North Carolina Supplemental Cardiovascular Disease Prevention Project: Design and Objectives

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Diagnosis Chronic Disease

• Prescription Lifestyle Medicine

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We are in a perfect storm
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U.S. Health Care as a Percentage of the GDP
Today 16 of GDP
US Military uses 3.2
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Annual Spending per Capita
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Infant Mortality
2001, General Accounting Office, 2004
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Life Expectancy in the World
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Life Expectancy in the World
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Cost Shifting
Employer Health Benefits 2005 Annual Survey
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Cost Absorbing?
Bureau of Labor Statistics
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U.S. Health Care as a Percentage of the GDP
Today 16 of GDP
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U.S. Health Care as a Percentage of the GDP
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U.S. Health Care as a Percentage of the GDP
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U.S. Health Care as a Percentage of the GDP
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U.S. Health Care as a Percentage of the GDP
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Doctor Day, January 1, 2226
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Health Care Costs for Each Person
Centers for Medicare and Medicaid Services
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Health Care Costs for Each Person
7490
Centers for Medicare and Medicaid Services
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Relative Costs of Poor Health
Health Care Costs
Workers Comp
Absenteeism
Presenteeism
Edington, Burton. A Practical Approach to
Occupational and Environmental Medicine
(McCunney). 140-152. 2003.
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LPT
Presenteeism
Absenteeism

unable to concentrate poor quality of
interpersonal communication the need to repeat a
job work more slowly
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Value of Lost Productivity
Annual Health Care Costs
3 X
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Nobody spends someone else's money as carefully
as he spends his own
Milton Friedman
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A Few Facts About Health Care

• The cost health care will continue to rise
• All health care costs are paid by individuals
• Only 1 goes to population-based prevention
• David Satcher, Surgeon General, April 14, 1999
• Spending on disease vs prevention is 11.51
• National Center for Chronic Disease Prevention
  and Health Promotion, CDC, USDHHS, Unrealized
  prevention opportunities Reducing the health and
  economic burden of chronic disease, March 1997

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Portion of Total Health Care Costs Caused by
Chronic Diseases
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The Bottom Line
Unhealthy behaviors
Health risks
Chronic disease
Health care costs
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Obesity Trends Among U.S. Adults1985
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Obesity Trends Among U.S. Adults1986
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Obesity Trends Among U.S. Adults1987
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Obesity Trends Among U.S. Adults1988
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Obesity Trends Among U.S. Adults1989
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Obesity Trends Among U.S. Adults1990
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Obesity Trends Among U.S. Adults1991
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Obesity Trends Among U.S. Adults1992
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Obesity Trends Among U.S. Adults1993
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Obesity Trends Among U.S. Adults1994
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Obesity Trends Among U.S. Adults1995
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Obesity Trends Among U.S. Adults1996
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Obesity Trends Among U.S. Adults1997
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Obesity Trends Among U.S. Adults1998
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Obesity Trends Among U.S. Adults1999
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Obesity Trends Among U.S. Adults2000
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Obesity Trends Among U.S. Adults2001
No Data lt10 1014
1519 2024
25
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Obesity Trends Among U.S. Adults2002
(BMI ?30, or 30 lbs overweight for 54 person)
No Data lt10 1014
1519 2024
25
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Obesity Trends Among U.S. Adults2003
No Data lt10 1014
1519 2024
25
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Obesity Trends Among U.S. Adults2004
No Data lt10 1014
1519 2024
25
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Obesity Trends Among U.S. Adults2005
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Obesity Trends Among U.S. Adults2006
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Percent of adults who are overweight or obese
67
2/3 of adults are overweight or obese
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Percent of adults who are overweight or obese
81
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Excess Body Weight and Reduction of Lifespan
-3.1
-3.3
-5.8
-7.1
Ann Intern Med. 200313824-32
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Health Care Costs and Obesity

• 9.1
• of health care costs are due to excessive weight

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Diabetes Among Adults in the U.S.,BRFSS 1990
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Diabetes Among Adults in the U.S.,BRFSS 1992

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Diabetes Among Adults in the U.S.,BRFSS 1994
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Diabetes Among Adults in the U.S.,BRFSS 1996
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Diabetes Among Adults in the U.S.,BRFSS 1997
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Diabetes Among Adults in the U.S.,BRFSS 1998
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Diabetes Among Adults in the U.S.,BRFSS 1999
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Diabetes Among Adults in the U.S.,BRFSS 2000
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Diabetes Among Adults in the U.S.,BRFSS 2001
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Diabetes and Reduction in Lifespan
-14.3 yrs
-11.6 yrs
JAMA 20032901884-1890
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Lifetime Risk of Diabetes for Children Born in
2000
49
Venkat Narayan, JAMA 20032901884
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Percent of Chronic Diseases That Are Caused by
Poor Lifestyle
91
82
71
70
Sources Stampfer, 2000 Platz, 2000 Hu, 2001
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Why Should We Care?
Morbidity
Lifespan in years
76
0
critical illness
Ann Intern Med, 2003139455-459
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Morbidity
Lifespan in years
0
?
76
86
critical illness
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End of Life Benefits
Morbidity
Lifespan in years
10-20 Years
Morbidity
Lifespan in years
70
End of Life Benefits
Morbidity
Lifespan in years
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End of Life Benefits
Morbidity
Lifespan in years
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End of Life Benefits
Morbidity
Lifespan in years
76
End of Life Benefits
Morbidity
Lifespan in years
77
What happened?
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5-a-day 1 million
Food Marketing 25 Billion
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Texas Double Whopper
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16 oz
32 oz
44 oz
52 oz
64 oz
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Somewhere in Florida
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Why should an employer care?
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1,500-3,500 in Excess Claims for Each
Additional Health Risk
Source Dee Edington, Health Management Research
Center
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Average 2003 Medical Care Costs
N1,706
Source StayWell Health Management
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Average 1997-1999 Medical Care Costs
N43,687
Source StayWell Health Management
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Days Absent in 2003
N941
Source StayWell Health Management
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Percent with Workers Comp Claims in 2003
N23,916
Source StayWell Health Management
100
Percent with STD Claims in 2004
N23,916
Source StayWell Health Management
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Return on Investment (ROI)
32 studies
14 studies
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The Bottom Line
Unhealthy behaviors
Health risks
Chronic disease
Health care costs
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Employee Population Health Management
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Employee Population Health Management
105
Well
Risk
Urgent
Disease
106
Well
Risk
Urgent
Disease
25
107
Well
Risk
Urgent
Disease
108
Well
Risk
Disease
Urgent
5
109
Well
Risk
Urgent
Disease
110
Well
Risk
Urgent
Disease
60
111
Well
Risk
Urgent
Disease
112
Well
Risk
Urgent
Disease
10
113
Well
Risk
Urgent
Disease
10
60
5
25
Top 15 of employees with disease 85 of costs
The rest 15 of costs
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Well
Risk
Urgent
Disease
115
Disease
25
59 Turnover
116
Disease
25
117
Urgent
5
118
Risk
60
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Well
10
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Who Needs Help Adopting and Maintaining Healthy
Behaviors?
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Who Needs Help Adopting and Maintaining Healthy
Behaviors?
100
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Effective Wellness Programs

• Awareness/education
• Motivation
• Tools, strategies
• Policy and environment

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Fairview Health Services
-13
-2
15
N3,577
Source StayWell Health Management
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Total Employee Costs
128
www.wellsteps.com