Transcript Slide 1

Best Health, Best Value:
Why Wellness Makes Sense
2009 State Agency Wellness Conference
Moving Agencies into Action
Eduardo Sanchez, MD,MPH,FAAFP
Vice President and Chief Medical Officer
Blue Cross and Blue Shield of Texas
October 12, 2009
Our mission is to
promote the health and wellness of our members and
communities through accessible, cost-effective, quality health care.
The most trusted brand in health care.
2
Health
A state of complete physical, mental,
social, and spiritual well-being
3
The Healthcare Spectrum Today
Understanding the Impact and Opportunity
Population Distribution
Healthy
At Risk
Acute
Conditions
Chronic
Conditions
Severe Illness and
Complex Disease /
End-of-Life Care
Healthcare Cost Distribution
4
4
Causes of Death, United States 2005
26.6%
Diseases of the heart
All cancers
22.8%
5.9%
Stroke
Chronic lower respiratory disease
5.3%
Unintentional injuries
4.8%
Diabetes mellitus
3.1%
Alzheimer’s disease
2.9%
Influenza and pneumonia
1.8%
Septicemia
1.4%
0%
9%
18%
27%
36%
Source: cdc.gov
5
The Preventable Causes of Death in the United States: Comparative
Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors
(Danaei,2009)
Deaths attributable to individual risk (thousands) in both sexes
6
What Drives Health Status and Health
Care Costs?
How Can We Encourage and Support Behavior Change?
Source: IFTF and Center for Disease Control and Prevention, Health and Healthcare 2010, January 2000
7
How Can We Encourage and Support
Behavior Change?
Environmental
and Policy Change
Personal
Responsibility
• Incentives
• Disincentives
8
Bending the Cost Curve:
A Critical Component of Health Reform
(JAMA, 9/16/09)
• Really bending the cost curve will take:
• Prevention, patient behavior change, and community changes
• Changes in hospital and physician behavior
• Accountable Care Organizations (ACOs)
• Primary Care Medical Home
• Comparative effectiveness – medical policy
• Reduction of waste, fraud, and abuse
• High performing clinicians, hospitals, and health plans
9
Cost of obesity
Medical costs related to obesity in America in 2008 may be as high
as $147
billion (Finkelstein, et al, Health Affairs on line, 2009).
Average annual medical costs
• Healthy weight
$3400
• Obese
$4900
(CDC.gov)
10
Improving Consumer Health:
Burden of Disease
Diagnosed Diabetes
Prevalence of Diabetes
60
16
13.6
14.3
15.2
16.3
16.8
50
Number per 1,000
population
Millions of People in
the U.S.
20
12
8
4
49
49
52
54
57
40
30
20
10
0
0
2002
2003
2004
2005
2006
2002 2003 2004 2005 2006
Note: Data on prevalence of diabetes is age adjusted.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics (2008) National Health Interview Survey (NHIS)
11
290104
Trends and projections
• The number of obese Texans will triple without prevention
efforts, study says
• More than one-fifth of young adults ages 18 to 25 were obese in
2007 – up from 10 percent in 2000
• “If people in their 20s are already overweight, as we go forward and
that [age group] ages into their 30s and 40s, the future obesity problem
in Texas can be staggering,” said Eschbach, a demography professor
at the University of Texas-San Antonio.
Dallas Morning News
12
Obesity in US Adults, by Race/Ethnicity
(Ogden, et al, JAMA, 4/5/06)
Whites
30%
Blacks
45%
Mexican-Americans
37%
14
U.S. Childhood Obesity Epidemic Trends
20
17
12
10
11
7
5
5
16
11
7
4
5
4
6
5
0
2-5y
1963-1970 NHES
1988-1994 NHANES III
6-11y
12-19y
1971-1974 NHANES I
1999-2004 NHANES
1976-1980 NHANES II
Obesity prevalence in U.S. children and adolescents by age and time frame, 1963-2004
(IOM)
I
O
15
2007 National Diabetes Facts
Race and ethnic differences in prevalence of diagnosed diabetes
• 6.6% of non-Hispanic whites
• 7.5% of Asian Americans
• 10.4% of Hispanics
• 8.2% for Cubans
• 11.9% for Mexican-Americans
• 12.6% for Puerto Ricans
• 11.8% of non-Hispanic blacks
CDC government
16
Latest Numbers
40%
More than
of American adults aged
20 years and older have hyperglycemic
conditions – prediabetes or diabetes.
Dallas Morning News
17
Metabolic Syndrome:
A Public Health Problem
• Approximately 50 million adults (25%) in the United States have
Metabolic Syndrome.
• Metabolic Syndrome is defined as a clustering of risk factors that
increase your chances for developing heart disease, diabetes
and/or stroke.
1)
2)
3)
4)
5)
high triglyceride level,
low high-density lipoprotein (HDL) cholesterol level,
high fasting blood glucose level,
presence of central obesity (waist circumference), and
high blood pressure.
• The more risk factors, the greater chance to develop heart disease,
diabetes or stroke. Research shows that a person with Metabolic
Syndrome is twice as likely to develop heart disease and five times as
likely to develop diabetes as someone without Metabolic Syndrome.
18
Environmental Change and Metabolic Syndrome
3X
2X
+527 kcal/day
3X
2.5 million years
Obesity Rare
1950s
2007
200 million overweight
Metabolic Syndrome
50 million patients
19
19
The Progression of Metabolic Syndrome
Controllable Causes
• Poor Diet
• Inactivity
• Stress
• Aging
• Genetics
Uncontrollable Causes
Metabolic Syndrome
Indications
•
•
•
•
Abdominal Obesity
High Triglycerides
Low HDL Cholesterol
Elevated Blood
Pressure
• Glucose
Intolerance
Complications
Severe Conditions / Events
• Hypertension
• Heart Attack
• Coronary Artery Disease
• Heart Failure
• Diabetes
• Aortic Aneurysm
• Vascular Disease
• Stroke
• High Cholesterol
• Kidney Failure
• Osteoarthritis
• Vision Loss
• Overweight / Obesity
• Nerve Damage/
• Sleep Apnea
Amputation
• GERD
• Cancer
• Intraocular Pressure
• Knee & Hip Replacement
• Chronic Liver Disease
• Liver Failure
Poor Work Performance
Disability
Left untreated, Metabolic Syndrome can be a contributing cause or aggravating
factor in a host of conditions that limit or disable the individual and negatively impact
their productivity and quality of life.
20
Clinical and Economic Risks of
Metabolic Syndrome
Working-age individuals with Metabolic Syndrome
had significantly higher medical costs
compared to those without Metabolic Syndrome:
• With Metabolic Syndrome: $626 per member
per month (PMPM)
* Source: Metabolic Syndrome and Employer Sponsored Medical Benefits: An Actuarial Study, Kathryn Fitch R.N., Med, Bruce Pyenson,
FSA, MAA, Kosuke Iwasake, FIAJ, MIAA, Milliman, New York, NY September 2007
21
Clinical and Economic Risks of
Metabolic Syndrome
Working-age individuals with Metabolic Syndrome
had significantly higher medical costs
compared to those without Metabolic Syndrome:
• With Metabolic Syndrome: $626 per member
per month (PMPM)
• Without Metabolic Syndrome: $367 PMPM
Of the $259 excess medical cost:
• $46 is attributed to additional cardiovascular events
• $213 is related to expenses of higher prevalence of
co-morbidities, particularly cardiovascular disease
and diabetes
* Source: Metabolic Syndrome and Employer Sponsored Medical Benefits: An Actuarial Study, Kathryn Fitch R.N., Med, Bruce Pyenson,
FSA, MAA, Kosuke Iwasake, FIAJ, MIAA, Milliman, New York, NY September 2007
22
Clinical and Economic Risks of
Metabolic Syndrome
Working-age individuals with Metabolic Syndrome
had significantly higher medical costs
compared to those without Metabolic Syndrome:
• With Metabolic Syndrome: $626 per member
per month (PMPM)
• Without Metabolic Syndrome: $367 PMPM
Of the $259 excess medical cost:
• $46 is attributed to additional cardiovascular events
• $213 is related to expenses of higher prevalence of
co-morbidities, particularly cardiovascular disease
and diabetes
An analysis of
claims from 2
million adult
patients aged 20
and older found
that individuals
taking medications
for at least 3 of
the risk factors
associated with
Metabolic
Syndrome had
an annual drug
spend more than
4 times that of all
other patients.
* Source: Metabolic Syndrome and Employer Sponsored Medical Benefits: An Actuarial Study, Kathryn Fitch R.N., Med, Bruce Pyenson,
FSA, MAA, Kosuke Iwasake, FIAJ, MIAA, Milliman, New York, NY September 2007
23
Metabolic Syndrome Program
Down Under
• 10 Australian Aborigines
• Overweight
• With diabetes
• Living a western lifestyle
• Returned to traditional homeland for seven weeks
• Average weight loss of 18 pounds
• Blood pressure reduction
• Normal triglycerides
24
William Dietz, Jason Lee, Howell Wechsler, Sarath Malepati, and Bettylou Sherry,
Health Plans' Role In Preventing Overweight In Children And Adolescents,
Health Affairs, Vol 26, Issue 2, 430-440
25
Copyright ©2007 by Project HOPE, all rights reserved.
Diabetes Prevention Program (DPP)
• a multi-center trial that examined the ability to prevent or delay the
development of diabetes in a population with
pre-diabetes
NEJM, 2002
26
Effect of Treatment on Incidence of Diabetes
Placebo
Incidence of diabetes
11.0%
Metformin Lifestyle
7.8%
4.8%
(percent per year)
Reduction in incidence
----
31%
58%
----
13.9
6.9
compared with placebo
Number needed to treat
to prevent 1 case in 3 years
The DPP Research Group, NEJM 346:393-403, 2002
27
Diabetes Prevention Program:
Lifestyle Modification vs. Metformin
• Compared with the placebo intervention, the lifestyle and metformin
interventions both increased the quality-adjusted life years (QALY) by:
• $31,300 per QALY for metformin
• $1,100 per QALY for lifestyle interventions
• A quality-adjusted life year or QALY is a year of life adjusted for its quality. Saving
one QALY through prevention is equivalent to extending a life for one year in perfect
health
March 2005 Annals of Internal Medicine Vol. 142 #5
28
Metabolic Syndrome Workshop:
Intensive Lifestyle Management
• The Metabolic Syndrome workshop runs for 10 weeks and can be delivered in
either a group or online setting.
• Individuals in either the online or group setting program are assigned
a health coach who monitors progress, weekly dietary habits, exercise and other
factors.
• The first class typically runs for two hours, with the remaining
9 sessions lasting one hour each.
• Classes focus on clinical health improvement by addressing
habits around eating, hunger and hydration.
• The workshop covers other topics including exercise and fitness, stress
management, health education, and psychological and emotional fulfillment.
29
The most trusted brand in health care.
BCBSTX Employee Metabolic Syndrome
Pilot Program Results
Program Participation Summary
• 200 BCBS employees, located in four states, started the 10-week program:
– 100 employees enrolled in the online module (Albuquerque and Tulsa)
– 100 in the onsite mode (Chicago and Richardson)
• 185 out of the 200 participants successfully completed the program
% that showed improvement
Triglycerides (N=162)
67.9
Glucose (N=162)
63.0
Blood Pressure (Systolic) (N=147)
73.5
Blood Pressure (Diastolic) (N=147)
68.0
HDL (N=160)
43.1
Waist Circumference (N=147)
77.6
Weight (N=149)
91.0
30
The most trusted brand in health care.
BCBSTX Employee Metabolic Syndrome Pilot – High
Touch Population Impact
Health and Lifestyle Impacts
100%
Reported improvement in sleeping
37.6%
Of at-risk participants reversed their Metabolic Syndrome
in 10 weeks (74.6% of total group)
91.9%
Experienced average weight loss of 12.9 lbs
39.5%
Reported they started exercise, 40.1% maintained existing
activity levels
29.9%
Reported reduction in medication usage
31
The most trusted brand in health care.
Benefits of Employee Wellness Programs
• Increased productivity
• Decreased employee absenteeism
• Increased motivation to practice healthy behaviors
• Lower health care and insurance costs
• Increased employee retention
• Improved employee morale
• Fewer work-related injuries
• Fewer worker compensation and disability claims
• Attractiveness to prospective employees
• Positive community image
• Healthy role models for children
32
Thank you!
33