A Personal Call to Action

Invest in Yourself

2010 State Agency Wellness Conference:Investing in Health

Eduardo Sanchez, MD,MPH,FAAFP

Vice President and Chief Medical Officer

BlueCross and BlueShield of Texas

September 22, 2010

Our mission is to promote the health and wellness of our members and communities through accessible, cost-effective, quality health care.

What Employers want from health insurers in 2010: Better information, more value

Employers are looking to their health plan providers for information, technology and strategies to help reduce waste in healthcare spending and better engage employees in managing their health.

4

(PwC's Health Research Institute)

5

The Healthcare Spectrum Today

5

Understanding the Impact and Opportunity

Population Distribution

Healthcare Cost Distribution

Healthy At RiskAcute

ConditionsChronic

Conditions

Severe Illness and Complex Disease / End-of-Life Care

Causes of Death, United States 2005

Source: cdc.gov

1.4%

1.8%

2.9%

3.1%

4.8%

5.3%

5.9%

22.8%

26.6%

0% 9% 18% 27% 36%

Septicemia

Influenza and pneumonia

Alzheimer’s disease

Diabetes mellitus

Unintentional injuries

Chronic lower respiratory disease

Stroke

All cancers

Diseases of the heart

The Preventable Causes of Death in the United States:Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (Danaei,2009)

Deaths attributable to individual risk (thousands) in both sexesDeaths attributable to individual risk (thousands) in both sexes

America's Fattest Cities – Men’s Heath 2010

Rank City Grade

1 Corpus Christi F

3 El Paso F

4 Dallas F

7 San Antonio F

9 Houston D-

13 Lubbock D-

54 Arlington C+

66 Fort Worth B-

Ready, Willing, And Unable To Serve (Mission: Readiness)

The Biggest Reason Why Young Americans Cannot Join the Military:

The Biggest Reason Why Young Americans Cannot Join the Military:

Physically unfit: 27 percent of young Americans are too overweight to join the military.

Physically unfit: 27 percent of young Americans are too overweight to join the military.

Diabetes Prevalence by Age

Between 2002 and 2006, the prevalence of diabetes has risen among all age groups

Num

ber

per

1,0

00

Pop

ulat

ion

Source: Centers for Disease Control and Prevention, National Center for Health Statistics (2008) National Health Interview Survey (NHIS)

Increasing Prevalence of Diabetes by Age: Burden of Disease or Opportunity

Clinical and Economic Risks of Metabolic Syndrome: Opportunity

With Metabolic Syndrome: $626 per member per month (PMPM)

Without Metabolic Syndrome: $367 PMPM

– $259 excess medical cost per month

– $3108 excess medical cost per year

Source: Metabolic Syndrome and Employer Sponsored Medical Benefits: An Actuarial Study, Kathryn Fitch R.N., Med, Bruce Pyenson, FSA, MAA, Kosuke Iwasake, FIAJ, MIAA, Milliman, New York, NY September 2007

Based on claims from 2 million claims, individuals taking medications for at least 3 risk factors associated with Metabolic Syndrome had an annual drug spend more than 4 times that of all other patients.

Working-age individuals with Metabolic Syndrome had significantly higher medical costs compared to those without Metabolic Syndrome:

High cost claims (3 BCBSTX clients)

Primary Diagnosis Number of Cases Expense per case

Chronic Kidney Disease 59 $405,219

Acute Myocardial Infarction

33 $198,407

Breast Cancer 67 $123,239

Colorectal Cancer 38 $128,177

Lung Cancer 27 $127,656

Cervical Cancer 2 $181,803

Obesity and Cancer

CANCER % Attributable to excess body fat

Number of cases/year preventable with healthy weight

Breast 17% 33,000

Colorectal 9% 13,200

Endometrial 49% 20,700

Pancreas 28% 11,900

(American Institute for Cancer Research)(American Institute for Cancer Research)

Medical & Pharmacy Costs$3,376 PEPY 2

5%

75%

Personal Health CostsMedical CarePharmacy

Productivity Costs

Presenteeism

OvertimeTurnover

Temporary StaffingAdministrative Costs

Replacement TrainingOff-Site Travel for Care

Customer DissatisfactionVariable Product Quality

Total Costs = $13,504 PEPY

Absenteeism

Health-RelatedProductivity Costs $10,128 PEPY

Short-term Disability Long-term Disability

Sources: Edington DW, Burton WN. Health and Productivity. In McCunney RJ, Editor. A Practical Approach to Occupational and Environmental Medicine. 3rd edition. Philadelphia, PA. Lippincott, Williams and Wilkens; 2003: 40-152 and Loeppke, R., et al. Health and Productivity as a Business Strategy. Journal of Occupational and Environmental Medicine. Vol 49, No. 7, July, 2007. Pages 712-721 and the 2006 Mercer Employer Annual Survey;

The Real Problem:

The Full Cost of Poor Employee Health

Chronic Conditions

Health and Productivity as a

Business Strategy: A Multiemployer

Study

Source: “Health and Productivity as a Business Strategy,” JOEM. Vol. 51, No. 4, April 2009 15

Total Medical, Pharma & Productivity-- per 1000/FTEs --

Hypertension

Other Chronic Pain

Other Cancer (vs Skin)

Allergy

GERD

Anxiety

Back/Neck Pain

Arthritis

Obesity

Depression

MedicalDrugAbsencePresenteeism

$300,000$100,000 $400,000

(HPBS – Phase 2 Employers)

$200,000

Source: “Health and Productivity as a Business Strategy,” JOEM. Vol. 51, No. 4, April 2009 16

Co-Morbidity and Lost Time

0

5

10

15

20

25

30

35

40

1 2 3 4 5 6 7 8 9 10+

# of chronic conditions

Lo

st d

ays

Absence lost time Presenteeism lost time

1.7

11.9

4.9

12.7

7.8

19.5

26.529.4

37.4

14.2

Source: “Health and Productivity as a Business Strategy,” JOEM. Vol. 51, No. 4, April 2009 17

Blue Cross and Blue Shield of Texas 18

Estimated Per Capita Health Expenditures,by Age and Sex, 1995

Healthy aging is dependent on a lifetime of healthy living

Prediction of Lifetime Risk for Cardiovascular Disease by Risk Factor Burden at 50 Years of Age, Lloyd-Jones, et al, Circulation 2006;113;791-798.

The absence of established risk factors at 50 years of age is associated with very low lifetime risk for CVD and markedly longer survival. These results should promote efforts aimed at preventing development of risk factors in young individuals.

Given the high lifetime risks and lower survival in those with intermediate or high risk factor burden at 50 years of age, these data may be useful in communicating risks and supporting intensive preventive therapy.

Small steps

A recent study of women who had walked 30 minutes a day five days a week at a 20 minute mile pace in their 50’s compared to women who had not:

• In their 70’s, the walkers were much less likely to have chronic diseases like heart disease, high blood pressure, or diabetes

• The walkers had better mental fitness than non-walkers

Life's Simple 7 for personal wellness

Never smoked or quit more than one year ago

Body mass index less than 25 kg/m2

Physical activity of at least 150 minutes (moderate intensity) or 75 minutes (vigorous intensity) each week

Four to five of the key components of a healthy diet consistent with current American Heart Association guideline recommendations

Total cholesterol of less than 200 mg/dL

Blood pressure below 120/80 mm Hg

Fasting blood glucose less than 100 mg/dL

American Heart Association

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Metabolic Syndrome Program Down Under

10 Australian Aborigines

• Overweight

• With diabetes

• Living a western lifestyle – “la vida loca”

Returned to traditional homeland for seven weeks

• Average weight loss of 18 pounds

• Blood pressure reduction

• Normal triglycerides

M. Pollan, In Defense of Food

Diabetes Prevention Program (DPP) Lifestyle works better (and less expensively) than medication

The DPP Research Group, NEJM 346:393-403, 2002

Placebo Metformin Lifestyle

Incidence of diabetes (percent per year)

11.0% 7.8% 4.8%

Reduction in incidence compared with placebo

– 31% 58%

Number needed to treat to prevent 1 case in 3 years

– 13.9 6.9

BCBSTX Employee MetS Program Pilot Results

Health and Lifestyle Impacts

37.6%Of at-risk participants reversed their Metabolic Syndrome in 10 weeks (74.6% of total group)

91.9% Experienced average weight loss of 12.9 lbs

29.9% Reported reduction in medication usage

39.5%Reported they started exercise, 40.1% maintained existing activity levels

100% Reported improvement in sleeping

Highest Ranking Preventive Services for U.S. Population

H.I. C.E. Total

Discuss daily aspirin use—men 40+, women 50+ 5 5 10

Childhood immunizations 5 5

Smoking cessation advice and help to quit—adults 5 5

Alcohol screening and brief counseling—adults 4 5 9

Colorectal cancer screening—adults 50+ 4 4 8

Hypertension screening and treatment—adults 18+ 5 3

Influenza immunization—adults 50+ 4 4

Vision screening—adults 65+ 3 5

Cervical cancer screening—women 4 3 7

Cholesterol screening and treatment—men 35+, women 45+

5 2

Pneumococcal immunization—adults 65+ 3 4

Breast cancer screening—women 40+ 4 2 6

Chlamydia screening—sexually active women under 25

2 4

In the clinical setting…In the clinical setting…

The Challenge

Engagement

“The man who does not read good books has no advantage over the man who can't read.”  - Mark Twain

“Drugs don’t work in patients that don’t take them.” - C. Everett Koop, M.D.

Where to engage

The workplace

Away from the workplace

• School (for dependents)

• Home

• Neighborhood/community

• TravelThe clinical setting

How to engage

By mail

By e-mail

Texting

Web-site

By phone• From the health plan

• From the doctor’s office

Wellness Options

• Completion of a Health Risk Assessment

• Condition management participation:

–Maternity

–Diabetes

–Asthma

–Coronary Artery Disease

–Congestive Heart Failure (CHF)

–COPD

• Lifestyle Management Participation

–Tobacco cessation–Weight management

Office based activities:

Annual preventive physical

Medical office visit

Preventive eye exam

Eye exam (medical)

Routine pap

Preventive hearing exam

Preventive mammogram

Medical mammogram

Clinical prostate exam

Consultation with a dietitian

HPV vaccine

Flu immunization

• Cholesterol screening

• Digital rectal exams

• Diabetes screening

• HBA1C test

• Bone density

• Colorectal cancer screening

• Fecal occult blood test

Physical Fitness that’s Affordable, Simple, and Accessible.

Members can mix and match health clubs and locations anywhere in the national network

Just $29 to sign up, then $29 per month – no contract obligation

1,900 health clubs and growing, including:

• Bally (all), 24 Hour Fitness (all), select YMCAs, and many other select fitness centers

Benefits:

Reinforcement of healthy behaviors

Healthier, more productive workforce

Benefits:

Reinforcement of healthy behaviors

Healthier, more productive workforce

BCBSTX Strategies to Enhance Quality of Care

Evidence-based measures (EBM)

Performance based reimbursement (PBR)

F-codes          

• pregnancy-related        

• tobacco use relatedBridges to Excellence (BTE)        

• diabetes  50 to 200        

• cardiac coming soon BCBSA Childhood Obesity Clinician’s Toolkit

PCMH pilots in North Texas        

• MAC interest Hospital Acquired infections reduction

EMR financial support for workforce initiative

       

Eduardo’s Wellness tips

Eat smart

Be active

Avoid tobacco

Stay connected

Sleep plenty

See your doctor as advised for age and gender

Thank you!