Wellness at Work

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Wellness at Work

• Cardiovascular
• Risk Reduction in
• Worksites
• Northeast Regional Workshop
• on Cholesterol Control
• May 1, 2008
• Bobbie Orsi, MS, RN, CDE
• Berkshire Health Systems
• Pittsfield, Massachusetts

NACDD
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? Health Status of America ?

• Cardiovascular disease is the 1 cause of death
  and disability
• (American Heart Association, 2006)
• Most health care spending (1.6 trillion) is on
  chronic disease care heart disease, stroke,
  diabetes, and asthma.
• (Dept of Health and Human Services, 2003)
• Overweight, physical inactivity, tobacco
  (modifiable risk factors related to lifestyle)
  account for 50 of all premature deaths and
  25-50 of all health costs (Health Promotion
  Advocates, 2006)
• Majority of patients with chronic diseases are
  inadequately treated (Bodenheimer, 2002).
• Americans receive only 55 of health
  recommendations
• (Asch, et, al, 2006)

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Why Wellnessand Why Now?

• Poor Health Status
• Aging Workforce
• 46 Million Uninsured
• Baby Boomers
• System Focus on Sick Care
• Tyranny of the Urgent
• Poor Quality of Care
• Obesity Epidemic
• Diabetes in Children
• The Perfect Storm!

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Common CVD Messages

• Time is muscle (heart attack action)
• Time is brain (stroke message)
• AEDs in schools and at worksites
• Get with the Guidelines
• (Hospital-based secondary prevention)
• ALL important!
• ALL late!

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National prevalence of health risks
80
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CDC, BRFSS, 2002
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The Lifestyle Syndrome

• Too many calories
• Too much saturated fat, sodium and alcohol
• Too much tobacco exposure
• Too little exercise
• Kotke et al. JAMA May 21, 2003

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Employers (and Communities) Need to Address the
Entire Care Continuum
Well No Disease
At Risk Obesity High Cholesterol
Acute Illness/Discretionary Care Doctor
Visits Emergency Visits

• Chronic Illness
• DiabetesCoronary Heart Disease

Catastrophic Head Injury Cancer, MI, Stroke

• Prevention
• Screenings
• Promotion
• - fitness
• - education
• - nutrition

• Health risk assessment
• Targeted risk reduction programs
• Risk modeling

• Nurse advice line
• Decision support
• Web tools
• Consumer directed plans

• Diseasemanagement
• Incentive design
• Self managementtraining

• Case management
• Predictive modeling

Behaviors Risk Progression
Disease Event
Disabling Conditions
Mercer Human Resource Consulting Edited by Orsi,
2008
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Wellness at WorkHealth Improvement Strategies
for Employers

• Wellness services for employers who are
  interested in improving the health and well-being
  of employees, while positively impacting rising
  health and productivity costs
• Early Intervention and referral
• Strong cardiovascular risk identification and
  reduction focus
• Behavioral change interventions, ongoing support
• Recommendations for appropriate programming
• Trained clinical wellness nurses
• Confidential
• Communication with Primary Care Physician
• Resultsoriented and outcome driven processes
• Ongoing evaluation of services

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Wellness at Work Process

• Point of service assessment (Wellness Cart)
• - Right process
• - Right provider
• - Right assessment
• - Right population
• Evidence-based clinical guidelines
• Nurse as coach
• Outcome orientation

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Personal Health Assessments

• Cholesterol (TC, HDL, non-HDL)
• Blood pressure and pulse
• Blood glucose, diabetes risk assessment
• Ht/Wt/BMI
• Framingham Risk
• PHQ2
• Targeted health questionnaire
• Immediate results, confidential
• Personal Action Plan
• Referral to health care provider, EAP, tobacco,
  etc
• 15-30 minute initial encounter
• Follow-up with stage based health coaching

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Personal Action Plan

• Learn about your personal risk factors for
  preventable illness .
• Set achievable health goals and health coaching
  schedule.
• Discuss your health goals with a wellness nurse.
• Develop a personal health action plan to improve
  your health.

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Clinical Practice Guidelines

• NCEP ATP III Cholesterol Guidelines
• JNC VII Blood pressure Guidelines
• ADA Diabetes Guidelines
• AHA Primary Prevention Guidelines
• AHA Prevention Guidelines for Women
• AHA Lifestyle Guidelines
• Prochaska Stage of Change Theory
• Motivational Interviewing Techniques
• APA Depression Guidelines
• Pedometer and Walking science

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Health System Model

• 3,500 employees
• 6 sites
• HRA and screening required for new wellness
  benefit 350 individual or 700 family cost
  savings
• Coaching voluntary
• Broad program support (tobacco, smoking,
  nutrition and fitness)
• 2 nurse FTEs 1 FTE Program Coordination

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Average change in 523 EEs who had 2006 and 2007
screening data
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Two Different Snapshots of Outcomes

• Heartsense Data
• (All employees with BP gt140/90,
• TC gt240, and/or prediabetes)
• 451 screened (1 nurse)
• 125 met criteria (28)
• 60 engaged (48)
• 41 had 2 data points
• Outcomes
• 38 decreased risk (93)
• 15 started on BP /or chol meds
• 68 improved BP
• 86 improved chol

• Using FR Scores
• (All employees w/ 2 screenings FRgt10)
• Total Screened 1,224
• Number w/FR gt 10 146 (12)
• Total w/2 data points 79
• LTF 23 (29)
• Engaged 56
• Outcomes
• Improved/same FR scores 40 (71)

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Crane Model

• 9 sites (manufacturing and office)
• Initial Health Risk Assessment with biometrics
  and action plan
• Six visits with a nurse coach
• Exit HRA with Screening
• Large cash incentives
• Demonstrated action by participants
• Keep them in the conversation
• 3 nurse FTEs

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Outcomes (n306)

• Risk Reduction
• - 27 (82) reduced total cholesterol
• - 38 (116) increased HDL (healthy)
• - 40 (121) decreased blood pressure
• - 23 (70) lost more than 5 lbs.
• - 34 (11) of smokers quit
• - 25 (77) decreased Framingham risk score
• Behavior Change
• - 71 increased servings of Fruits Veggies
  (gt3/day)
• - 69 increased physical activity (gt3/wk)

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Evaluations (n125 )
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Regional Wellness Pilot - Goals

• Promotes the regionalization efforts of the MA
  DPH with wellness initiative for municipal
  employees
• Special focus on quitting smoking and protection
  from secondhand smoke (Tobacco Control Network)
• Identification of health risks in the municipal
  population (HRA)
• Provide programs that focus on physical activity,
  nutrition, stress reduction, based on health risk
  assessment data

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Barriers to Prevention Efforts

• Health Care System
• System focus on sick care
• Bigger ERs - More ICU/CCU beds - Expand
  Dialysis
• Leadership and vision for paradigm shift
• Resources
• Time
• Physician and nursing shortage
• Personal Barriers
• My Doc already does this
• Confidence that numbers are OK
• Entitlement mentality
• Confidentiality ( at worksites)

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Next Steps

• Well Workplace Initiative
• Employer driven wellness initiative with 5-6
  large local employers
• Provides a framework for implementing a
  results-oriented wellness program
• HERO Scorecard (Health Enhancement Research
  Organization)
• Business process that leads to healthier
  community
• Partners
• DPH, Chamber, Insurers, Health System, large
  worksites
• Municipal Wellness Pilot
• Research (Steve Aldana, Lifestyle Research Group)
  
• Advocacy (Health Promotion Advocates)

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Together we can create a healthier communityone
worksite at a time.