GE Energy Pre Diabetes Intervention A Collaboration with Centers for Disease Control & Prevention and the National B

1. GE Energy Pre Diabetes InterventionA Collaboration withCenters for Disease Control & Prevention and the National Business Group on Health March 16, 2005 Business Health Agenda National Business Group on Health

2. Welcome Ron Finch, EdD Director, Center for Prevention and Health Services National Business Group on Health David Pratt, MD Medical Director, GE Energy

3. CDC’s New Goal: Bridging Public Health and the Business Community

4. Business Values vs Community Health Values

5. ROI Stay in business Productivity Profit and loss Overhead Employees as a capital investment Public good Healthy people Public and private partnerships Non-profits Advocacy Business vs Community Health

6. CoCHis DDT, CVD DNPA, Asthma OSH, DRH ROI Presenteeism NBGH Know the Language

7. Community and Public Health • Community health= primary domain of the public health entities. • Models, based on epidemiological evidence, target populations with identified health risk factors or conditions. • Engaging business in such activities is challenging, and many community health development efforts lack effective partnership with local businesses.

8. Opportunity knocks to open the doors between business and community health

9. CDC Reinvention • Two Overarching Health Protection Goals • Health promotion and prevention of disease, injury, and disability: • Preparedness

10. CDC Reinvention: Six Strategic Imperatives • Health Impact. • CDC will be a customer-centric organization. • Public Health Research. • Leadership for the nation’s health system.Global Health. • Effectiveness and Accountability.

11. CDC New Initiatives • Cooperative agreements • Multiple divisions working together, sharing expertise and resources • DDT, CVD, DNPA • Asthma • Center for Public and Private Partnerships

13. We Have an Epidemic of Diabetes !

15. Why pick diabetes for a health promotion intervention? • Costs over $100 billion/year in health care expenditures • Effective interventions promote multiple good outcomes • Leading cause of heart disease and stroke • Leading cause of blindness in adults • Leading cause of end stage renal disease requiring dialysis

16. Consequences of uncontrolled diabetes • Loss of productivity • Increased direct and indirect health care expenditures • Poorer quality of life for employees • Possible permanent disability

17. Why Control Diabetes? • Better control translates into fewer complications • Fewer complications translate into fewer days lost to absenteeism and disability, and future savings on health care expenditures

18. Why the workplace as a site of disease education? • Unique opportunity for education • Less time away from work • Improves employer-employee relations and shows employer cares about employees

19. Do Any of These Things Work? • Bottom Line: Does better glucose control translate to better outcomes or better health in the individual? • Does better glucose control translate into improved productivity in the workplace?

20. Economic Benefits of Improved Glycemic Control • Testa et al, JAMA, Nov 1, 1998 • Workers with better Hba1c had fewer days lost to absenteeism • Fewer days of restricted activity

21. Strategies for Better Outcomes: Examples of Worksite Programs • Canada:worksite physical activity classes:savings of $679/person • Coca Cola company:worksite wellness >$500 /year/person x 2500 people • First Chicago:Worksite diabetes education program-improvement of HbA1c 9.0% to 8.3%

22. National Diabetes Education Program (NDEP) Goals: • CDC and NIH program formed after evidence showed that better glucose control translated into fewer complications • Public and private partnerships to improve diabetes treatment and outcomes • Increased public awareness of the seriousness of diabetes, its risk factors, and strategies for preventing diabetic complications

23. NDEP Workgroups • African American Workgroup • Latino Hispanic Workgroup • American Indian – Alaska Native • Diabetes in youth • Older adults • PPOD • Business and Managed Care Workgroup

24. NDEP Business and Managed Care workgroup

25. Business and Managed Care Work Group (BMC) • To increase awareness of the benefits of quality diabetes care among employers, benefits managers and managed care decision makers • To provide employers, health plans and employees with tools and information for incorporating diabetes education programs into the workplace • To promote the value of investing in prevention

26. NDEP Business/Managed Care Workgroup: Who are we? • CDC and NIH • Large and small businesses • Unions • Occupational health professionals • Public health agencies • Managed care groups • Non-profit organizations

27. NBGH GE Power GM American Association of Health Plans United Automobile Workers Union Wisconsin Diabetes Control Program Novo-Nordisk Harrington and Chappell National Fed of Ind Businesses BMC Work Group

28. NDEP TARGET GROUPS • Occupational health professionals • Wellness coordinators • Benefits personnel and HR managers • Large and small businesses • Unions • Regional and national business groups • Managed care organizations

29. BMC Workgroup Projects • Diabetes White Paper : Call to action! • Diabetes Needs Assessment Tool • Diabetes Worksite Intervention Kit • Regional partner conferences: General Motors, DFWBGH, Federal Reserve, Land’s End

31. Needs Assessment • What is it and why does my company need to address diabetes? • Helps to see the potential prevalence of diabetes in the company based on NHIS data. Each company has a unique workforce, based on age, ethnicity • Is diabetes relevant at this time?

32. Diabetesatwork.org: Content • Planning Guide • Assessment Tool • Choosing a Health Plan • Lesson Plans • Fact Sheets • Resources • Frequently Asked Questions (FAQ's)

33. Diabetesatwork: Content • General Diabetes Education • Managing Diabetes Complications • Cardiovascular Disease • Emotional Well-Being • Nutrition, Weight Control, and Physical Activity • Dealing With Type 1 Diabetes

34. Lesson Plans, Lunch & Learns • High and Low Blood Glucose Symptoms and Causes • Making Your Doctor Visit Count • Cardiovascular risk factors • Feet

35. Other Topics • Guide to choosing a health plan, developed with AAHP • Supervisor’s guide • Shift work • Links to other NDEP sites

38. What Can My Company Do? • Develop a Supportive Work Environment • Seize the moment for education • Educate other employees about diabetes • Create a wellness committee • Sponsor health screenings • Coordinate All Health Efforts

39. Resources • National Business Group on Health www.wbgh.com • WK Kellogg Foundation, The Business Interest in a Community’s Health, pdf on NBGH web site, • National Business Coalition on Health www.nbch.org • American College of Occupational and Environmental Medicine www.acoem.org • American Occupational Health Nurses www.aaohn.org

40. Resources: American College of Occupational and Environmental Health • www.acoem.org • Consensus Statement on Health and Productivity • The Business Case for Managing Health and Productivity • Health and Wellness in the Workplace • Business and Managed Care Diabetes and Health Resource Kit

41. Remember • New evidence: DPT Diabetes Prevention Trial; lifestyle and/or meds can PREVENT type 2 diabetes • The lifestyle changes and medical care recommended for diabetes control helps prevent and control MANY chronic diseases.

42. Diabetes Prevention@ GE Energy Donna Tomlinson, MD MSc Health Promotions Manager, GE Energy Tiana Howland, RN Cardiovascular Disease Prevention Specialist & Health Coach, Community Care Physicians

43. GE Energy Risk ManagementOverview • Cardiovascular Risk Assessment • CRA input • CRA output • Cardiovascular Risk Management • Energy Health Coach • Diabetes Prevention @ GE Energy • Sample of program • Implementation & Planning • Results

44. Diabetes Prevention@ GE Energy • Cardiovascular Risk Assessment Input • 11 questions • Height, weight, girth • Blood pressure • Lipids & glucose

45. Data QualityMisclassification Bias Digit bias resulted in 362 false positive diagnoses of hypertension with an unnecessary physician referral. Cost of unnecessary referrals: 350 * $70 = $24,500 Frequency Systolic BP Ones Digit

46. AssessmentTime • Production time focus • Customer oriented • Efficiently

47. Cardiovascular Risk Assessment

48. 10 year risk of cardiac event 10 year risk of stroke Existing CAD, PAD, CVA Blood pressure Including medication use Tobacco users LDL-cholesterol Including medication use Overweight/obese Hypertriglyceridemia Metabolic Syndrome Diabetes Cardiovascular Risk Assessment Output

49. GE Energy Profile 78% male mean age 42.7 2% CVD 17% metabolic syndrome

50. Percent of Population withMetabolic Syndrome Risk Factors