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Sodexo’s Population Health Management Approach & the Key Role of Registered Dietitian Nutritionists

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Population Health Management (PHM Defined)

Population Health Management, or PHM, is a broad effort whereby individual-, organizational- and cultural-level interventions are planned and implemented to improve the disease burden of entire groups or populations. By keeping people well at the onset, PHM strategies can be used to decrease overall health care usage and to encourage primary prevention efforts that avoid future overuse of the health care system. Taking into consideration the social, economic, environmental and behavioral factors that contribute to health disparities and continuum of care, PHM takes a systematic approach by stratifying populations across health-risk profiles and applying different behavioral strategies to mitigate further risk.

The purpose of this white paper is to highlight Sodexo’s PHM initiatives, with specific emphasis on nutrition and wellness solutions that go beyond food, to help employees and other populations achieve optimal health. The role of the RDN (Registered Dietitian Nutritionist) in these efforts will also be discussed, and case studies and examples will be provided to illustrate the outcomes achieved by Sodexo’s PHM solutions.

“Not only do providers need to concern themselves with patients who seek care, they also must engage whole populations in order to meet expectations. A population-driven, patient-centered model of care can meet the needs of all consumers regardless of where those consumers are on the continuum of health. With primary care at the center of a model surrounded by support that includes a combination of health information technology, the care team and ancillary providers, diverse care needs can be met, quality can be improved and cost will be sustainably impacted.”

- Care Continuum Alliance, 2012

POPULATION HEALTH MANAGEMENT

Sodexo’s Population Health Management (PHM) Approach and the Key Role of RDNs (Registered Dietitian Nutritionists)Jennifer M. Petrelli, SM, MPH, Nutritional Epidemiologist, Innovations 2 Solutions by Sodexo

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Why does Sodexo Focus on PHM?

The CDC reports that nearly 50% of all adults (or 117 million people) have one or more chronic health conditions and 25% have two or more chronic health conditions. Many of these issues are caused by preventable risk factors, such as poor nutrition, lack of physical activity, sleep deprivation, alcohol dependency, or smoking addiction. Employee health and well-being can have a significant impact on the overall performance of the organization. In addition to having healthier, happier employees, organizations can save millions on health care and disability costs. They can also benefit from increased workforce productivity, reduced employee absenteeism, and decreased rates of injuries and accidents.

Sodexo partners with organizations to develop and deliver programs that improve the health and well-being of employees through modification of one or more of these risk factors. Company-sponsored wellness programs offer structure, motivation and tools that drive positive change. However, many institutions don’t follow through with their plans for a Population Health Management strategy. Few understand its theoretical foundations, and even fewer understand the importance of multi-stakeholder collaboration to make PHM strategies successful. Sodexo brings together our subject matter experts in diet and nutrition, epidemiology, and outcomes-based research to work with the system in order to leverage research and practice to create the best possible outcomes. Any true approach to PHM is collaborative and co-created.

A Harvard University study of 100 peer-reviewed journal articles, Workplace Wellness Programs Can Generate Savings, found that a properly designed wellness program that includes chronic disease management yields impressive ROI. The analysis showed that medical costs fall $3.27 for every dollar spent on wellness programs, and absentee day costs fall by $2.73 for every dollar spent after three years.

The Role of RDNs in Population Health Management

When we think of professionals working in the Population Health Management (PHM) arena, we often think of doctors, nurses, epidemiologists and other public health professionals. However, Registered Dietitian Nutritionists (RDNs) are an overlooked and untapped resource in PHM efforts.

RDNs translate the science of nutrition into practical solutions for healthy living. They have a unique skill set coupled with the ability to bring about behavior change in a wide range of populations. Specifically, RDNs bring value to multidisciplinary teams by providing care that can lead to improved outcomes for people with a variety of health risks, morbidities or medical conditions.

“All stakeholders within the health care system need to recognize and embrace the value and multidimensional role of the RDN. Studies confirm positive outcomes and cost-effectiveness of medical nutrition therapy (MNT). As the population changes to include a greater number of older individuals with multiple chronic diseases, the role of the registered dietitian nutritionist will become even more crucial to effectively manage this population.”

- Sonja L. Connor, MS, RDN, LD, FAND, President of Academy of Nutrition & Dietetics

A large body of research has shown that disease prevention and intervention via nutrition can have a significant public health impact. In addition to providing nourishment and preventing the onset of chronic disease, research shows that consuming the right nutritional mix contributes to cognitive performance and improves mental clarity, energy, focus and even memory. In the workplace, these outcomes are especially significant, as they are directly correlated with employee productivity and performance. It’s not just about decreasing absenteeism via a healthier workforce; it’s also about decreasing “presenteeism” among employees – that is, reducing the amount of time they are at work but not fully focused and engaged.

Sodexo fully recognizes that RDNs are the force multiplier in PHM strategies to maintain or improve health and well-being among low-risk populations, and combat chronic disease and other medical conditions among high-risk populations. Our more than 4,700 RDNs play a key role in developing and implementing our PHM solutions, which will be subsequently described.

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Meeting Population Health Needs: Sodexo’s Suite of Solutions

Our partners recognize that disease prevention via nutrition and wellness solutions is good business sense. In the current healthcare climate, what business cannot afford to invest in prevention? PHM strategies are key to prevention and cost control.

Sodexo creates tailored nutrition and wellness programs based on client needs (see Figure 1). The following sections will describe these solutions in greater detail, and case studies will be provided that showcase some of the outcomes we have achieved with our partners.

Medical Nutrition Therapy for Diabetes and Kidney DiseaseAs part of our community outreach, Sodexo’s RDNs have counseled over 20,000 people with diabetes in 86 locations — from Hawaii to New York. The resulting statistical outcomes, HgbA1C (lab test indicative of diabetes management) and weight, were assessed at very significant and greater than national averages.

Sodexo’s Core4™ ProgramsSodexo offers three Core4™ programs: Core4™ for Adult Weight Management, Core4™ for Pediatrics, and Core4™ for Diabetes. All of these programs were developed by RDNs using proven evidence-based

methods. The Core4™ programs are also taught by RDNs, who help participants learn how to improve their eating habits, lifestyle and activity choices. In addition, participants are taught how to maintain their weight loss and lifestyle changes in the long-term. The program is 100% reimbursable by some insurance plans.

Sodexo’s Core4™ for Adult Weight Management is offered as a 3-month or 12-month program. Both programs include 12 one-hour weekly sessions; however, after the first 12 weeks the 12-month program continues with 9 additional monthly sessions. Each week, different aspects of weight loss are addressed, including portion control, choosing foods wisely, why extreme diets don’t work, food labels and exercise. Core4™ gives participants the support they need not only to lose weight, but also to maintain weight loss.

Core 4™ for Adult Weight Management has been included in several hospitals’ employee wellness programs with significant ROIs. Over 5,000 people have completed the program at 26 sites from New York to Texas. Many clients include Core4™ in their employee wellness program free of charge or subsidized. The program has been shown to have statistically significant outcomes: the 3-month program produced an average weight loss of 4%, and the 12-month program’s weight loss increased to 7.6%.

Figure 1

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• Preferred One pays 100% for Core4™ for all beneficiaries regardless of weight• 634 participants completed Core4™ over 3 years• Average weight loss in 12 weeks: 4%• Average waist inches lost: 2.5 inches• Total weight lost: 4,150 pounds• Total inches lost: 1,160 inches

Virtual Counseling: Denver Wellness and Nutrition, a Sodexo Company

Virtual nutrition services through Sodexo’s Denver Wellness Center can provide services anywhere in the U.S. The Center’s RDNs provide expert, evidence-based nutrition counseling through individual sessions, group classes and virtual appointments. They are trained specialists in family meal planning, weight loss, weight management, diabetes, gestational diabetes, high cholesterol, hypertension, cancer, food

intolerance allergies, pregnancy, pediatrics, gastric bypass, lap band, Celiac Disease (gluten sensitivity), inflammatory bowel disease, and renal insufficiency and have training in the scientific principles of medical nutrition therapy. Clients include Google, AOL, Cronkey Sports, Trust American Rose Preventative Medicine, and Skyridge Medical Center.

Sodexo’s Comprehensive Malnutrition PlatformSodexo’s Comprehensive Malnutrition Platform is a program that coordinates identification and documentation of malnourished patients, and provides interventions to improve their quality of care, optimize outcomes and maximize reimbursement. The program addresses the challenge of identifying and treating patients with nutritional needs, as it is not always easy to recognize malnourished patients. Malnutrition can lead to chronic disease, and during an acute illness, can slow patient recovery and may lead to death. Training dietitians to identify, document and treat patients early in their hospital stay improves overall patient outcomes and plays a key role in reducing readmissions. The results of Sodexo’s Malnutrition Coding Study show that the average 300-bed hospital will capture an additional $250,000 a year with program implementation.

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Essentia Health

Essentia Health partnered with Sodexo and successfully addressed the challenges of identifying and treating patients with nutritional needs. Sodexo’s National Nutrition Team provided solutions to this complex problem by implementing Sodexo’s Malnutrition Documentation Program, which includes proper training for clinical and nutrition-focused clinical assessment of patients, accurate medical record documentation and coding procedure to ensure compliance with CMS regulations, as well as technical support to identify and capture all allowable reimbursements. The program results were positive: Essentia Health achieved a substantial increase in potential reimbursement dollars, annualized at $216,760, in the first seven months of implementation.

Key Highlights of Essentia Health and Sodexo’s Comprehensive Malnutrition Program Partnership:• Successful implementation of malnutrition coding assessment and training program• Ensures regulatory Compliance with CMS Conditions of Participation for Malnutrition coding• Improves malnutrition diagnosis capture rate and allowable reimbursements

Client Perspective“Talk about hitting a wall and climbing right over it. This program is proactive, innovative and brings value and best practices to our organization.”

-Doug Vang, Vice President Inpatient Care, Essentia Health

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YLehigh Valley Network provides the following services:

• Sodexo’s Core4™ for Adult Weight Management program is reimbursed for Lehigh Valley Network employees under their wellness benefits.

• Dietitians provide community education programs via Million HeartsR, a national initiative co-led by CDC and the Centers for Medicare and Medicaid Services (CMS), to meet the national goal of preventing 1 million heart attacks and strokes by 2017.

• Sodexo Dietetic Interns engage consumers in food deserts to support Cooking Matters, a collaboration between Share Our Strength and local program partners. Cooking Matters provides families with hands-on education as they shop for food, teaching them how to compare foods based upon cost and nutrition.

• Sodexo’s Sports Nutrition services at LVHN Fitness use Olympic guidelines to assess, educate and provide counseling based on the type of activity in which you engage.

• A Healing Herb Garden was created under the leadership of Sodexo’s Executive Chef, a cofounding member of Grow Leigh Valley, which is a collaboration of Sodexo culinary teams in the Lehigh Valley that sources fresh, local, sustainable and seasonal ingredients.

“MUSC continues to display their dedication to population health improvement and innovative spirit by implementing environments and programs, supported by policy, that provide employees, patients, and community with easy access to the healthiest choice. MUSC has accomplished amazing things in a short amount of time, but more impressive is their willingness to share the lessons learned and successful strategies to lift up worksite wellness culture in hospitals and businesses throughout SC, as a Working Well Center of Excellence.”

-Jen Wright, Working Well Manager

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MUSC, Sodexo, and the Gold Apple Hospital Award

Sodexo has partnered with the Medical University of South Carolina (MUSC), a 725-bed acute care academic medical center, to deploy key PHM strategies tailored to the MUSC culture and environment. MUSC is one of 10 Sodexo hospital partners in South Carolina that has been recognized as a Gold Apple hospital for “providing the highest standard of excellence for the healthy food environments offered to employees, patients and visitors.” MUSC received this acknowledgment for the first time in 2012 from Working Well, which is an effort to improve the health of hospital employees across the state of South Carolina by creating worksite wellness environments where the healthy choice is the easy choice.

In 2013, MUSC was named a Gold Triple Threat hospital. To earn the Gold Triple Threat designation, a hospital must reach the highest standard of excellence and earn Gold in all three pillars: Gold Star for tobacco, Gold Apple for nutrition and Gold Medal for physical activity. MUSC also received the 2013 Prevention Excellence award from NCPP in recognition of their efforts to create a culture of wellness.

In order to earn Gold Apple recognition, MUSC worked in collaboration with Sodexo to create healthy food environments supported by comprehensive policies and systems. Hospitals earn the Gold Apple Award by implementing five key components to a healthy food environment: pricing, access, marketing, benefits, and incentives. Sodexo’s chefs, nutritionists, and researchers carefully craft menus, education initiatives, and nutrition resources for clients that are informed by the most up-to-date evidence-based research on diet and health.

The complete MUSC case study can be found on Sodexo’s I2S Knowledge Library.

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ConclusionPopulation Health Management is an approach designed to shift the focus toward wellness using a broader perspective that promotes improved health outcomes for entire groups or populations. In order to be optimally effective, however, PHM efforts must be developed and implemented by collaborative, multidisciplinary teams. Registered Dietitian Nutritionists are an essential part of PHM initiatives, and Sodexo fully recognizes and embraces the value and multidimensional role of RDNs on any PHM team.

The goal of Sodexo’s PHM approach is to engage partners to improve population and community health in a comprehensive way, with an emphasis on prevention. Whether in the workplace or in healthcare settings, the path to population health is via well-being improvement. Sodexo recognizes that well-being involves not only keeping people healthy, but also reducing lifestyle risks, and optimizing care for those with known conditions or chronic disease.

We strive to create unprecedented opportunities with our partners to implement evidence-based programming that drives real health and fiscal outcomes. Our suite of nutrition solutions – including Medical Nutrition Therapy, Core4™, Virtual Counseling, and our Comprehensive Malnutrition Platform – establish best practices in population health and have been proven to be effective in transforming health, well-being and care. In fact, Sodexo has improved the wellness state of the organizations we partner with, and we are confident we can do the same for other clients.

Sodexo9801 Washingtonian Blvd.Gaithersburg, MD 20878888 SODEXO 7www.sodexo.com