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GE Energy Pre Diabetes Intervention A Collaboration with Centers for Disease Control


GE Energy Pre Diabetes Intervention A Collaboration with Centers for Disease Control & Prevention and the National Business Group on Health March 16, 2005 – PowerPoint PPT presentation

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Title: GE Energy Pre Diabetes Intervention A Collaboration with Centers for Disease Control

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

CDCs New Goal Bridging Public Health and the
Business Community
Business Values vs Community Health Values
Business vs Community Health
  • 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

Opportunity knocks to open the doors between
business and community health
CDC Reinvention
  • Two Overarching Health Protection Goals
  • Health promotion and prevention of disease,
    injury, and disability
  • Preparedness

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

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We Have an Epidemic of Diabetes !
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Why pick diabetes for a health promotion
  • Costs over 100 billion/year in health care
  • Effective interventions promote multiple good
  • Leading cause of heart disease and stroke
  • Leading cause of blindness in adults
  • Leading cause of end stage renal disease
    requiring dialysis

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

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

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

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?

Economic Benefits of Improved Glycemic Control
  • Testa et al, JAMA, Nov 1, 1998
  • Workers with less diabetic problems had fewer
    days lost to absenteeism
  • Fewer days of restricted activity

Strategies for Better Outcomes Examples of
Worksite Programs
  • Canadaworksite physical activity classessavings
    of 679/person
  • Coca Cola companyworksite wellness gt500
    /year/person x 2500 people
  • First ChicagoWorksite diabetes education
    program-improvement of HbA1c 9.0 to 8.3

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

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

BMC Work Group
  • 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

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

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, Lands End

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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?

25 Content
  • Planning Guide
  • Assessment Tool
  • Choosing a Health Plan
  • Lesson Plans
  • Fact Sheets
  • Resources
  • Frequently Asked Questions (FAQ's)

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

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

Other Topics
  • Guide to choosing a health plan, developed with
  • Supervisors guide
  • Shift work
  • Links to other NDEP sites

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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

  • National Business Group on Health
  • WK Kellogg Foundation, The Business Interest in a
    Communitys Health, pdf on NBGH web site,
  • National Business Coalition on Health
  • American College of Occupational and
    Environmental Medicine
  • American Occupational Health Nurses

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

  • 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.

Cardiovascular Risk Assessment Output
  • 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

GE Energy Profile
78 male mean age 42.7 2 CVD 17 metabolic
Percent of Population withMetabolic Syndrome
Risk Factors
Net Effect of CRA As an Intervention
  • Change in Predicted Risk of Primary Cardiac Event
  • (Cardiac Event fatal non-fatal MI, sudden death
    or surgical intervention)
  • Mean change in Real 5 yr. CHD risk -0.002, p
  • Mean change in Real 10 yr. CHD risk -0.003, p
  • Mean change in 5 yr. CHD risk (age held
    constant) -0.004, p 0.000
  • Mean change in 10 yr. CHD risk (age held
    constant) -0.008, p 0.000
  • Per 1000 employees screened, 4 events (in 5
    years) are averted
  • 24.8 events averted in our screened population
  • At 40,000 per event 992,000

Complications of Diabetes
  • 1 Cause of Blindness
  • 90 Preventable
  • 1 Cause of Kidney Failure
  • Most is Preventable
  • 1 Cause of NT Amputation
  • 40 to 50 Preventable
  • 60 to 70 of Diabetes
  • Deaths are Cardiovascular
  • Stroke
  • Heart Failure
  • Coronary Heart Disease

Counting Saturated Fats
(Sat fat per serving) (Servings) Grams of Sat
3 g x 2 Servings 6 g Sat Fat 7 g x 2
tablespoons of butter 14 g Sat Fat 20 g Sat Fat
Some examples of saturated fat content 8 oz
glass of whole milk 5 g Sat Fat One tablespoon
heavy cream 3 g Sat Fat 1 ounce slice cheese
5 g Sat Fat 3 oz serving skinless white chicken
1 g Sat Fat 3 oz serving dark meat chicken 2
g Sat Fat 3 oz lean pork 4 g Sat Fat 3 oz
marbled steak or roast 4 to 11 g Sat Fat Hot
dog 5 to 11 g Sat Fat Double quarter pound
cheeseburger 20g Sat Fat
Counting Grams of Saturated Fat
  • Breakfast sausage egg and cheese on a biscuit, 2
    hash browns and large coffee with cream
  • Lunch big bacon classic burger, biggie fries,
    and a medium frosty
  • Dinner 10 oz steak with mashed potatoes with
    butter and salad with hidden valley original with
  • Dessert 1 pint of Haagen-Dazs ice cream

Counting Grams of Saturated Fat
Sausage egg with cheese
2 Hash Browns
Large Coffee w/6 tablespoons cream
Big bacon classic
Biggie Fries (5.6 ounce)
Frosty medium
10 ounce steak
Mashed potatoes
Butter 3 tablespoons
Hidden Valley Dressing 4 tablespoons
1 pint 2 cups Haagen-Dazs
8 g
3 g
13.2 g
12 g
3.5 g
7 g
18 g
0 g
21.6 g
0 g
10 g
44 g
Diabetes and High Blood PressureAre Like Twins
Create a Blood Pressure Action Plan
  • Johns average blood pressure is 132/85
  • He should reduce his systolic blood pressure down
    below 120
  • 132 -120 12 points

Obese Does not exercise Eats fast food daily Does
not drink alcohol
Create a Blood Pressure Action Plan
  • Harrys average blood pressure is 124/81
  • He should reduce his systolic blood pressure down
    below 120
  • 124 -120 4 points

Healthy weight, but gained 5 pounds last
year Moderately active Eats typical American
diet Has 1 or 2 drinks on the weekend
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You will learn that our nutrition message is more
than just 5 A Day . . .
Top 10 Daily HasslesA Survey of Middle-aged
  1. Concerns about weight
  2. Health of a family member
  3. Rising prices
  4. Home maintenance
  5. Too many things to do
  6. Misplacing or losing things
  7. Yard work or outside home maintenance
  8. Property, investments, or taxes
  9. Crime
  10. Physical appearance

Diabetes Prevention _at_ GE EnergyProgram Sites
  • Houston
  • Pilot program complete (24 employees)
  • Schenectady
  • Program in progress (11 employees)
  • Minden
  • Program in progress (25 employees)
  • Bangor
  • CRA first week in June program to begin same

Implementation Planning
Role CRA Diabetes Prevention
Top Management Culture of confidence in Medical director Digitization drive in 2001 Access prototype Largely unnoticed as a separate program
HQ Medical Team Expertise available Software Public Health/CVD Prevention design Implementation Public Health/CVD Prevention Health Coach Experience
Site Nurse Short term intense commitment Commitment of minimum of 10 hours
Site Leaders Most familiar with our product Nurses present case, has not been an obstacle
Major investment from business Most costs are from site nurse and production time
Planning Upfront, Direct, Simple
Eligible Costs to Business Planning Steps
Group high risk for diabetes. 3 or more metabolic syndrome risk factors No direct expenditure for site Recommend hourly workers participate in the program on the clock for ½ of the program Giveaways provided by GEE Health services without charge Nurse or health educator time to present materials required. Minimal preparation time. View program materials Identify program lead       Obtain site approval Approved by      On clock/off clock    Order sample materials and printed script from Joan. Schedule classes (begin within 30 days of CRA) 1-1     1-2   1-3   1-4  2-1     2-2  3-1   3-2   4-1  4-2  6-1   Prepare invitation (with schedule above) to be distributed at CRA event Identify invite participants to prevention program at the time of the event. Give pre-program survey to all who are eligible for the program.
Pilot Study Results
Business and Public Health Bridging the Gap in
Health Improvement
  • Impetus for the project
  • CEO concerned about health status of employees
  • Top management wants productive workforce
  • Management understood link between health status
    and productivity
  • GE, CDC and NBGH
  • Cooperative Agreement
  • Objectives of the collaboration
  • Science-to-Service
  • Link CDC scientist with business

ROI The Business Case
  • Healthcare costs increasing 10 annually
  • 95 of healthcare costs goes to direct medical
  • 5 is allocated to preventing disease
  • 50 to 70 of all diseases are associated with
    modifiable health risks
  • CFO want costs justification

Developing the ROI
  • Identify the populations
  • Participants
  • Control Group
  • Monitor healthcare costs and utilization during
    periods of
  • Pre-intervention
  • Intervention
  • Post Intervention

Costs and Utilization Metrics
  • Costs
  • Health Plan Claims Data
  • Prescription Medication Costs
  • Disability Costs Data
  • Utilization Data
  • Admissions
  • ER visits
  • Scripts
  • Disability Days/Events

Discussion of Pre-Intervention Data
  • Data collected
  • 6, 12, 18 month intervals
  • Review of Data
  • Range 139,000 to 00 over 18 month period
  • Breakdown by range and categories
  • Included in ROI calculation is costs of
  • Spouse
  • Children

Intervention Participation Rate
  • Dose Response
  • Percent of Activities Attended
  • Participant Survey
  • Lifestyle changes
  • Exercise
  • Healthy Diet
  • Adherence to Medications

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Program Costs
Current Status
  • Houston, TX pilot
  • Continuing to monitor claims data
  • Will offer reassessment at 1 year
  • Schenectady, NY began 2/15/05
  • Minden, NV began 2/28/05
  • Greenville, SC on hold for now
  • Bangor, ME to begin week of CRA event in June

Next Steps
  • Continue to implement and evaluate program
  • Use data for additional six sigma projects