Evidence-based Health Management

Tools, Resources, and Effective Models

http://HealthPromoSolutions.com/

Agenda• Introduction and Background • Health Management & Wellness Best Practices• Evidence-based Health Assessment Tools • Measuring ROI on Wellness Initiatives• Overcoming Challenges for hard to reach populations• Health Management in new venues

– Convenient Care Clinics– Medical Fitness Centers

• Community Wellness Models• Employee Remote Healthcare Delivery and DM

Health Promotion Solutions

Provides health care organizations with consulting, project management and evidence – based solutions that support risk reduction, disease management and health outcomes .

HPS Client List• Government – HHS Region II, III, V

– Consultant – Building Healthier Communities

• Retail – CVS / Minute Clinic, Kroger / Little Clinic, Walgreens / Take Care Clinics , Walmart clinics

• Employers – CBS, Covenant Trucking, FedEx JBS, Trucking, McDonald’s, Norfolk Southern, Tenaska Power

• Non Profit –, American Diabetes Association, Shaping Americas Health, Healthy Trucking Association

• Hospital Systems – Tallahassee Memorial, Einstein • Academic Institutions – New York University, U of Penn• For more info, visit http://HealthPromoSolutions.com/

Best Practices – Worksite Chronic Disease Management Programs

1. Culture of Health – Environment where health is the norm

2. Biometric Testing– Point of care ; real time feedback

3. Validated Assessment Tools – Risk, Nutrition, Activity

4. Incentives – participation and engagement for one full year

5. Teams – Team competition within employer

6. Coaching – Individual therapy and behavioral change session

7. Credential staff – Registered Dieticians, Health coaches, Pharmacists, Nurse Practitioners

Health Promotion Solutions Consulting

Team of Leading Experts with extensive backgrounds in : – Strategy Development– Employee Communications– Biometric Screening– Behavior Change / Health Coaching– Employer Benefit Design– Nutrition – Fitness Center Management – Outcomes Measurements– Claims Modeling– Telemedicine

Point of Care Cholesterol Testing

•Less than 2 minutes for results•Good accuracy - NCEP •No refrigeration of test strips•Full lipid profile and glucose•Export data into EMR system• Opportunity for counseling

Health Risk Assessments

Risk Factor Framingham Predictive Risk Models

Age / gender x x

Total cholesterol x x

High Density Lipoprotein x x

Smoking x x

Diabetes x x

Blood Pressure x x

hscRP x

Prior CHD x

Prior Stroke x

Family History x

Aspirin use x

HRT x

BMI x

Exercise x

Comparison of Predictive Models and HRAs Framingham Risk

Zhou A, Hu N, Hu G, et al. Synthesis Analysis of Regression Models with a Continuous Outcome, Collection of Biostatistics Research Archive. December 26, 2008.

Individual Report Risk of Onset, Modifiable Risk and

Risk Comparison for a 57yo female participant

Risk Factors with the Most Impact to Reduce Disease Risk

By modifying just this one risk factor such as weight this individual would decrease her risk of onset for several conditions significantly.

Weight

Aggregate Financial Report Predictive Risk Tool Data

DiseasePredicted Total Cost

PredictedExcess Cost

Type 2 Diabetes $12,819,993 $10,475,149

Coronary Heart Disease $7,487,243 $5,078,151

Stroke $5,556,468 $3,894,488

Heart Failure $1,424,963 $426,782

COPD $1,747,442 $681,885

Lung Cancer $2,214,926 $1,173,156

All Diseases $31,251,035 $21,729,611

Study population of 12,575 participants

Baseline Post Intervention Inches/lbs Lost Average Per Participant

Waist (inches) 86,525 82,437 4,088 1.8

Weight (lbs) 425,358 408,326 17,033 7.5

Baseline Post Intervention Difference % of Change

Type 2 Diabetes 80.5 54.6 -25.9 -32%

Coronary Heart Disease 47.3 39.1 -8.2 -17%

Stroke 28.9 21.2 -7.7 -27%

Baseline Post Intervention Difference Per Participant**

Type 2 Diabetes $2,001,277 $1,358,214 $643,064 $283

Coronary Heart Disease $1,156,871 $954,529 $202,343 $89

Stroke $814,508 $597,117 $217,390 $96

All Diseases $3,972,656 $2,909,860 $1,062,796 $468

Pre-Post Intervention Comparison of 2271 Participants

Know Your Number® Predicted New Cases of Disease

* Formula used to calculate probable cost is: probability of disease onset (KYN) x 2.5 years x annual cost of disease** Cost avoidance per participant

The annual cost for type 2 diabetes is $9,943; coronary heart disease is $9,775; stroke is $11,293; and congestive heart failure is $6,566 per patient year.

Associated Costs* for New Cases of Disease

Validated Nutrition Assessment: VioScreen

•USDA developed tool used in research •Creates personalized 90 day dietary profile •Used with RDs and health coaches

• VioScreen Usability & Validation Study - Ohio State University

Demographics: 40 Females, 42 Males; African-American, White, Asian Demonstrated significantly better tool than any currently on market Age 33 (18-29); 30 (30-49); 19 (50-70)

• 93% rated VioScreen as either great or excellent• 100% thought the VioScreen was easy to use• 75% judge the length of time was about right (2 actually said too

short)• 95% agreed that the food pictures helped in selecting portion

sizes• 95% agreed that VioScreen included the foods usually

consumed

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Nutrition Education and Engagement

• Suggests foods to overcome identified dietary deficiencies

• Guidance to achieve a healthy diet not just weight control

• BMI, EER, Energy Requirements• Repeat after intervention to

measure change

Personalized Nutrition Plans

Employer Benefit Design for Nutrition RD Reimbursement

Texas Instruments Eligible diagnoses for Professional Nutrition Therapy (PNT)

1) All conditions that can be assisted by Certified Dietician

2) Obesity (BMI = 30)

3) Overweight (BMI = 25 – 29.9) with 2 or more risk factors

Criteria • 4 visits/year per eligible diagnosis• Billing over 200 ICD9 codes • Co-insurance and deductible apply• MD referral, professional referral, or self-referral• 9,200 received one on one counseling over seven years

Internal Data Professional Nutrition Therapists

Online physical activity assessment (IPAQ) calculations based on the Dietary Reference Intake (DRI) Estimated Energy Requirements (EER) . Omron Pedometer which can be used for tracking incentives and team competition.

Validated Activity Assessment Tools

BARRIER ASSESSMENT / BEHAVIOR CHANGE

HEALTH COACHING TOOLS

• Identifies 147 barriers to dietary and physical activity behavior change

• Delivers configurable and localized strategies to overcome barriers

• Developed with Dr. Katz at Yale University

Health Promotion Solutions Web-portal

SHORTCUTS TO WELLNESS

1 2 3 4

Programs & Events

Incentive Management

Wellness Toolbox

Fitness & Nutrition

Health Risk Assessments

WELLTREK

Health Metrics

Work Week Meal Plans

VIDEO ON DEMAND

Co. Specific Wellness Links

United HealthCare Seminars

EAP Services

Obesity in America

Welcome, Pam!

Same color as menus (company specific) or keep as black… thoughts??

Company specific links

Company specific videos

Company specific slideshow. Ability to upload 3-4 images on rotating timer.

Wellness Challenges

Professional Staffing and Education

1) Professional Staffing • RDs -Professional Nutrition Therapists• Health Coaches – Behavior Change• Tobacco Treatment Specialists• Certified Diabetes Educators

2) Professional Education• Health Coaching Certification

Health Coaching Clinical Model

• Traditional health promotion not working very well – “PEPM model” Poor engagement rates

• Recognizes the individual as the “real change agent” in self-management, not as an “information receptacle”.

• It improves outcomes

• Payer demand for ROI and credentialing

Why has Health Coaching Emerged?

Health Station / Biometric Kiosk

•Blood Pressure•BMI•Risk Assessment•Web portal •Incentives •Data port•Lifestyle Coaching•Flexible Platform

EVOLVED

Health Station TM

Blood Pressure Kiosk

Internal data Wellness Press

Team Based Competition – Health First Case Study BMW – North America

• Pre Body Mass Index: 73% overweight or

obese:27% Normal weight43% Overweight30% Obese • 92% met completion criteria

• • 38% dropped to a lower BP classification• 49% dropped LDL avg 15%• 42% dropped Total Cholesterol avg 9%• 44 increased HDL avg 7 points• 4 of 7 smokers quit, 2 reduced • Weight 0.6-pound/person/wk

Employee Wellness & Chronic Disease Challenges

Chronic Disease Management Challenges In Trucking Industry

• Overweight /Obesity – 71%• Smoking -53%• Blood Pressure 82%• Diabetes 35% (undiagnosed and at risk)• Over 70% do not have primary care MD• No central location for effective Health Promotion• 3.2 Million long haul drivers • Fleets contract with Occ. Health Clinics for DOT exams• Government regulations on biometrics and drivers health

Small health care facilities located in high-traffic retail outlets with pharmacies

Usually staffed by nurse practitioners or physician assistants, with local physician collaboration

All use EMR and work with referring physicians and hospitals

Ownership includes retailers, health systems, corporations – Largest growth Hospitals

What Are Convenient Care Clinics

Convenient Care Clinic

Convenient Care Clinics - Quality

99.15% of convenient care clinic providers adhered appropriately to diagnostic and treatment guidelines for acute pharyngitis (Woodburn et al., 2007).

Quality scores and rates of preventive care offered are similar for convenient care clinics as for other delivery settings (Mehrotra et al., 2009).

All clinics are either certified or accredited by a third party

Retail and Lab Vouchers

HealthSpot Telemedicine Station

The Care4 Station Patient Device UsageHigh Definition Derma scope

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Videoconference Appointment

L

Pulse Oximeter Otoscope

Stethoscope Dermascope

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Clinician Portal

Displays patient summary

Device control Image capture Dictation E-prescriptions

and EMR integration in development

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Discussion