Population Health Management: Improving Health Where
NDEP Webinar SeriesPopulation Health Management:Improving Health Where We Live,Work, and PlayThe findings and conclusions in this webinar are those of thepresenters and do not necessarily represent the official position ofCenters for Disease Control and Prevention.
Welcome and IntroductionsPam Allweiss, M.D., M.P.H.Medical OfficerCDC Division of Diabetes Translation
Today’s PresentersRon Loeppke, M.D., M.P.H., FACOEM,FACPMVice ChairmanU.S. Preventive MedicineJeanette May, Ph.D., M.P.H.Principal InvestigatorRobert Wood Johnson Foundation Grant
Why Are We Here?Hot off the press from CDC researchers: We have an epidemic of diabetes AND in the past two decades,managing diabetes has become more expensive, mostly due to thehigher spending on drugs. CDC researchers also asked whether costs were higher becausepeople used health services more or because the price of theservice had risen.– The answer? Both.– Patients now use more medication, and the costs of the drugs havealso risen.Published online before print January 15, 2015. Diabetes Care. January 15, 2015. Doi: 10.2337/dc14-1687.
Goals Learn about the benefits of population health management wherepeople live, work, and play. Learn strategies for collaboration between worksites andcommunities to improve health. Learn about resources in the public domain that can be used toimprove health management in worksites and communities with anemphasis on the launch of the new Diabetes at Work website.
What Is the National DiabetesEducation Program (NDEP)? Established in 1997 as an initiative of the U.S. Department of Healthand Human Services to:– Promote early diagnosis.– Improve diabetes management and outcomes.– Prevent/delay the onset of type 2 diabetes in the United Statesand its territories. Jointly sponsored by CDC and National Institutes of Health (NIH). Involves 200 federal, state, and private sector agency partners.
What Is the NDEP Business HealthStrategies Stakeholder Group? Public and private partners such as:– Business coalitions– Occupational health providers such as the American College ofOccupational and Environmental Medicine (ACOEM) and theAssociation of Occupational Health Nurses (AOHN)– Population Health Alliance– Health plans– State health departments
Making the Community an IntegralPart of Your Care Team Better health, better health care, and better value
Population Health ManagementRon Loeppke, M.D., M.P.H., FACOEM, FACPM
Population Health Management:Overview of Presentation WHY?Delineate the converging trends that are advancing the value ofhealth and the power of prevention in population healthmanagement. WHAT?Discuss the solid business case for why employers should beinterested inpopulation health management. HOW?Examine the attributes and results of successful workplace-orientedpopulation health management initiatives.
Converging Trends Driving the Needfor Population Health Management Epidemiological trendsPolitical trendsCultural trendsFinancial trends– The problemo The cost crisis due in large part to the health crisis– The bigger problemo Total cost impact of poor health to employers– The solutiono Evidence-based population health management
Converging Trends Driving the Needfor Population Health ManagementEpidemiological Trends The global burden of health risk and chronic illness The age wave—silver tsunami about to hit the healthcare system The compression of morbidity
The Challenge—The Epidemic of NonCommunicable Diseases (NCDs) Global drivers of mortality due to unhealthylifestyle behaviors: Five lifestyle behaviorsoooooPhysical inactivityPoor nutritionSmokingAlcoholMedicine non-adherence Five chronic conditionso Diabeteso Heart diseaseo Lung diseaseo Cancero Mental illnessSeventy-five percent of deaths worldwide
When the Age Wave Hits the Shore:Implications for Caring for Aging BabyBoomers
Health Care Costs: Which Matters More,Age or Health Risk?Annual Medical Costs 11,965 11,909 10,785 7,991 12,000 5,114 5,710 7,989 9,000 8,927 6,625 6,000 4,620 2,565 3,353 3,000 5,756 3,734 1,776 2,193 4,613 2,740HighMed RiskLow 019-3435-4445-54Age Range55-6465-7475 Edington. AJHP. 15(5):341-349, 2001.
Personal Health Behaviors Are the MainCauses of DeathHealth Behaviors: The Main Mortality Risk Factors in the United StatesHealth tyle51%HeredityEnvironmentHealth ServicesMokdad AH, et al. Actual causes of death in the United States, 2000. JAMA. 2004; 291:1238-1245.
Live Healthier Longer and Die More Suddenly at Lower CostHealth“Sudden Death in Overtime”“Acceptable QOL”“Disability”Age The compression of morbidity relates to postponing the age of onset ofmorbidity, disability, and cumulative health costs—even though lifeexpectancy is increased largely by reducing health risks.Hubert, Bloch, Oehlert , Fries. Lifestyle habits and compression of morbidity. J Gerontol A Biol Sci Med. June, 2002; 57(6) M347-51 .
Converging TrendsDriving the Need for Population HealthManagement Epidemiological Trends– Global burden of risk and illness– The age wave—silver tsunami about to hit the health care system– Compression of morbidity Political Trends– Affordable Care Act National Prevention Strategy– Aligning incentives among consumers, providers, and employers– Accountable care organizations (ACOs)/patient centered medicalhomes (PCMHs)
ACOs/PCMH Definitions Accountable Care Organizations (ACOs)– Care model that makes physicians and hospitals more accountable– Outcomes-oriented, performance-based with aligned incentives– Goal to improve value of health services, control costs, improvequality– ACOs sharing in a portion of any savings gained Patient Centered Medical Homes (PCMHs)––––“Whole-person” and “whole-population” orientationIntegrated and coordinated careMore emphasis on quality, safety, better access to physiciansAligned incentives for improving health as well as better clinicaloutcomes
Converging Trends Driving the Needfor Population Health Management Epidemiological Trends– Global burden of risk and illness– The age wave—silver tsunami about to hit the health care system– Compression of morbidity Political Trends– Aligning incentives among consumers, providers, employers– ACOs/Pay for Performance/PCMH Consumer-centered health athome– Cultural Trends– Health as the new green: the ultimate sustainability strategy– Social networking/game theory innovations in health– Mobile/wireless tech transforming the health care industry
Mobile Technology:The World’s Most Ubiquitous Platform More people have access to cell phones thandrinking water, electricity, or a toothbrush.Source: IMS Report: The World Market for Internet Connected Devices, 2012.
Transforming Health CareBy 2020, 160 million Americans will be monitoredand treated remotely for at least one chronic condition.Johns Hopkins University. Chronic Conditions: Making the Case for Ongoing Care. Retrieved 2/19/15 es/chronicbook2004.pdf
Prescription Apps—Wireless Engagement Poised to transform health care as weknow it Effective channel to deliver behaviorchange interventions to largegroups at lower costs (Noar &Harrington, 2012) Perpetual connectivity/communication– Information into knowledge– Reminders/notifications– Knowledge into action– Clinical and social support– Action into results Always with you, always on Noar, S., & Harrington, N. (2012). eHealth applications: Promising strategies forbehavior change. New York, NY: Routledge.Evidence BasedMobile Health Apps
Converging Trends Driving the Needfor Population Health ManagementEpidemiological Trends– Global burden of risk and illness– The age wave—silver tsunami about to hit the health care system– Compression of morbidityPolitical Trends– Aligning incentives among consumers, providers, and employers– ACOs/PCMHsCultural Trends– Wellness as the new green: the ultimate personal sustainability– Social networking/game theory innovations in wellness– Mobile/wireless tech transforming the health care industryFinancial Trends– The problem: the cost crisis largely due to the health crisis
Patients With Chronic Diseases Account forSeventy-Five Percent of U.S. Health Care CostsOf the 3 trillion spent on U.S. health careOf every dollar spent 75 cents went towards treating patientswith one or more chronic diseasesIn public programs, treatment of chronic diseases constitutes an even higher portion ofspending:More than 96cents in Medicare and 83cents in Medicaid“The United States cannot effectively address escalating health care costswithout addressing the problem of chronic diseases.”-- Centers for Disease Control and Prevention
Population Health Management:Good Health is Good Business As health risks go, so go health costs Dr. Dee Edington– Zero Trends
Learning From the Past
Converging Trends Driving the Needfor Population Health ManagementEpidemiological Trends–Global burden of risk and illness–The age wave—silver tsunami about to hit the health care system–Compression of morbidityPolitical Trends–Aligning incentives among consumers, providers, and employers–ACOs/PCMHsCultural Trends–Wellness as the new green: the ultimate personal sustainability–Social networking/game theory innovations in wellness–Mobile/wireless tech transforming the healthcare industryFinancial Trends–The problem: the cost crisis largely due to the health crisis–The bigger problem: the total cost impact of poor health to employers
The BiggerProblem: The FullCost of Poor HealthPersonal Health CostsMedical Care– Pharmaceutical costsProductivity CostsAbsenteeism– Short-term disability– Long-term disabilityPresenteeism– Overtime– Turnover– Temporary staffing– Administrative costs– Replacement training– Offsite travel for care– Customer dissatisfaction– Variable product qualityIceberg of Full CostsFrom Poor HealthProductivity CostsSources: Loeppke R., et al. Health and productivity as a business strategy: A multi-employer study. JOEM.2009; 51(4):411-428. [And ]Edington DW, Burton WN. Health and productivity. InMcCunney RJ, Editor. A Practical Approach To Occupational and Environmental Medicine. 3rd edition. Philadelphia, PA. Lippincott, Williams and Wilkens; 2003: 40-152.
Top 10 Health Conditions by Med Rx CostsPer 1,000 Full Time Employees (FTEs) for Employers 200,000 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0DrugMedicalLoeppke R., et al. Health and productivity as a business strategy: A multi-employer study. JOEM. 2009;51(4):411-428.
Top 10 Health Conditions by Full Costs for Employers(Med RX Absenteeism Presenteeism) Costs/1,000 FTEs 400,000Presenteeism 350,000Absenteeism 300,000Drug 250,000Medical 200,000 150,000 100,000 50,000 0Loeppke, R., et al. Health and productivity as a business strategy: A multi-employer study. JOEM. 2009;51(4):411-428.
The Business Value of Better Health andProductivity Market cap value impact from regaining one day of productivity peryear per FTE 58,000 employees, current 8 days per FTE of health-relatedproductivity loss1 day per FTE of regained productivity 18.8M Earning Before Interest, Taxes,Depreciation and Amortization13x (EBITDA Multiple) 244.4M estimated market cap increase 292M shares 0.84 in additional per share valueLoeppke R. The value of health and the power of prevention. Int J Workplace Health Management. 2008; 1(2)95-108.
Converging Trends Driving the Needfor Population Health ManagementEpidemiological Trends–Global burden of risk and illness–The age wave—silver tsunami about to hit the health care system–Compression of morbidityPolitical Trends–Aligning incentives among consumers, providers, and employers–ACOs/PCMHsCultural Trends–Wellness as the new green: the ultimate personal sustainability–Social networking/game theory innovations in wellness–Mobile/wireless tech transforming the health care industryFinancial Trends–The problem: the cost crisis largely due to the health crisis–The bigger problem: total cost impact of poor health to employers–The solution: evidence-based population health management
Evidence-Based PreventiveMedicine a Key Component CDC has found that:– Eighty percent of heart disease and type 2 diabetesand forty percent of cancer are preventable if peoplejust:o Stopped smoking.o Ate healthy.o Exercised.
Whole Population Health Management
Need for Better Diabetes Population HealthManagement86 millionAmericanshave PREDIABETES77 millionareUNAWAREGoal:Reduce orEliminate RiskFactors and AvertDisease29 millionAmericanshaveDIABETES21 millionof thoseareDIAGNOSED17 millionof those areTREATED8.5 million havetheir diseaseCONTROLLED8 millionareUNDIAGNOSED4 millionare diagnosedbut NOTTREATED8.5 millionare treatedbut NOTSUCCESSFULLYCONTROLLED20.5 million haveDiabetes that isNOT CONTROLLEDGoal:Goal:Manage Disease toFind and TreatDisease in ItsAvoid ComplicationsEarliest Stages toand DiseaseStop ItsProgressionProgressionSources: NIH, CDC, American Diabetes AssociationGoal:Manage Disease toAvoid Complicationsand DiseaseProgressionGoal:Avert Onset ofDiabetes or Costs Dueto Untreated orUncontrolled Disease
Significant Overall Health Risk Reduction of PopulationParticipating in a Personalized Preventive Plan for 2 YearsNet Movement of Health Risk Levels in CohortBaseline vs Year 2 on Preventive PlanN 6%498HighLoeppke R, Edington D, Bender J, Reynolds A. The association of technology in a workplace wellness program with health riskfactor reduction. Journal of Occupational and Environmental Medicine: March, 2013; Volume 55, Number 3: pp 259–264.
Population Health Risk Transitions in Markov Chain AnalysisAfter 2 Years on a Personalized Preventive PlanN 7,804ParticipantsLoeppke R, Edington D, Bender J, Reynolds A. The association of technology in a workplace wellness program with health risk factorreduction. Journal of Occupational and Environmental Medicine: March, 2013; Volume 55, Number 3: pp 259–264.40
Individual Health Risk Reductions After Participatingin Their Personalized Preventive Plan for 2 Years(Total N 7,804)Individual Risks# people and % of overallpopulation (7,804) with highrisk in baseline yearBlood Pressure 923 (12%)(M 142/90)# people and % of thebaseline high risk groupremaining high risk afteryear 2# people and % of thebaseline high risk groupreducing risk out of high riskafteryear 2179 (19%)(M 143/90)744 (81%)(M 123/77)HDL328 (4%)(M 31)134 (41%)(M 30)194 (59%)(M 41)Cholesterol836 (11%)(M 263)353 (42%)(M 265)483 (58%)(M 208)Fasting BloodGlucose1616 (21%)(M 116 mg/dL)926 (57%)(M 123 mg/dL)690 (43%)(M 92 mg/dL)Body Mass Index(BMI)3338 (43%)(M 33)2937 (82%)(M 34)401 (12%)(M 26)Loeppke R, Edington D, Bender J, Reynolds A. The association of technology in a workplace wellness program with health risk factorreduction. Journal of Occupational and Environmental Medicine: March, 2013; Volume 55, Number 3: pp 259–264.
Total Medical and Pharmacy Claims Costs forOne Actual Employer Over 1 yearTotal Claims Paid Between 6/1/2012 and 5/31/2013Medical Paid 94,318,172.00Rx Paid 30,836,368.78Total Paid 125,154,540.78
Example of Data Analysis for EvidenceBased CARE GAPS
Employer Case Study of Diabetes Care Management:*Total Costs Per Person with Diabetes Per Month across 3 Years in ProgramN 299 1,400.00*Total Costs Include Medical/Rx Claims Costs as well asthe Costs of the Diabetes Care Management Program 1,262.15 1,200.00 1,000.00 849.17 800.00 600.00 400.00 200.00 0.00(33%) 691.85 667.20(45%)(47%)
Employer Case Study of Diabetes Care Management:*Total Annual Costs for 299 Individuals with Diabetes across 3 Years in ProgramN 299 5,000,000 4,500,000 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 -*Total Cost Savings After Subtracting the Costs of theDiabetes Care Management Program3 Year Cumulative Cost Savings 5,662,689( 18,938 Savings per Person) 4,528,594.20 3,046,821.96 2,482,357.80 2,393,913.60Pre-ProgramYear 1Year 2Year 3
Population Health andPublic/Private PartnershipsJeanette May, M.P.H., Ph.D.
EL18County Health Rankings—Take Action Cycle
Efforts to Enhance Public–Private easurementand MetricsClinton HealthMattersRobert WoodJohnsonFoundationCulture ofHealthInstitute ofMedicinePopulationHealthRoundtableHealthy Workplaces, Healthy Communities HERO Environmental Scan HERO Executive Convening ebsiteBluezonesPreventionPartners , etc.EmployerRoundtable—Building theBusiness Case
Business Case Development andEvolutionComplianceDriven(e.g., meetingminimalregulatorystandards forworker safety)Charitable(e.g., corporategiving campaignsthat enhancecompany brand,image)Strategic(e.g., core businessand managementsystems deployed togenerate health andbusiness value)Systemic(e.g., systemicsolutions designed tointentionally generatepopulation health andbusiness value, and toaddress socialdeterminants ofhealth)Adapted from: Visser W. J Bus Systems, 2010; A New CSR Frontier. BSR, 2013; HERO: Role of Corporate America inCommunity Health, 2014
Resources in the Public Domain: NoCopyrightDiabetes at Work website www.diabetesatwork.org Ten-year anniversary Completely updated by an NDEP Task Group chaired by Dr.LoeppkeGeneral NDEP materials http://www.cdc.gov/diabetes/ndepPrimary Prevention of Diabetes http://www.cdc.gov/diabetes/prevention
www.diabetesatwork.org Featured Resources– GAME PLAN Fat and CalorieCounter– Diabetes Snapshot Quick Links– Lesson plans– Depression (ContinuingEducation given)– Fact sheets Ask the Expert– Find answers to your questionsfrom experts in diabetes andworksite wellness.
www.diabetesatwork.org Diabetes Basics––––––––What is diabetesDiabetes and the workplaceEmployees with diabetesDiabetes preventionDiabetes managementEmotional healthHealthy lifestylesDiabetes and pregnancy
www.diabetesatwork.org Plan– Understand yourenvironment.– Conduct a health riskassessment.– Make the business case.– Set goals, timeline, budget.– Work with third-partyproviders.
www.diabetesatwork.org Build– Developing a culture ofwellness– Program activities– Lesson plans– The health care team– In the community
For more information, call 1-800-CDC-INFO (800-232-4636).TTY 1-888-232-6348 or visit www.cdc.gov/info.To order resources, visit www.cdc.gov/diabetes/ndep.Or contact:Pam Allweiss M.D., M.P.H.Medical OfficerCenters for Disease Control and PreventionDivision of Diabetes Translationpca8@cdc.govFebruary 2015
Jan 15, 2015 · Lifestyle 51% Heredity 20% Environment 19% Health Services 10% Lifestyle Heredity Environment Health Services Mokdad AH, et al. Actual causes of dea
6th Grade Social Studies: World Geography and Global Issues SS60301 Unit 3: Population and Migration Lesson 1 Michigan Citizenship Collaborative Curriculum Page 1 of 11 Oakland Schools November 9, 2012 Graphic Organizer Population Patterns Population Growth Population Distribution Population Density . 6th Grade Social Studies: World Geography and Global Issues SS60301 Unit 3: Population and .
Every population of organisms is founded by some initial population. This portion of the module will examine how characteristics of the initial population can impact how quickly the population can grow. In sexually reproducing organisms, at least one male and one female must be present in the founding population for the population to ever grow.
Effective Population Size Census population size often inappropriate for population genetics calculations Breeding population size often smaller For genetic drift, historical events or nonrandom mating patterns might reduce EFFECTIVE size of the population Effective Population Size is an ideal population of size N in which all parents have an equal probability of being
The prison population stood at 78,180 on 31 December 2020. The sentenced prison population stood at 65,171 (83% of the prison population); the remand prison population stood at 12,066 (15%) and the non-criminal prison population stood at 943 (1%). Figure 1: Prison population, December 2000 to 2020 (Source: Table 1.1) Remand prison population
Population growth rate Data from Population Reference Bureau. 2009. 2009 World population data sheet. Human Population 231 Growth Rate Has Slowed For much of the twentieth century, the human population growth rate rose from year to year. Growth rate refers to how a population
A population pyramid displays a country's population in terms of age and shoe size. 2. By looking at the world's population pyramid, we can tell that the global population is 7.8 billion. 3. When a population pyramid's shape is closer to a rectangle than a pyramid, that country's population growth rate is slow. 4.
of the state (Census of India, 2001). Among all the states in India, Jharkhand holds 6th and 10th position in terms of ST population and the percentage share of the ST population to the total population of the state, respectively. The growth of the ST population in the state has been lower than the growth of the total population during 1991-2001.
Population profile As at 2009, the official population size for Eastleigh was 315,496 (GoK, 2010). However, the African Population and Health Research Centre (2002) and Campbell (2005) indicated that the population ranged between 300,000- 500,000 (table 1). Table 1: Trends and Patterns of Population Growth Between1969 and 2009
