Transcript wellness and fitness center at the workplace

Workplace Health Centers:
Driving employee wellness and productivity through integrated workplace
Health, wellness and fitness
Raymond Fabius, MD
President & Chief Medical Officer
CHD Meridian Healthcare
• There is a competitive advantage to having a wellness
and fitness center at the workplace in the quest to
create healthier, more productive workforces.
• In this presentation we will address workplace health
and productivity and describe how integrating workplace
health centers, wellness programs and fitness centers
can create a competitive advantage by producing a fit,
healthy and productive workforce.
Learning objectives:
1. Understand the advantages gained from collaboration of health
centers, pharmacies, and wellness and fitness centers at the
workplace.
Presentation
overview
2. Describe how workplace health, wellness and fitness centers
benefit employees and their families.
3. Gain an appreciation of the outcomes possible from workplace
health, wellness and fitness centers through a brief review of
relevant published research.
4. Recognize how the current obesity epidemic makes employer
commitment to workplace health, wellness and fitness centers
particularly important today.
2
Copyright © 2008 CHD Meridian Healthcare, LLC - All Rights Reserved
Brief workplace health update
Creating integration & synergy with existing programs:
Adding wellness to workplace health centers scope of services
PRIMARY SERVICES
Occupational Health
Acute/ Extended Episodic Care
Primary Care
Pharmacy
Prevention/ Wellness
ADDITIONAL SERVICES
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Fitness
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Physical Examinations
Disease Management
Disease Management Wellness
Care Coordination
Health Screening
Health Fairs
Health Coaching
Health Advocacy
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Compliance: OSHA , AED, CLIA and
VIS
Medical Surveillance
Workplace Safety
Return to Work Program
Ergonomics
Pharmacy Concierge Services
Specialty Pharmacy Services
Integrated PBM/ Mail Order
Services
Physician Referral Network
Disaster Management
Travel Medicine
Disability Management, Including
STD, LTD & FMLA
Physical Therapy
Laboratory Services
Specialty Services Rotations
Woman’s Health
Medical Emergency Services
Substance Abuse Testing
Global Medical Leadership/
Direction
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“Migration & Integration” of workplace health services:
Yielding great improvements in productivity
Risk Management
Medical
Surveillance
Exams
Injuries &
Illness
Ergonomics
Emergency
Response
Medical Management
OSHA
Reporting
Workers
Compensation
25%
5
Case
Management
Absence Management
EAP
Behavioral
Health
Wellness/
Prevention
Disability
Management
Population Management
Disease
Management
Fitness
Physical
Therapy
Emergency
Preparedness
Urgent
Care
Dental
Travel
Medicine
% of Employer Healthcare Costs
75%
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Primary
Care
Pharmacy
Referral
Management
Health Advocacy
Employer of Choice
The value
propositions
of workplace
health
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Patient satisfaction
Access
Availability
Wellness programs
Trusted relationship
Quality Care
Worker Safety
• Medical surveillance
• Injury & illness
• Return to work
• Ergonomics
Cost Savings
• Metric driven
• Direct medical
• Clinical excellence
• Total population health
• External accreditation
• Cost avoidance
• Reduced lost time
• Health advocacy
• Measurable ROI
6
Copyright © 2008 CHD Meridian Healthcare, LLC - All Rights Reserved
CHD Meridian / HEDIS Scorecard
Source
CES
3rd Line Antibiotics Utilization
(appropriateness)
Threshold 90%
CES
Pharyngitis Treatment
Site
Experience
HEDIS
commercial
89%
N/A
82%
Peds, adults
73%
Peds
CES
Outcomes
DB
Diabetics: HbA1c < 7.5 (threshold 50%)
HbA1C < 7
72%
64%
N/A
42%
Outcomes
DB
Hypertension: BP < 140/90
69%
60%
61%
53% (all HL dx.)
N/A
57% (only CV dx.)
69% composite
Breast: 70%
Cervical: 81%
Colon m&f: 54.5%
CES
Outcomes
DB
CES
7
Description
Hyperlipidemia:
Cholesterol: < 200 (threshold 50%)
LDL: < 100
Preventive Care Screening – Women
Cervical, breast, colon, and others
(threshold 80%)
Copyright © 2008 CHD Meridian Healthcare, LLC - All Rights Reserved
Worksite primary care and pharmacy delivers real savings
PUPY Annual Average Total Cost (2003-2006): All Members < age 65
$3,500.00
Risk adjusted* cost savings for
patients who use Worksite Primary
Care (PC/Rx locations only)
$3,450.56
$3,450.00
$3,400.00
$3,350.00
Patients who use worksite primary care cost on
average $265.12 per year less* than patients at
the same locations who use community primary
care only
$3,300.00
$3,250.00
$3,185.43
$3,200.00
$3,150.00
$3,100.00
$3,050.00
Worksite Primary Care Patients
Community Patients at CHD-PC/Rx Available Locations
Risk adjusted* cost savings for
patients at 4 CHD-PC/Rx
locations versus 4 similar
locations without CHD-PC/Rx
PUPY Annual Average Total Cost (2003-2006): All Members <
age 65
$3,200.00
$3,168.49
$3,150.00
$3,100.00
Patients at locations where CHD Primary Care and
Pharmacy is available cost on average $119.67 per year
less* than similar patients at locations where CHD Primary
Care and Pharmacy is not available regardless of whether
they use onsite medical services
$3,048.82
$3,050.00
$3,000.00
$2,950.00
Preliminary Results
8
CHD-PC/Rx Available Locations
Copyright © 2008 CHD Meridian Healthcare, LLC - All Rights Reserved
No CHD PC/Rx Locations
Comprehensive ROI analysis of Goldman Sachs
(Continues to be Refined)
Net Savings: Total Health Center
Savings as a % of Cost Avoidance
Savings: Total Operating Expenses
Q1 2007 Q2 2007 Q3 2007 Q4 2007
81.45% 83.38% 83.88%
4.39
5.01
5.02
Total
82.97%
4.87
Average Operating Cost per Visit (Total Op, Exp / A1)
The average cost per visit of operating the facility in conjunction with CHD Meridian management
9
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Workplace Health Opportunities for
Integration
Integration with Occupational Health &
Environmental Health & Safety
Optimizing the health of the employer community:
Partnering with health and safety and medical leadership
Medical
H&S
Regulatory compliance
Exposure management
Ergonomics
Industrial hygiene
Injury documentation
Workplace safety
Accident investigation
Surveillance
exams
Diagnostic testing
Acute care
Responding to the needs
identified by Client’s H&S and Medical Leadership to
deliver the highest level of medical compliance and protect
every worker from occupational illness and injury
12
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• Assist employees in obtaining appropriate
medical service as quickly as possible
• Select and monitor specialty physicians
to ensure efficiency and communication
Treating
workplace illness
& injury
Key principles
• Educate employees, their treating providers
and plant supervisors regarding available
modified or restricted duty programs
• Reduce absenteeism and disability
related costs by facilitating an employee’s
early return to work
• Track workplace injuries & illnesses to
develop preventive programs
• Assess job functions and worksite
ergonomics to identify safety issues
• Assure that employees receive their entitled
absence benefits
13
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Reducing the impact of worker’s compensation
Total Incurred Costs
$1,400,000
Severity Rates
500
$1,271,780
450
$1,200,000
400
$1,000,000
$761,152
$800,000
350
$703,708
300
250
$600,000
$356,009
$400,000
$197,249
$220,306
158
200
$102,615
$200,000
$0
443
150
71
100
25
50
Pre- Pre- Year 1 Year 2 Year 3 Year 4 Year 5
CHDM CHDM
1
2
0
PreYear 1
CHDM 1
Lost Time Days
2250
8
2046
7
1750
6
1500
5
1250
750
14
Year 4
Year 5
6.5
5
2.8
3
725
2.09
2
304
116
183
250
0
6.7
4
500
Year 3
5
Lost Time Accident Rates
2000
1000
Year 2
12
39
0.75
1
0.37
0
PreYear 1
CHDM 1
Year 2
Year 3
Year 4
Year 5
PreCHDM 1
Year 1
Year 2
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Year 3
Year 4
Year 5
National
Avg
Integration with Wellness & Fitness
Workplace fitness & health: Minimize days away from work
Fitness
Personal
Trainer
Workplace
Safety
Ergonomics
Work
Hardening
Physical Therapist
Return to Work
Disability
Management
Injury at Work
Physician /
Nurse
Work Readiness
Occupational
Therapist
16
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Association of risk levels with several corporate cost measures
Outcome
Measure
Low-Risk
(N=671)
MediumRisk
(N=504)
High-Risk
(N=396)
Excess Cost
Percentage
Short-term
Disability
$120
$216
$333
41%
Worker’s
Compensation
$228
$244
$496
24%
Absence
$245
$341
$527
29%
$1,158
$1,487
$3,696
38%
$1,751
$2,288
$5,052
36%
Medical &
Pharmacy
Total
Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002
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Deaths Attributable to Various Causes
Fatal 5 and the Impact of Obesity/Poor Diet
1990 vs 2002 USA
500000
 8%
435,000
2000
400,000
400,000
# of
deaths
and
%
1990
 25%
375000
300,000
250000
 (20%)
125000
100,000
80,000
 (16%)
90,000
76,000
 (8%)
60,000
55,000
0
Tobacco
Poor
Diet/Exercise
Alcohol
Microbes
Mokadad, A Jama 2004; 291: 1238-1245
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Toxic Agents
Greatest Cost Savings Opportunity Getting the Obese Group to
Exercise
3500
3000
$500
2500
very active
2000
active
1500
sedentary
1000
500
0
normal weight
overweight
obese
BMI, Physical Activity, and Health Care Costs; Wang et al; JOEM :Vol. 46, No. 5, May 2004, pp. 428- 436
A Study done comparing HRA self reported data to claims information following over 20K ee’s in a
manufacturing environment that including GM.
19
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Integration with Absence Management
Optimizing the health of the employer community:
Partnering with human resources and medical leadership
Medical
HR
Hiring & training
Wellness & Health
promotion
Drug testing
Work-life balance
Return-to-work
Disability mgmt
Benefit design
Absence
management
Acute care
Responding to the needs identified
By Human Resources and Medical Leadership
to optimize employee health and productivity
21
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NEW SCHOOL:
The Skill & The Will &
NOT ILL
Health is Not a Cost!
It is an Investment into Human Capital
22
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Integration with Disease Management
Traditional DM
1
The power of
integration:
Healthcare center
drives improved
engagement &
retention rates
100% 100%
Integrated DM
96%
75%
0.8
0.6
60%
51%
0.4
24%
0.2
12%
0
Eligible
Contacted
Participated
CHD-Meridian/Goodyear; and Lynch, et al. JOEM 2006;48:447-454
Retained for
one year
To be
Published
24
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Chronic illness is better managed:
Workplace care vs. Community care
•
Study Design – control vs. study
groups
•
Primary Care/ Rx Site
•
Chronically ill patients 4X more likely
to use CHD Meridian for primary
medical care
•
Chronically ill patients who utilize the
Medical Center for primary care
exhibit:
–
–
–
–
–
25
Cross Sectional Analysis
More primary care visits - 24%
more total office visits per year
Less hospitalization - Inpatient
admission rate reduced by 50%
Less ER/hospital use - Hospital
outpatient visits reduced by
42%
Less need for referral Community office visits are
reduced by 36%
Less prescriptions/More use of
mail order - PBM scripts are
reduced by 61%
Patients With A Chronic Disease
Annual Per Patient Healthcare Costs
Do Not Use
Medical
Center
$6,394
Use Medical
Center
$1,621
$4,849
$0
$2,000
Medical
$1,386
$4,000
$6,000
$8,000
Pharmacy
Medical claims costs reduced by 32%
Pharmacy claims costs reduced by 17%
Total medical and Rx costs reduced by 29%
Copyright © 2008 CHD Meridian Healthcare, LLC - All Rights Reserved
Integration with Consumerism &
Health Advocacy
Consumers need health advocacy:
Even presidents have difficulty selecting providers
• Higher quality lowers cost
• Many consumers do not realize some
doctors/hospitals are better than
others
• Pareto Rule : 20% of covered lives
spend 80% of the dollars and have
choices
• By steering to high performance
providers, costs will decrease and
quality will increase
Bill Clinton to have scar tissue removed
Hospital
Beth Israel
Risk-Adjusted
Mortality Rate (RAMR)
2.67
Columbia Presbyterian
3.93*
Lenox Hill
2.26
Mount Sinai
2.81
NYU Hospitals Center
1.95
Weil Cornell – NYP
0.95*
Westchester Medical Center
3.27
Surgeon
RAMR
State Total
2.25
Smith, C
4.15
Six months after undergoing heart bypass surgery, former US President Clinton
will return to the hospital this week to have a rare buildup
of fluid and scar tissue removed from his chest.
President Clinton could have benefited From a trusted clinician’s guidance!
27
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Identifying best specialists & hospitals and directing employees to them
Toyota presentation to IHPM
2006 Actual
2006 Actual
The CHD specialty referral
rate is 40% lower than the
community referral rate.
15%
10.00%
8.00%
2007 Actual
Billed Charges
Paid January thru June
4.00%
0.00%
94%
2007 Actual
Billed Charges
Paid January thru June
6%
38%
62%
Tier 1
Tier 2
%Using Best Hospitals 2006 vs 2007
28
6%
10%
6.00%
2.00%
85%
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68%
32%
Tier 1
Tier 2
%Using Best Specialists 2006 vs 2007
29
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Integration with Workplace
Primary Care & Pharmacy
Integrated primary care and pharmacy:
Greater Use of Generics
•
•
•
•
31
Much higher Generic
Dispensing Rate for PC/
Rx
Above industry average/
retail-PBM average
Affects COMMUNITY
providers as well
Each % point of GDR ~
$100-$200K/ year
incremental savings
(depending upon volume)
Copyright © 2008 CHD Meridian Healthcare, LLC - All Rights Reserved
Evidence-based prescribing practices generate value
(recently published article in Journal of Health & Productivity – March 2007)
Figure 2
Antibiotic Line and Average Cost: Workplace Treated v.
Community Treated
70
60
50
40
Workplace Treated
30
Community Treated
20
10
0
% 1st Line
% 2nd Line
% 3rd Line
Average Cost/Rx
($)
Better Care – and a Potential Savings of $1.5 Million for Antibiotics Alone
32
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15% Greater medication adherence
CHD primary care & pharmacy users versus community care patients
Increased Compliance with Diabetes medications for Patients using CHD Primary Care and Pharmacy
Increased Compliance with Blood Pressure medications for Patients who use CHD Primary Care and
Pharmacy
90.00%
90.00%
82.83%
82.41%
77.57%
80.00%
67.31%
72.20%
70.48%
72.76%
71.97%
70.00%
81.73%
80.00%
77.50%
75.00%
74.07%
81.82%
81.19%
83.49%
82.66%
70.64%
69.81%
70.00%
67.31%
58.65%
60.00%
60.00%
50.00%
50.00%
Community Only Patient
CHD PC/Rx Patient
40.00%
Community Only Patients
CHD PC/Rx Patients
40.00%
30.00%
30.00%
20.00%
20.00%
10.00%
10.00%
0.00%
ALPHAADRENERGIC
BLOCKING AGENTS
ANGIOTENSIN II
RECEPTOR
ANTAGONISTS
POTASSIUMSPARING
DIURETICS
POTASSIUMSPARING
DIURETICS
(HYPOTEN)
THIAZIDE
DIURETICS
0.00%
VASODILATING
AGENTS,
MISCELLANEOUS
BIGUANIDES
FIBRIC ACID DERIVATIVES
INSULINS
SULFONYLUREAS
Increased compliance with Heart Arrhythmia medications for Patients Using CHD Primary Care and Pharmacy
Increased Compliance with Heart Disease medications for Patients Using CHD Primary Care and Pharmacy
90.00%
90.00%
84.27%
83.27%
82.52%
82.42%
80.00%
76.32%
73.88%
84.27%
85.00%
74.23%
73.98%
72.15%
83.28%
82.65%
82.42%
68.99%
70.00%
80.00%
68.42%
61.54%
80.00%
60.00%
77.56%
74.69%
75.00%
74.23%
Community Only Patients
50.00%
74.22%
73.98%
CHD PC/Rx Patients
Community Only Patients
72.70%
71.34%
CHD PC/Rx Patients
40.00%
70.00%
30.00%
65.00%
20.00%
10.00%
RS
IN
HI
B
ID
CLASS IC
ANTIARRHYTHMICS
D
RE
G
IH
AT
IO
YD
R
N
IN
O
PY
R
AG
IC
TO
N
IO
ET
-A
G
G
C
AR
D
CLASS IB
ANTIARRHYTHMICS
AT
EL
PL
N
HA
N
ANTIARRHYTHMICS,
MISCELLANEOUS
IU
M
-C
IT
O
ES
EN
TS
)
TE
N
O
(H
YP
IS
C
K.
AG
T,
M
O
C
BL
EL
R
AD
TA
-
0.00%
33
C
AL
C
G
IO
AN
BE
TE
N
SI
N
-C
O
NV
E
R
EN
ER
T.
E
G
IC
NZ
Y
M
BL
O
E
IN
CK
I
H
NG
IB
(
H
YP
AG
EN
O
TN
TS
)
60.00%
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CLASS II
ANTIARRHYTHMICS
CLASS III
ANTIARRHYTHMICS
CLASS IV
ANTIARRHYTHMICS
Medication patient safety: Significantly better than retail pharmacy
(Based on 1 million prescriptions filled over 5 year contract)
• With a retail error rate recently
reported in USA Today of 1/1000
- Expect 1000 errors
At $2000 per ADE (IOM) = $2 Million
4 Hospitalizations at 10,375 each (IOM)
24 ER visits at $ 1444 each (IOM)
• With our error rate of 3/10000
(prior to implementation of new IT platform)
- Expect less than 300 = $600K
- 1 Hospitalization
Retail
RX
PC/RX
0.01
0.005
0
Error Rates
Comparison
PATIENT SAFETY COST SAVINGS = 1.4 Million
2% of all hospitalizations are due to medication misadventures
34
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Integrating Care at the Workplace
Leveraging the “Trusted Clinicians”
Physicians, Pharmacists, Nurse Practitioners, Nurses, Therapists, Sports
Physiologists, Health Coaches, Care Managers, Personal Trainers
Illness
Drug Management
Behavioral Health
Disease/Case Management
Managing the
Medical Community
Specialists
Tests
Hospitals
Treatment Options
Wellness
Screenings
Immunizations
Health Coaching
HRA
Fitness
Work Readiness
Ergonomics
Work Hardening
Return to Work
35
Environment
Smoking Ban
Traditional Occ Health
Safe Workplace
Cafeteria
Copyright © 2008 CHD Meridian Healthcare, LLC - All Rights Reserved