description
WORKPLACE WELLNESS
Transcript of Wellness Presentation
- 1. From Wellness to Disease Management: Covering the Health
Care Continuum
- 2. Reality Check
- The top three causes of death are heart disease, cancer and
stroke; The leading cause of all three is. A.) High Blood Pressure
B.) Fatigue C.) Obesity
- The director of the Behavioral Medicine Research Center at
Baylor College predicts what percentage of Americans will be
overweight or obese by 2040. A.) 50% B.) 90% C.) 75%
- What percentage of US adults do not engage in any leisure time
physical activity. A.) 40% B.) 25% C.) 60% (Department of Health
and Human Services)
- An American Cancer Society report shows obesity and lack of
physical activity causes how many cancer cases in the United
States? A.) 1/5 B.)1/2 C.) 1/3
- 3. For Every 100 Employees
- 4. 60 are Sedentary
- 5. 25 Smoke
- 6. 64 are Obese/Overweight
- 7. 27 Have Heart Disease
- 8. 10 Have Diabetes
- 9. 50 Have High Cholesterol
- 10. 24 Have High Blood Pressure
- 11. 50 Are Distressed or Depressed
- 12. Small changes, Big Impact
- Reducing one health risk can
-
- Improve productivity by 9%
Reference: Pelletier B, Boles M, Lynch W. ( 2004). Change in health
risks and work productivity over time. J Occup Environ Med.
- 13. Activation!
- Our level of personal activation (Take Chargedness) determines
our behavior, our risks, our likelihood to change, and our medical
costs.
-
-
- Disease specific self-management
- 14. Increased health risk, increased cost Impact of Modifiable
Risk Factors on Medical Expenses Annual adjusted medical expenses
ie. Overweight individuals cost 21% more than those whose weight is
in the healthy range Adapted from Goetzel RZ, Anderson DR, Whitmer
RW, et al, Journal of Occupational and Environmental Medicine (40)
(10) October 1998, 1-12
- 15. Care Management: Every Day Health
- Integration between systems, people, programs
- Lifelong support for members at any health stage
- Simplification for member, employer, physician
- Transformation of health care system
CareEnhance Health Coach Special Beginnings Disease Management Case
Management SUPPORT FOR EVERY DAY HEALTH WELLNESS COACHING SUPPORT
MANAGEMENT
- 16. CareEnhance: Decision Support The difference
betweenwondering what to do and knowing.
- 17. CareEnhance: Decision Support
- 24/7 toll-free phone access to registered nurses
-
- 5 call centers and support for more than 100 languages
- Help knowing when, where (or whether) to seek care
- Library of over 1,100 prerecorded health topics
- Program reminders mailed to members quarterly
- Administered by McKesson Health Solutions
.
- 18. Health Coach: Lifestyle Change The difference
betweeninaction and taking charge.
- 19. Special Beginnings: Healthy Pregnancy The difference
betweenworry and peace of mind.
- 20. Special Beginnings: Healthy Pregnancy
- Nurses provide one-on-one member support
-
- Assess each members risk to determine education and
outreach
-
-
- Members choice of pregnancy book or DVD (Spanish options)
-
-
- What to expect during pregnancy and birth
-
-
- Signs of premature labor and other complications
-
-
- Tailored pregnancy information
-
- 24/7 phone access (CareEnhance after hours)
- Engine rewards for completing program
- 21. Case Management: Advocate, Navigate The difference between
going it alone and having a trusted advisor help you through.
- 22. Case Management: Advocate, Navigate
- Support for serious illness or injury
- One-on-one nurse support based on conditions
-
- Nurses advocate, navigate and coordinate care
- Avert unnecessary expenses ($20 million in 2005)
-
- 1% of members drive 30% of health care costs
Reminder: Case managers can help members understand their
conditions, work with multiple providers and make the most of their
benefits.
- 23. Disease Management: Change the Future The difference
between an existence controlled by your condition and taking
control of your life.
- 24. Disease Management: Change the Future
- Targets diabetes, cardiac, and respiratory conditions
-
- AdviCare packages may cover additional conditions
- Prevent or postpone complications
- Nurses and clinicians offer one-on-one support
-
- Interventions based on members risk level
-
-
- Newsletters, care reminders, phone contact, other outreach
-
- Support treatment plans and improve compliance
-
-
- Improved clinical measures and outcomes
-
- Help members understand and manage their condition(s)
- 25. Disease Management: Change the Future
- Disease management is the difference between...
BEFORE Uncontrolled Diabetic with Non-Healing Wound 3 Office Visits
$ 375 Hospital Admission $25,000 Surgeon Fees $ 6,000 Prosthetic
$12,000 Rehabilitation $24,000 Insulin $ 6,000 TOTAL $73,375 AFTER
Controlled Diabetic 6 Office Visits $ 750 Foot Care $1,100
Dietician $ 300 Physical Therapy $ 500 Insulin $4,500 Pharmacy
Services $ 110 TOTAL $7,260
- 26. Why Regence Disease Management Matters
- 45% of members with chronic conditions do not receive
evidence-based care*
-
- Medications, tests and exams, doctor visits
-
- Improve diet and exercise
- Engaged members make better health care decisions
- Improvements in quality of life may
-
- Reduce absenteeism and presenteeism
-
- Slow cost trends over time
- *Source: McGlynn, et al., New England Journal of Medicine, 2003
.
- 27. Regence Disease Management Basics
-
- Coronary artery disease (CAD)
-
- Congestive heart failure (CHF)
-
- Chronic obstructive pulmonary disease (COPD)
- Prevents or postpones complications
- Supports treatment plans and improves compliance
- Helps members understand and manage their condition
- 28.
- 29. Having A Chronic Illness Is Complicated Only about 20% of
people with health conditions do what they should to maintain good
health
- 30. Physicians Have Challenges, Too
- Health care systems have driven physicians to fix patients, not
maintain their health
-
- Lack of time with patients
-
- Increasing prevalence of chronic conditions
-
- Shift to short term episodes rather than long term health
status.
Our goal is to support the physician with patient behaviors between
office visits
- 31. We Stratify the Population
-
- Individually stratifies the population so we know where to
start
Low Risk High Risk
- 32. We Apply the Right Level of Intervention
- 4 levels of risk stratification
- Program tailored to risk level
- Fluid stratification algorithms (claims, prescriptions,
updates, self report, physician and care calls)
- Interventions based on member specific needs and best practice
guidelines
Level of intervention is based on individual stratification and
risk status of the member
- 33. What do members participating in the program receive?
- AdviCare participants will be offered:
- One-on-one nurse-based counseling
- Support through telephone calls designed to help the member
through coaching and education
- Members talk by phone with a knowledgeable
- One-on-one nurse-based counseling
- Understands the complexities of their conditions
- Can take the time to answer all of their questions
- Has access to a variety of educational materials
- 34. We Address the Whole Person
- Its about people, not the disease
- Understand individual behaviors and help the participant modify
them
- In order to create change you must establish unconditional
credibility and positive intent
- Set goals with the patient that are achievable
All co-morbidities and behaviors must be managed simultaneously by
the same trusted relationship
- 35. We Extend the Physicians Reach
- Expanded interventions between office visits
- Comprehensive health condition protocols (evidence based
standards of care)
- In market nurses supporting practice patterns with tools and
education
A primary goal of our program is to support the physician with
patient behaviors between office visits
- 36. Outcomes Reporting
- Financial semi-annual report reflects pre- versus post program
results
- Clinical Outcomes semi-annual report on members overall
compliance with selected standards of care
- Utilization semi-annual with % change in admissions, length of
stay, ER visits and bed days
- Member Satisfaction - annually
- Activity quarterly report showing members counts and
type/frequency of member contact
- Note: Client level reporting varies based on group size.
- 37. Program Results Health Care Cost for Diabetes Population
Declined During Years 1 and 2 both in Real Terms and when Compared
to Adjusted Base Period Costs Year 1 Trend is 7% Year 2 Trend is
12%
- 38. Diabetes Clinical Indicator Improvement
- 39. Results
- 43,492 Program participants
- 677,940 Educational mailings
- 186,088 Telephonic interventions
Office Visits ALOS (days) ER visits Admissions Bed Days Utilization
Other Professional Pharmacy Outpatient Inpatient Overall Costs 6.56
6.0 263 157 938 $45 $97 $106 $58 $145 $431 Intervention 6.93 5.2
307 206 1,061 $47 $137 $118 $118 $147 $551 No Intervention -5% 13%
-14% -24% -12% -4% -29% -10% -51% -2% -22% % Change
- 40. Member Satisfaction Percent of Members Rating the Program
Good to Excellent Member satisfaction with healthcare increases
steadily so you hear less noise. 78% 89% 78%
- 41. Success Story
- Diagnosed with type 2 diabetes for over a decade.
- During a Welcome Call, she told the AdviCare nurse that upon
receiving her AdviCare diabetes workbook,she read it from "cover to
cover." She stated more than once how pleased she was with it; in
comparing it with others she had read, she found AdviCare's to be
"more readable" and to contain "better dietary information" than
others she had read. She reported that despite her long time
diagnosis, she looked forward to participating in the AdviCare
program.
- 42. Making a Difference in Someones Life
- A member had a history of substance abuse and uncontrolled
diabetes prior to her calls from the AdviCare program. For four
years she had not been having regular laboratory testing or reviews
of her medications. In 2005, the AdviCare nurses sent her workbooks
and encouraged the member to review the standards of care. The
member also set a goal to call member services and find a physician
to help her manage her diabetes. Since then the member has had her
medications reviewed, her annual exams, and A1C testing. She has
continued to remain sober and stated she attributes her current
health with diabetes to the information and support provided by the
AdviCare nurses.
- 43. Thank you for attending
- Jennifer Havlin, BA, BSN, RN