The Journey to Good Health

[Pages:8]The Journey to Good Health:

Case Study: Office of the Constitutional Tax Collector Serving Palm Beach County

EXPERIENCE TRUE HEALTH 5 Batterson Park Rd, Suite 1 Farmington, CT 06032 TEL: 860.773.6580 FAX: 860.677.0612

Research consistently demonstrates that

cardiovascular disease is both preventable and

reversible.

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Introduction The Office of the Constitutional Tax Collector (OCTC) serving Palm Beach County, Florida employs 295 employees and serves approximately 1.3 million residents and taxpayers. Anne M. Gannon, the Constitutional Tax Collector, is a visionary thought leader who sees employee health and wellness as a top priority in controlling healthcare spending, a key fiduciary responsibility. In 2009 Ms. Gannon directed her office to begin a wellness program to mitigate the cost impact of chronic disease in her workforce on the taxpayers of Palm Beach County. In 2010 the OCTC expanded their wellness program by implementing Karelia Health's Risk Reduction Program as an intervention for individuals at high risk for near-term onset of preventable chronic disease. Karelia Health was selected based on its documented results, the medical model and evidence base on which it is built, and its aggressive approach to prevention of chronic illness.

Evidence OCTC validated the potential for success from models that included:

? The North Karelia, Finland Project ? a population of 158,000 people reduced cardiovascular mortality rates by 73% and cancer mortality rates by 44%, through a cardiovascular-focused lifestyle intervention. The reduction of total cholesterol of 17% was cited as the strongest contributor to their outcomes. This longitudinal study began in 1972 and continues to the present day. It is one of the largest and longest running studies of its kind and is the inspiration behind the Karelia Health name.*

? A rural Georgia company of 4,600 employees kept annual health care cost increases over 12 years to only 2.5% annually through an internally delivered cardiovascular disease focus. Their efforts were "home-grown" and implemented with minimal support from external consultants.*

? A large Alabama municipality of 2,000 employees held annual health care cost increases to 2% annually over 5 years following implementation of a cardiovascular risk reduction intervention highlighted by 100% participation in the initiative.*

* Note: Karelia Health did not contribute to these initiatives.

Rationale: Prevention of cardiovascular disease and type 2 diabetes is the primary focus of the Karelia Health initiative for the Office of the Constitutional Tax Collector for three reasons. Treatment costs for these diseases present a significant financial risk to the OCTC and to virtually all employers. Heart disease is the number one cause of death for American men and women, and is the leading cause of death for diabetics.

These diseases share risk factors and root causes with other high cost chronic illnesses such as stroke, hypertension and certain cancers. Lowering risk factors for one disease often reduces the risk of onset for all of them.

Research and evidence consistently demonstrate that these diseases are preventable and often reversible through aggressive prevention efforts.

OCTC understood that success was based on targeting their greatest need and knew that a focused intervention was needed to achieve their goals of reducing the number of high risk individuals and their associated costs. They also understood that by prioritizing their budget and realigning their resources toward measurable and actionable results, they would need to move beyond traditional "wellness" programs to change their risk profile.

Track Record OCTC selected Karelia Health's Risk Reduction Program as their partner to implement and manage the program based on successes with previous organizations that improved employee health and reduced health care costs. A few examples are noted below.

? An international auto parts manufacturer with a self-funded health plan covering approximately 2,500 employees in the U. S. launched the Risk Reduction Program in 2004 as a pilot and expanded the program to all locations in 2005. Documenting an 18% reduction in cholesterol among their 330 high risk employees, the company also reduced their annual healthcare cost trend from a historic average of 13% to 3.1% after the program was implemented. Disability and workman's compensation claims decreased by 11%.

? An employer with 450 employees identified 74 employees at high risk for chronic disease. By implementing the aggressive Risk Reduction Program, post intervention annual healthcare cost trend for their insured health plan decreased from a historic average of 17% to 5%-6% for each of the last two years after the Program was instituted.

? The City of Dalton, GA provides a self-insured health plan to approximately 450 employees. Sponsoring the Risk Reduction Program between 2006 ? 2009, the City identified 82 high risk individuals and reduced the number at high risk by 67% at program end. Average annual health care cost trend was reduced to 1%.

OCTC Program and Results Implementing the Risk Reduction Program in 2010 and 2011, OCTC adopted a focus on nutrition and reduction in cholesterol as a primary indicator to reduce the prevalence of chronic diseases like cardiovascular disease, hypertension, type 2 diabetes, and obesity. An initial evidence-based health screening identified individual health risks based on participants' clinical laboratory values, biometric measures and responses to a brief Health Risk Questionnaire. They were then invited into a risk reduction education program based on their risk profile. Following completion of the curriculum, participants were rescreened to identify changes in their profile compared to the baseline assessment. The results documented in the High Risk groups for 2010 and 2011 are outlined on the following pages.

OCTC found thatit could focus on cholesterol as the primary indicator to reduce theprevalence of chronicdiseases like cardiovascular disease, hypertension, diabetes,

andobesity.

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Any weight loss experienced by the participants is an outcome of healthy lifestyle changes.

2010 Program Number of employees screened: 208 Number of participants in the RRP: 67

*NOTE: the 2010 Risk Reduction Program was offered on a voluntary basis. Not all employees who participated in the program were at High Risk, although the outcomes of the program reflect only the data pertinent to High Risk participants.

2010 High Risk Group Outcomes:

Total Cholesterol LDL Cholesterol (LDL-C)

- 86% of participants showed improvement

- There was an average reduction of 31mg/dL (a 12% reduction from initial screening.)

- 64% moved from a High Risk classification to Moderate or Low Risk classification

- 100% of participants in the High Risk group were identified as Borderline or High LDL-C prior to the program.

- 86% reduced their LDL-C by an average of 26 mg/dL (a 16% reduction from initial screening.)

Fasting Plasma Glucose

- 71% of participants showed improvement

- An average reduction of 25 mg/dL was observed (a 21% reduction from initial screening.)

- 64% of participants moved from High or Moderate Risk classification to Low Risk classification.

Weight

- 59% of participants lost weight.

- Average weight loss was -6.6 lbs.

- The Risk Reduction Program is not a weight loss program, but weight loss is typical with healthy lifestyle changes

2011 Program Number of employees screened: 180 Number of participants in the RRP: 97

59 High Risk Participants 38 Moderate Risk Participants

2011 Program Outcomes

Total Cholesterol LDL Cholesterol (LDL-C)

- 75% of participants showed improvement

- There was an average reduction of 33mg/dL (a 13% reduction from initial screening.)

- 63% moved from a High Risk classification to Moderate or Low Risk classification.

- 100% of participants in the High Risk group were identified as Borderline or High LDL-C prior to the program.

- 63% reduced their LDL-C by an average of 23 mg/dL (a 14% reduction from initial screening.)

Fasting Plasma Glucose

- 83% of participants showed improvement

- An average reduction of 40 mg/dL was observed (a 23% reduction from initial screening.)

- 33% of participants moved from High or Moderate Risk classification to Low Risk classification.

Weight

- 52% of participants lost weight.

- Average weight loss was -7 lbs.

- The Risk Reduction Program is not a weight loss program, but weight loss is typical with healthy lifestyle changes

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Outcomes: Dietary Change Participants were encouraged to increase fruits, vegetables and whole grains while decreasing their consumption of animal proteins. Participants were provided with lifestyle tracking forms to document daily food consumption.

Servings

(1/2 cup = serving)

Fruits and Vegetables Animal Proteins

Servings/Day

at Program start

3.9 6.1

Servings/Day

at Program conclusion

5.6 (44% increase) 4.7 (23% decrease)

NOTE: The "Healthy People 2010" goal is the daily consumption of 5 fruits & vegetables.

Outcomes: Physical Activity (Exercise) Participants were encouraged to incorporate aerobic and weight bearing activity into their daily routine 3 to 5 times per week. Participants were provided with lifestyle tracking forms to document daily exercise activities.

Changes in Exercise

Total Group

Days/Week at Start

2.4

Days/Week at Conclusion

3.1 (29% increase)

2010 & 2011 Participant Cohort Group: As we continue programming from year to year we are able to document the ability of participants to sustain their results . There are 135 OCTC employees who participated in the health risk screening in both 2010 and 2011 (i.e., the Cohort Group). Overall, more than 50% showed improvement in the various measures. Highlights from this data are outlined in the table below:

Total Cholesterol HDL LDL Triglycerides Weight Systolic Blood Pressure Diastolic Blood Pressure Glucose

Cohort Group Improvements (% of total Group)

76 Employees (56%) 63 Improved (47%) 82 Improved (61%) 65 Improved (48%) 59 Improved (44%) 76 Improved (56%) 97 Improved (72%) 70 Improved (52%)

Average Change -19.3 +5.7 -17.5 -22.3 -9.1 -13.9 -10.6 -9.6

Participants were encouraged to

incorporate aerobic and weight bearing activity into their daily routine 3 to 5 times per week.

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What Participants Said About the Program Participants who completed the risk reduction curriculum were asked to complete a sixteen question confidential post-program questionnaire to evaluate employee experience and program effectiveness. The survey response rate was an unusually high 97% (n=95). Three highlights of the survey are outlined below.

Question: Do you think this program should be offered to other "high risk" associates in the future? 98% answered "yes".

Question: Do you think this program should be offered to other "moderate risk" associates in the future? 96% answered "yes".

Question: Do you think the OCTC offering this program at work was a good use of your time? 99% answered "yes".

"I first want to thank Anne Gannon for allowing us to take the health classes and the benefit it has to our employees. It means so much that my employer values my health and making my life easier. I have brought back what I learned to my family, it makes dealing with insurance and doctors easier, and I feel a closer connection to my co-workers. If it wasn't for her, this wouldn't have happened and wouldn't have impacted my life so greatly."

"It's awesome that Anne did this for us. Initially, people were scared. They didn't know what this meant for them. But, now we know that they really do care for us. It's not only giving back to our organization by saving health care premium costs, but giving back to our employees and to our families--really enriching our lives. I can't say thank you enough to Anne for giving me the opportunity to make a lifestyle change in a healthier direction." -- Terri

Financial Impact The OCTC healthcare benefit plan is fully insured through a major national health insurer. Although it is a small population sample and the OCTC financial history certainly cannot be attributed solely to the Risk Reduction Program, the clinical outcomes and financial results documented for the OCTC are very similar to those of other larger clients that have sponsored the program as their core risk reduction intervention.

The chart below demonstrates that the average annual cost trend for the OCTC health plan was 11.6% for the five year period preceding their wellness program (2005 ? 2009) and 4.2% for the three year period following the implementation (2010 ? 2012). Of note, the OCTC plan renewed with no rate increase, no benefit reductions and no increases to employee cost shares for 2012.

Now, I am actively more conscious of what I do, what I eat, and how I prepare it.

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Conclusion: The Constitutional Tax Collector's Office has discovered, through implementation of Karelia Health's Risk Reduction Program that employees who are at high risk for preventable chronic diseases can significantly improve their risk factors and mitigate the risk of onset of illnesses that no one wants to have.

As the OCTC embarks on a third year with the Risk Reduction Program they have found that their employees are healthier and more attuned to their health than ever before. Participant feedback about the program is positive and consistently supportive of the OCTC's focus on health in the workplace. This feedback is used to shape future programs that will meet employee needs and expectations as well as provide the clinical and financial outcomes that the OCTC is looking to achieve for the employees and taxpayers of Palm Beach County.

It's not only giving back to our organization

by saving health care premium costs, but giving back to our employees and to our families--really enriching

our lives.

EXPERIENCE TRUE HEALTH

5 Batterson Park Rd, Suite 1 Farmington, CT 06032

TEL: 860.773.6580 FAX: 860.677.0612



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