Metabolic Syndrome Pilot Program

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• Metabolic Syndrome Pilot Program
• FY 2007

Prepared by Lisa Hofman Presented by Jill
Young 10/03/07
2
Objectives

• What is Metabolic Syndrome?
• Pilot Program Overview
• Pilot Program Results
• Measuring Outcomes

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What is Metabolic Syndrome?

• Those with Metabolic Syndrome have 3 of 5 risk
  factors
• Triglycerides 150 mg/dl or higher
• Glucose 100 -125 mg/dl
• HDL
• Men 40 mg/dl or less
• Women 50 mg/dl or less
• Blood Pressure 129/84 or greater
• Waist measurement
• Men 40 or greater
• Women 35 or greater

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Why Should MUS Care About Metabolic Syndrome?

• Of 12,400 MUS plan members in FY07
• 32 or 4,000 are likely to have Metabolic
  Syndrome
• ? Risk of getting Metabolic Syndrome increases
  with age
• ? 40 of people ages 40 60 are estimated to
  have it
• ? Greatest growth is people ages 20 44 (49
  increase)
• Sources Milliman Consultants Actuaries,
  Medical News Today

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Why Should MUS Care About Metabolic Syndrome?

• People with Metabolic Syndrome are at increased
  risk of
• ? Diabetes
• ? Heart Disease
• ? Hypertension
• ? Heart Attack
• ? Stroke
• Sources Milliman Consultants Actuaries

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Health/Wellness Disease
Continuum
? Health Wellness
? Disease? Diabetes Heart Disease Hypertension He
art Attack Stroke
? Metabolic Syndrome
Once a person has a disease, he/she will forever
manage that condition and the related costs.
With Metabolic Syndrome, a person does not have a
disease yet and can reduce his/her risk factors
and move to the left of the continuum, towards
health and wellness.
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Why Should MUS Care About Metabolic Syndrome?

• Of the estimated 4,000 MUS plan members who may
  have Metabolic Syndrome
• ? 18 (720 people) will develop Diabetes within
  next 3 years
• ? Annual Medical Costs 13,243 per person
• Estimated Total Annual Medical Costs (720 X
  13,243)
• 9,500,000
• Sources Milliman Consultants Actuaries,
  Diabetes at Work, CDC, National Diabetes
  Education Program, National Institutes of Health,
  Department of Health and Human Services

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Why Should MUS Care About Metabolic Syndrome?

• Of the estimated 4,000 MUS plan members who may
  have Metabolic Syndrome
• ? 15 (600 people) will have Heart Disease
  within next 3 years
• ? Annual Medical Costs 11,000 per person
• Estimated Total Annual Medical Costs (600 X
  11,000)
• 6,600,000
• Sources Milliman Consultants Actuaries,
  Framingham Risk Studies

9
Why Should MUS Care About Metabolic Syndrome?

• Of the estimated 4,000 MUS plan members who may
  have Metabolic Syndrome
• ? 48 (1,920 people) will have Hypertension
  within next 3 years
• ? Annual Medical Costs 309 per person
• Estimated Total Annual Medical Costs (1,920 X
  309)
• 600,000
• Sources Milliman Consultants Actuaries

10
Why Should MUS Care About Metabolic Syndrome?

• Of the estimated 4,000 MUS plan members who may
  have Metabolic Syndrome
• ? 5.3 (212 people) will have a Heart Attack
  within next 3 years
• ? Annual Medical Costs 55,600 per person
• Estimated Total Annual Medical Costs (212 X
  55,600)
• 11,800,000
• At least 5 of these plan members will die
• Sources Milliman Consultants Actuaries

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Why Should MUS Care About Metabolic Syndrome?

• Of the estimated 4,000 MUS plan members who may
  have Metabolic Syndrome
• ? 1.4 (56 people) will have a Stroke within
  next 3 years
• ? Annual Medical Costs 48,500 per person
• Estimated Total Annual Medical Costs (56 X
  48,500)
• 2,700,000
• At least 5 of these plan members will die
• Sources Milliman Consultants Actuaries

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Potential Cost of 4,000 MUS Plan Members with
Metabolic Syndrome -Annual Cost of Treating
Diseases-

• ? Diabetes (720 X 13,243) 9,500,000
• ? Heart Disease (600 X 11,000) 6,600,000
• ? Hypertension (1,920 X 309) 600,000
• ? Heart Attack (212 X 55,600) 11,800,000
• ? Stroke (56 X 48,500) 2,000,000
• Total 31,000,000
• Sources Milliman Consultants Actuaries,
  Diabetes at Work, CDC, National Diabetes
  Education Program, National Institutes of Health,
  Department of Health and Human Services,
  Framingham Risk Studies

13
Potential Costs of 4,000 MUS Plan Members with
Metabolic Syndrome -Annual Cost of Treating
Syndrome-

• ? Medical costs are approximately 70 higher for
  those with Metabolic Syndrome
• ? Average cost of treating adults with Metabolic
  Syndrome exceeds 4,000 per person per year
• 4,000 MUS plan members X 4,000
• 16,000,000
• Source Grundy, SM, et al., Medical News Today

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Risk Factor Facts

• ? People with Metabolic Syndrome have higher
  incidences of Liver Kidney Disease and may also
  have higher risks for developing Cancer.
• ? High Triglycerides increases the of Heart
  Attack Stroke by 66 annually and are the most
  significant Metabolic Syndrome risk factor in
  determining future cardiac care costs.
• ? Impaired or High Glucose increases the risk of
  Heart Attack and Stroke by 30 annually.
• ? Blood Pressure of 129/84 or greater increases
  the risk of Heart Attack Stroke by 44
  annually.
• ? The risk of Stroke is 2.5 times higher for
  people with Hypertension.
• ? Low HDL increases the risk of Heart Attack
  Stroke by 35 annually.
• ? Obese individuals with Metabolic Syndrome are
  more likely to have Diabetes, Heart Disease, and
  Hypertension.
• ? The more risk factors one has, the more likely
  a catastrophic health event will occur.

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What Is The Treatment For Metabolic Syndrome?

• Weight Loss
• Increased Physical Activity
• Dietary Modification
• Drug Therapy
• Source Grundy, SM, et al.

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Effects of Treatment

• ? Drugs are effective in reducing Metabolic
  Syndrome 7 of the time
• ? Diet Exercise are effective in reducing
  Metabolic Syndrome 8 of the time
• ? Diet Exercise combined with individualized
  support are effective in reducing Metabolic
  Syndrome 41 of the time
• Sources University of Wisconsin Department of
  Medicine Public Health

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Pilot Program Overview
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MUS Metabolic Syndrome Pilot Program
November, 2006 May, 2007

• Intervention Protocol
• ? 1 Free Resting Metabolic Rate Measurement
  (MedGem) used to calculate daily caloric
  needs
• ? 3 Consultations with Registered Dietitian
  (DASH Diet)
• ? 3 Consultations with Exercise Specialist
• ? 2 Group Support Calls with Life Coach
• ? 1 Free follow-up Chemistry Screening
• Intervention Focus
• Dietary Modification and Increased Physical
  Activity Some Support

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Metabolic Syndrome
Pilot Program Participants

• ? 100 Applicants
• 85 Active Participants
• ? 77 Completed Chemistry Screens
• ? 56 Completed Evaluations
• Note Although only 56 participants completed
  evaluations, we were able to extract follow-up
  Triglycerides, Glucose, and HDL levels from 77
  participants who completed their Chem Screens.

.
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15 Pilot Program Drop-outs

• ? Did not complete enrollment materials or
  medical release (3)
• ? Electronic (email) complications (subsequently
  joined) (3)
• ? Co-morbidities referred to MUS Disease Case
  Manager (1)
• ? Cancer (1)
• ? Death in family (2)
• ? Major Surgery (2)
• ? Reported being too busy to follow program (3)
• .

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Participants Gender
22
Participants Campus Distribution
23
Participants Employment Status
24
Participants Age Distribution
Prime MetSyn years
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Participants Risk Factor Profile
4 Risk Factors
3 Risk Factors
5 Risk Factors
N85
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Pilot Program Results
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Risk Factor 1 Triglycerides
88 Have Risk
12 Dont
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Number of Participants
Triglyceride Levels
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Improved Triglycerides

• 45 lowered Triglycerides
• 47 of those, lowered Triglycerides by 20 or
  more
• 8 of those, lowered Triglycerides by 40 or
  more
• Incomplete data on 8 participants

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Risk Factor 2 Glucose
59 Dont
41 Have Risk
31
Number of Participants
Glucose Levels
32
Improved Glucose

• 58 improved Glucose
• (improved within a range or moved to a new
  range)
• 41 maintained Glucose
• 1 poorer Glucose
• Incomplete data on 8 participants

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Risk Factor 3 Blood Pressure
82 Have Risk
18 Dont
34
Number of Participants
Blood Pressure Levels
35
Improved Blood Pressure

• 63 improved Blood Pressure
• 27 maintained Blood Pressure
• 6 poorer Blood Pressure
• Incomplete data on 29 participants

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Risk Factor 4 HDL
73 Have Risk
27 Dont
37
Number of Participants
HDL Levels
38
Improved HDL

• 33 improved HDL (Good Cholesterol)
• (improved within a range or moved to a new
  range)
• 49 lowered HDL (undesirable HDL should be
  high)
• (attributed to an overall decrease in
  Cholesterol and improvements in
  cardiovascular risks)
• ? Incomplete data on
  8 participants

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Improved Cholesterol LDL

• 64 improved their Total Cholesterol
• Average participant lowered their Cholesterol by
  13
• 49 lowered their LDL (Bad Cholesterol)
• 10 brought Cholesterol from high to optimal

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Risk Factor 5 Waist Measurement
64 Have Risk
36 Dont
41
Improved Waist Measurement (participant n 32
incomplete data on 53 participants)
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Improved Total Risk Factors
Percent of Participants
43
Participant Profile Start of Pilot Program
4 Risk Factors
3 Risk Factors
5 Risk Factors
N77
44
Participant Profile End of Pilot Program
3 Risk Factors
2 Risk Factors
4 Risk Factors
1 Risk Factor
5 Risk Factors
N77
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Pilot Program Results-Change in Risk Status-

• ? 35 no longer meet criteria for Metabolic
  Syndrome
  (35 based on 85 participants,
  39 based on 77 Chem Screens)
• ? 30 people no longer have Metabolic Syndrome

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Pilot Program Results-Anecdotal Data

• The following anecdotal data was gathered from
  the
• 56 program participants who completed an
  evaluation

47
Diet Consultation Client Participation
2 Calls
3 Calls
1 Call
The majority participated in 2 of 3 diet
consultations
48
Participants Followed Dietitians Advice
The majority followed the Dietitians advice
at least 50 of the time
49
Evaluation Question The Dietitian provided
useful information and advice.
50
Evaluation Question Overall the Dietitian was
51
Evaluation Question The quality of the diet
portion of the program was excellent.
52
Evaluation Question Did You Follow a Healthy
Diet Before After Program?
53
N55
Exercise Consultation Client Participation
2 Calls
1 Call
3 Calls
The majority participated in 3 exercise
consultations
54
Participants Followed Exercise Specialists
Advice
The majority followed the Exercise Specialists
advice at least 50 of the time
55
Evaluation Question The Exercise Specialist
provided useful information and advice.
56
Evaluation Question Overall the Exercise
Specialist was
57
Evaluation Question The quality of the exercise
portion of the program was excellent
58
Evaluation Question Did You Follow a Daily
Exercise Program Before After Program?
59
Group Support Calls Client Participation
2 Calls
Both Calls
1 Call
The majority participated in both Group Support
Calls
60
Evaluation Question The quality of the Group
Support calls were excellent.
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Other Successes Weight Loss
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Other Health Improvements

• ? 40 reported overall health improvements
• ? 36 stated they feel better, healthier,
  stronger
• ? 24 reported other health benefits including a
  reduction in depression, improvement in energy,
  stamina and sleeping better.
• ? 19 met their specific health goals
• ? 15 reported their families health improved
  because of their participation in the program
• ? 3 eliminated medications for Metabolic
  Syndrome
• My original goal was to lose 100 lbs. I now see
  that was unrealistic in so short a time. But I
  did lose 42 lbs and improved my health. Im happy
  with my progress.
• Overall my health was improved. I do feel
  physically and mentally better. I still have a
  ways to go, but I feel like weight loss, etc. is
  now achievable. I like the changes that have
  taken place.

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Continuous Quality ImprovementFor This Plan Year
(FY08)

• ? Program Assistant will schedule all
  appointments (50 of professionals time last year
  was devoted to scheduling).
• ? The pilot program participants who still have
  Metabolic Syndrome can rejoin program.
• ? The participants who no longer have Metabolic
  Syndrome can join the Ask an Expert program for
  diet/exercise follow-up and/or Metabolic Syndrome
  Group Support Calls.
• ? New participants can apply anytime during plan
  year (no official start or end date like pilot
  program).
• ? The Application, Health History, Medical
  Release and educational forms can all be accessed
  via the wellness website (mailed if no computer).
  

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Continuous Quality ImprovementFor Next Plan Year
(FY09)

• We hope to hire internal Health Coaches for
  ongoing follow-up support, accountability, and
  goal-setting to help sustain long-term results.
• Adding individualized support increases
• effectiveness 41 of time, compared with
• just improving diet and exercise, which are
  effective only 8 of time.

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Measuring Outcomes
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Participant Outcomes

• 35 of our original 85 participants no
  longer meet criteria for Metabolic
  Syndrome!
• 30 individuals no longer have
  Metabolic Syndrome!

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Risk Factors vs. Medical Claims Costs
51,180 Savings. Does not show 6 RFs
11,000 Annual Cost ? 3/yr since 1991) Source
American Journal of Health Promotion, Steelcase
Study DW Edington, 1991
68
Pilot Program Costs
30,000
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Return on Investment Costs vs.
Savings-Treating Diseases-

• 85 Participants
• ? Diabetes (18 15 X 13,243) 203,000
• ? Heart Disease (15 13 X 11,000) 140,000
• ? Hypertension (48 41 X 309) 13,000
• ? Heart Attack (5.3 5 X 55,600) 278,000
• ? Stroke (1.4 1.2 X 48,500) 58,200
• Total 692,200
• If 35 of 85 participants no longer have
  Metabolic Syndrome then there is a potential
  annual savings of 35 of 692,200 242,270
• Measuring Return on Investment
• 242,270 (savings) minus 30,000 (program cost)
  212,270 ? 30,000
  7 1 ROI

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Return on Investment Costs vs.
Savings-Treating Syndrome-

• ? Annual cost of Treating Metabolic Syndrome
  4,000 per person
• ? 85 participants X 4,000 340,000 per year
• If 35 of 85 participants no longer have
  Metabolic Syndrome then there is a potential
  annual savings of 35 of 340,000
• 119,000
• Measuring Return on Investment
• 119,000 (savings) minus 30,000 (program cost)
  
• 89,000 ? 30,000 3 1 ROI

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Return on Investment Costs vs. SavingsWhat If?
? Cost of Pilot Program 30,000 ? 85 plan
members completed the program ? Cost per 85 plan
members is 353 per person What if we took 353
X 4,000 MUS Plan Members who might have Metabolic
Syndrome and provided services? Program Cost
1,412,000 Compare that with the estimated cost
of treating all the possible diseases
31,000,000 Compare that with the estimated cost
of treating Metabolic Syndrome alone
16,000,000
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Return on Investment Costs vs. SavingsWhat If?
Of the estimated 4,000 MUS plan members who
may have Metabolic Syndrome, what
if only 10 (400 people) successfully completed
the program, our annual cost avoidance and health
improvements would be significant.
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Was the Pilot Program Worth Doing?

• 30 People in the Montana University System No
  Longer Have Metabolic Syndrome
• 30 People are HEALTHIER