Community Initiative on Cardiovascular Health and DiseaseHealth Policy Forum on Cardiovascular Health and WellnessSeptember 29, 2006Marti Macchi, MEdDirector, Special StudiesKansas Department of Health and Environment

Todays ObjectivesWhy WorksitesPrivate/Public PartnershipThe CICV ProjectNext Steps

Why Worksites?Most people spend more of their waking hours at work than anywhere elseWorksite organizational culture and environment are powerful influences on behaviorHeart disease, stroke and multiple risk factors are costly to employersProductivity, absenteeism and presenteeism cost concerns of employers

Employees HeartsAbout 1 in 4 Americans have a cardiovascular condition. Heart disease and stroke-related costs in the United States for 2005 are estimated at $393 billion, and are expected to rise by the year 2010.

American Heart Association. Heart disease and stroke statistics: 2005 update. Dallas, TX; 2005

In 2002, U.S. employers paid an average of $18,618 per employee per year for all health and lost productivity costs.Parry T. Integrated Benefits Institute; 2004GH Group health (employees and dependents)WC Workers compensationSTD Short term disabilityLTD Long term disability*Unpaid leave (incidental absences) unpaid leave associated with an employees or dependents serious health condition, as permitted under the Family Medical Leave ActFigure 1 Legend

2002 Benefit Data

$5,617

$981

$4,845

$178

$6,052

$945

In the first bar, you see the magnitude of full costs reflected as a % of net income. In this case, the median full costs for the group of 60 employers represented over 20% of the net income of the company. Representing full costs in the context of net income is useful because it is easily transferable to bottom-line potential for the company

Source: Business Roundtable questionnaire of 131 CEOs of companies with a combined workforce of more than 10 million employees and $4 trillion in annual revenue. Percentages do not equal 100% due to rounding.CEOs: What cost is your companys biggest concern in 2005?What is keeping executives up at night?Source: Mercer Health and Benefits Consulting 2006

Public-Private Partnerships

Building Blocks of Success

Heart Disease and Stroke Prevention

CAUSES of DEATH Kansas, 2003Note: Other CVD deaths were deaths due to essential hypertension, atherosclerosis and other circulatory diseases defined by ICD-10 codes I00-I99. Source: 2003 Kansas mortality data. Office of Health Care Information. KDHE.

Chart2

16.9

7.2

12.7

21.6

5.8

4.4

3.2

2.8

2.7

20.4

Percentage Distribution of Leading Causes of Death, Kansas 2003

Sheet1

199519961997199819992000200120022003

Males256237.5238.6227.4214213200.7192.4180.2

Females143.1132.6129.4126.2124.9121.8115.7106.4102.1

199519961997199819992000200120022003

Blacks191.1196.8194.8180.9160198176.1179.1164.4

Whites190.4176.8175169.4163.2161.4151.5141.8135.4

TotalMalesFemalesBlacksWhites60 years and youngerOlder than 60 years

Pre-transport deaths54.349.559.553.754.447.255.3

Non pre-transport deaths45.750.540.546.345.652.844.7

199519961997199819992000200120022003

Kansas67.368.46265.261.860.660.159.456.5

USA63.162.561.159.361.660.857.956.2

199519961997199819992000200120022003

Males66.770.663.56659.659.460.661.154.5

Females67.366.659.963.461.959.659.157.357.3

199519961997199819992000200120022003

Blacks103101.290.91008887.386.379.180

Whites66.46760.763.760.960.259.358.455.7

TotalMalesFemalesBlacksWhites60 years and youngerOlder than 60 years

Pre-transport deaths56.748.161.448.857.226.158.8

Non pre-transport deaths43.351.938.651.242.873.941.2

199519961997199819992000200120022003

Kansas360.8347334.7334.1327323.3310.3308.1292.7

USA380.5372.1362.4353.8350.7341.3328.2319

CHDStrokeAll Other CVDCancerChronic lower repiratory disesaeUnintentional injuriesAlzheimer's diseasePneumonia and InfluenzaDiabetes MellitusAll other causes

16.97.212.721.65.84.43.22.82.720.4

24417

Sheet1

0

0

0

0

0

0

0

0

0

0

Percentage Distribution of Leading Causes of Death, Kansas 2003

Sheet2

18-24 years25-44 years45-64 years65 years and above

811.732.654.3

19921993199519971999200120032004

Males19.822.723.219.620.523.622.225.8

Females23.42523.32121.222.82323.3

19921993199519971999200120032004

21.422.822.320.22123.122.724.7

Take medicationNo medication

7624

19921993199519971999200120032004

With Hypertension80.581.38279.489.590.79088.2

Wihout Hypertension65.763.668.55368.472.469.181.8

With high blood pressureWithout high blood pressure

Within the past year82.870.7

Within the past 2 years1115.8

Within the past 5 years3.38

Five or more years35.4

With high blood pressureWithout high blood pressure

Flu shot50.229.8

Pneumonia shot40.915.9

With high blood pressureWithout high blood pressure

30.721.4

19921993199519971999200120032004

Age-adjusted prevalence25.730.429.32524.726.526.529.4

18-24 years25-44 years45-64 years65 years and above

8.82041.346

19921993199519971999200120032004

Males24.229.826.724.825.326.927.930.2

Females26.930.631.225.12425.92528.6

19921993199519971999200120032004

25.830.929.724.525.227.227.129.3

19921993199519971999200120032004

68.867.871.658.472.676.77472.8

Blood cholesterol test within the past five years

Kansas95.4

HP 2010 Goal80

KansasHP 2010 target

Blood cholesterol test within the past five years95.480

Sheet3

1992199319941995199619971998199920002001200220032004

23.220.522.122.522.52321.621.421.322.522.120.519.8

18-24 Years25-44 Years45-64 years65 years and above

26.421.920.29.4

1992199319941995199619971998199920002001200220032004

Males24.522.123.323.92626.522.824.12422.422.820.721.7

Females22.118.820.72118.919.620.418.818.722.621.420.418

1992199319941995199619971998199920002001200220032004

23.320.722.522.523.323.321.62221.322.522.120.319.6

1992199319941995199619971998199920002001200220032004

4.54.44.14.83.52.945.25.75.66.35.96.4

18-24 years25-44 years45-64 years65 years and above

13.18.215.4

1992199319941995199619971998199920002001200220032004

Males4.74.95.44.53.32.84.75.46.55.76.466.3

Females4.34.13.25.13.73.13.45.15.15.76.55.86.7

1992199319941995199619971998199920002001200220032004

4.24.23.94.83.12.73.64.95.45.265.66.2

19921993199419951996199820002001200220032004

29.138.434.530.7363830.226.522.425.723.2

18-24 years25-44 years45-64 years65 years and above

14.420.524.633.9

19921993199419951996199820002001200220032004

Males27.540.634.129.638.639.228.724.521.324.522.4

Females30.83634.731.83536.831.428.323.426.923.8

19921993199419951996199820002001200220032004

Age-adjusted prevalence28.837.733.729.534.436.527.925.221.124.621.5

1992199319941995199619971998199920002001200220032004

Overweight Only35.134.934.234.334.739.537.137.33835.437.737.737.6

Obese Only13.712.312.416.213.614.91819.120.921.822.92323.3

Overweight OnlyObese Only

18-24 years27.617.4

25-44 years37.622.9

45-64 years40.328

65 years and above40.520.4

1992199319941995199619971998199920002001200220032004

Males44.645.943.74244.550.747.145.746.344.146.744.346.3

Females25.523.72426.424.528.126.928.62926.228.73128.8

1992199319941995199619971998199920002001200220032004

Males13.111.61518.112.517.518.519.621.823.323.423.623.3

Females14.312.79.814.214.712.317.418.420.120.122.422.323.1

1992199319941995199619971998199920002001200220032004

Overweight Only34.734.233.734.134.439.136.836.238.135.138.237.737.5

Obese Only13.611.912.215.813.413.917.818.620.721.422.522.722.9

1992-19961997-20012002-2004

Crude prevalence15.121.121.5

Age adjusted prevalence13.623.423.9

1992199319941995199619982000200220032004

74.168.668.578.371.27676.18180.481

1992199319941995199619982000200220032004

Males79.471.370.480.272.179.281.384.783.484.6

Females69.266.266.576.870.17371.277.577.677.5

1992199319941995199619982000200220032004

73.768.368.978.87176.375.981.280.780.8

1992-19961997-20012002-2004

Crude prevalence75.882.778.7

Age adjusted prevalence75.282.579.8

1992-19961997-20012002-2004

Crude prevalence77.279.386.4

Age adjusted prevalence76.775.384.3

High blood pressureHigh blood cholesterolSmokingDiabetesNo leisure time physical activityOverweightObeseNot enough fruits and vegetables

With Stroke68.455.722.224.942.740.82885.3

Without Stroke24.432.420.5623.438.522.581.8

Causes of DeathMissouri, 2004

The PartnershipPublic Health (partial project funding source through the HDSPP funding from Centers for Disease Control and Prevention)Kansas Heart Disease and Stroke Prevention ProgramMissouri Heart Disease and Stroke Prevention ProgramCDC, CMSMid-America Coalition on Health Care (non-profit/non-governmental)Private OrganizationsFor-profit private large employers both health care and non-health care industries (14 employers)

The CoalitionMid-America Coalition on HealthcarePublic HealthPrivate Industry

Mid-America Coalition on Health CareKey to linking Public Health with multiple large employersAn employer-driven coalition 501(c)(3) non-profitNumber of employers/stakeholder organizationsIn existence for almost 30 yearsMission:To improve the health of employees and their familiesPromote employee and community wellness and illness preventionDevelop strategies and initiatives for containing business health care costsGenerate and communicate health care information to the communityMembership60 members (large and small employers)

Mid-America Coalition on Health CareActivitiesBreak down barriersFocuses employer energiesReduces health system complexitiesDevelop model programs and informs stakeholdersServes as a national model

Mid-America Coalition on Health Care Community Initiative on Cardiovascular Health and Disease2005 Mid-America Coalition on Health Care

What is the Community Initiative on Cardiovascular Health and DiseaseWorksite

Project ObjectivesIncrease employee participation in employer/plan programsIncrease knowledge of CV risks, prevention strategies and individual CV health statusImprove long-term health of employeesAssess the continuum of careReduce overall employer health care costs

CICV Phases and TimelinePhases I, II, III and IVPhase I Information Gathering (Literature review, Research Design: Jan June, 2005)Phase II Employer Buy-in and Baseline Assessments (Fall 2005 Summer 2006)Phase III Goals, Objectives and Implementation (Fall 2006 - 2008)Phase IV Measurement (2009)

Phase II: Baseline Assessment Tools

Productivity MeasurementMedical Claims AnalysisHealth Risk Appraisals Medical Screenings

Leadership Survey Heart Healthy Lifestyles Employee Attitudinal Survey Employer Worksite Wellness Environment Inventory Cardiovascular Health Plan Benefit Design Survey (CDC Heart-Healthy and Stroke-Free Worksites Toolkit)

Heart Healthy Lifestyles Employee Survey

To measure employees:

Knowledge of signs and symptoms of heart attack and stroke and heart disease risk factorsAttitudes about employer Involvement in health improvementHealth behavior most likely to improve and barriers Perceptions of worksite health improvement support, including leadership, management and co-workers.Preferences for receiving and use of employer health improvement information.Attitudes about health benefits

DemographicsResponse rate: 7,404 (22.4%)65% femaleAgeUnder 35 = 31%35-54 = 56%55 and older = 14%Ethnic 83 % Non-Hispanic3% Hispanic15% No ResponseRace85% White6% Black/ African American3% Asian, Native Hawaiian, American Indian7% No response

Demographics, cont.EducationHigh School or Less = 5.1%Some College or Trade = 18.9%College Degree or beyond = 76%PositionNon-Manager = 74%Manager = 26%Smokers No = 93%Exercise 3 times per week or more 60%Overweight 49%

Knowledge60% and 76% of respondents were able to identify five or more signs and symptoms correctly for heart attack and stroke, respectively.75% of respondents were able to identify the majority of heart disease risk factors.

Employer Involvement

Support

Perception of Support by Leadership, Manager and Co-workers in Efforts to Improve Health

Health Benefits

Perception of Employee Health Improvement Participation on Health Benefits and Costs

Information

Preferences for Receiving General Health of Health Improvement Information From Employer

Whats Next ?Reporting PlanIndividual Employer Report Integration PlanCombined with other CICV Employer assessment activities. (e.g. Benefit Design, Environment Inventory)Use results to:Identify and design CICV Employer interventions.Identify community resources to address findings (e.g. American Heart Association and Public Health)

CICV Phase IIIEstablish Goals, Objectives and Benchmarks (F06)Intervention Design: Connecting the Dots (F06)Based on Employee Survey and other assessmentsIncorporated into existing employer wellness plansCreate an evaluation plan (i.e. Phase IV)Implementation (Early 07 Fall 08)Individual and group activitiesTotal Time Frame: Fall 2006 Fall 2008

Connecting the Dots

CICV Phase IVMeasurement, Measurement, MeasurementScore CardsImprovement in baseline assessment scoresEnvironment InventoryBenefit Design LeadershipCreation of Replicable ModelTime Frame: Early 2009

Lessons Learned Up To This Point:

Public-Private Partnerships can workBe willing to learn from each otherDont assume employer viewpoints or concernsPrivate Partnership LanguageRealism of the projectLength of timeMACHC role in bringing Public Health and private companies together

Contact InformationMarti Macchi, MEdDirector, Special StudiesKansas Department of Health and EnvironmentOffice of Health Promotion1000 SW Jackson, Suite 230Topeka, KS 66612(785) 291-3743MMacchi@kdhe.state.ks.us