0 Prevalent diabetes
3.0 Cured diabetes ?
CRA 1 CRA 1 CRA 1 CRA 1
CRA 2 Tobacco ? Tobacco ? Tobacco
CRA 2 ? Tobacco 1,047 33 1,080
CRA 2 ? Tobacco 15 78 93
CRA 2 1,062 111 1,173
Net tobacco quit rate at 1.2 years 28.3
53Net 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
54CRA 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
55CRA Follow UpLess Intensive Intervention
- Criteria for Intensive
- Risk gt 10, modifiable
- Risk gt 7.5, LDL med level
- Trigs gt 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
56 57Complications 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
58Six Sigma Care?
- You have got to take an active role in monitoring
measuring your health. - Waiting for the system to help you just wont
work.
- 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
59Counting 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
60Script forInstructor
61Counting 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
62Counting Grams of Saturated Fat
Sausage egg with cheese
2 Hash Browns
Large Coffee w/6 tablespoons cream
Big bacon classic
Biggie Fries (5.6 ounce)
Frosty medium
10 ounce steak
Mashed potatoes
Butter 3 tablespoons
Lettuce
Hidden Valley Dressing 4 tablespoons
1 pint 2 cups Haagen-Dazs
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
63Diabetes and High Blood PressureAre Like Twins
64Create a Blood Pressure Action Plan
- Johns 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
65Create a Blood Pressure Action Plan
- Harrys 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
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67You will learn that our nutrition message is more
than just 5 A Day . . .
68Top 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
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70Diabetes Prevention _at_ 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
71Implementation Planning
Role CRA Diabetes Prevention
Top Management Culture of confidence in Medical director Digitization drive in 2001 Access prototype Largely unnoticed as a separate program
HQ Medical Team Expertise available Software Public Health/CVD Prevention design Implementation Public Health/CVD Prevention Health Coach Experience
Site Nurse Short term intense commitment Commitment of minimum of 10 hours
Site Leaders Most familiar with our product Nurses present case, has not been an obstacle
Major investment from business Most costs are from site nurse and production time
72Planning Upfront, Direct, Simple
Eligible Costs to Business Planning Steps
Group high risk for diabetes. 3 or more metabolic syndrome risk factors No direct expenditure for site Recommend hourly workers participate in the program on the clock for ½ of the program Giveaways provided by GEE Health services without charge Nurse or health educator time to present materials required. Minimal preparation time. View program materials Identify program lead Obtain site approval Approved by On clock/off clock Order sample materials and printed script from Joan. Schedule classes (begin within 30 days of CRA) 1-1 1-2 1-3 1-4 2-1 2-2 3-1 3-2 4-1 4-2 6-1 Prepare invitation (with schedule above) to be distributed at CRA event Identify invite participants to prevention program at the time of the event. Give pre-program survey to all who are eligible for the program.
73Pilot Study Results
74Business 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
75ROI 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
76Developing the ROI
- Identify the populations
- Participants
- Control Group
- Monitor healthcare costs and utilization during
periods of - Pre-intervention
- Intervention
- Post Intervention
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78Costs and Utilization Metrics
- Costs
- Health Plan Claims Data
- Prescription Medication Costs
- Disability Costs Data
- Utilization Data
- Admissions
- ER visits
- Scripts
- Disability Days/Events
79Discussion 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
80Intervention Participation Rate
- Dose Response
- Percent of Activities Attended
- Participant Survey
- Lifestyle changes
- Exercise
- Healthy Diet
- Adherence to Medications
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82Program Costs
83ROI (Cont)
- First Employee only
- Second Employee and family
- Third Participants compared to control group
84Current Status
- Houston, TX pilot
- Continuing to monitor claims data
- Will offer reassessment at 1 year
- Schenectady, NY began 2/15/05
- Minden, NV began 2/28/05
- Greenville, SC on hold for now
- Bangor, ME to begin week of CRA event in June
85Integrating Health Promo Programs With Health Plan
- Lynn Kohrs
- Healthcare Manager,
- GE Energy
86Group 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
87Group 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
88Health 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 1
1 /Active EE 6,850 13,000
89Next Steps
- Continue to implement and evaluate program
- Use data for additional six sigma projects
90Summary
- Goals/Objective
- Public Private Partnerships
- Lessons Learned Strength/Weaknesses
91Open ForumQA