Thank you so much and welcome, everybody,
to the National Diabetes Education Program's
cross-cutting webinar on population health.
We have a wonderful audience and some wonderful presenters.
Our audiences really are from where people
live, work, and play.
About a third work for nonprofits.
A third work for the government, and about a third are involved
in the business world.
We also have some wonderful presenters,
with a lot of experience.
We have Dr. Ron Loeppke, who is vice chair of
U.S. Preventive Medicine.
He is past president of the American College of Occupational
and Environmental Medicine, and he also was the chair of
a workgroup that has updated the National Diabetes Education
Program's Diabetes at Work website,
which we will look at later.
Our second speaker is Dr. Jeanette May, who is a principal
investigator of a Robert Wood Johnson Foundation (RWJF) grant
that looks at how communities and businesses can get together
to improve the health of their communities.
So why are we here?
Hot off the press, in the past two weeks, there was an article
from Centers for Disease Control and Prevention (CDC) researchers
in the Division of Diabetes Translation that has shown that
the costs to people who have diabetes have increased.
And the reasons are that people are accessing more services, and
also that people are using more medication, and because
the costs of drugs have risen.
So we know that we have an epidemic of diabetes.
So what can we do?
The goals of this webinar include learning about the
benefits of population health management, where we all
live, work, play, and actually pray, as well.
We want to learn strategies to show how worksites, businesses,
and community organizations can work together.
What are some best practices?
Why does it matter?
The last thing is that we want you to learn about resources in
the public domain that everybody can access to help them manage
diabetes where people live, work, and play.
These are resources that everybody can use--
providers and consumers.
And we will go over those as well.
So, some background:
What is the National Diabetes Education Program?
We always use the acronym, NDEP.
NDEP was established in 1997, because we wanted to promote
early diagnosis, improve diabetes management outcomes,
and prevent and delay the onset of type 2 diabetes in people
who might be at risk.
It is jointly sponsored by the Centers for Disease Control and
Prevention and the National Institutes of Health.
We also have over 200 partners in many sectors--
federal, state, and private.
We also have stakeholder groups.
The group that is really involved in this particular
webinar is the Business Health Strategy stakeholders group.
This group includes business coalitions, groups such as
Population Health Alliance, health plans, state health
departments, occupational health providers, folks from
the American College of Occupational and Environmental
Medicine and the American Association of Occupational
Health Nurses, and others, of course.
We want you to make the community an integral part of
your health care team, as we said, where people
live, work, and play.
So I'll turn it over to Dr. Ron Loeppke,
who will start our webinar.
Thank you, Ron.
Thank you, Dr. Allweiss, and
thank you everyone for joining today.
It's a privilege to share some thoughts with you about
population health management, and I have
a lot of information to go through.
You will have access to all of our slides later, but
I will be moving quickly in the time available.
I want to talk about the "why," the "what, and the "how" of
population health management: why it's important, given the
converging trends that are really advancing the value of
population health management;
what the business case for it is, and why employers are
interested; and how it works-- actually examining some of
the attributes and results of successful workplace-oriented
population health management initiatives.
First of all, the converging trends:
There are epidemiological, political, cultural, and
financial trends that are driving the need and the
interest in population health management.
The epidemiologic trends include the global burden of health risk
and chronic illness; the age wave, the so-called silver
tsunami that is about to hit the health care system; and
the compression of morbidity as one of the
potential positive solutions.
The challenge, this global challenge, is the epidemic of
noncommunicable diseases that tend to drive mortality
because of unhealthy lifestyle behaviors.
We could call it the 5-5-75.
The five lifestyle behaviors-- physical inactivity, poor
nutrition, smoking, alcohol, medicine nonadherence--and
the five chronic conditions-- diabetes, heart disease,
lung disease, cancer, and mental illness-- that impact 75 percent
of the deaths worldwide.
The age wave: As we all know, our baby boomer generation is
hitting the beaches of our health care system.
There are over 10,000 people every day turning 65, and
there's going to be a lot of demand on the health system, in
large part due to a lot of lifestyle-related
illnesses and chronic diseases.
One thing to consider: Dr. Dee Edington has shown in many years
of research that, from a health care cost perspective,
it's actually the health risk that impacts costs more greatly
than the age of the individual or the population.
In other words, you can see the costs across the age bands, and
those for low-, medium-, high-risk individuals.
For example, an individual between age 35 and 44, but who
has high health risk, will have, on average,
about $5,700 in annual medical costs.
Whereas, someone that's greater than 75 years old,
but has low health risk, will also have around
$5,700 in medical costs.
So actually, risk trumps age in terms of
health costs in America.
In the United States, everyone is familiar with the fact that
over half of all causes of death are related to lifestyle,
but don't know that only 20 percent actually are related to
heredity, so we can't blame our parents for everything, for
the illnesses and conditions that we tend to develop.
In fact, one professor in my preventive medicine residency
said that largely, how we live dictates how we die in
the United States.
But some good news is the growing body of evidence and
science for a phenomenon called the compression of morbidity.
What we see is that, in America, people are born,
they get into their late twenties to early thirties, and
typically, they're at the peak of health; then, in general,
society tends to see their health deteriorate over time and
they actually get to a lower-than-acceptable
quality of life in later years.
By this time they're having multiple chronic conditions,
are on many medications, and are in and out of
emergency rooms and hospitals.
It could be different, though.
It has been shown that, if people just paid attention to
some of their healthy lifestyle--and I'm not
talking about being a marathon runner,
I mean actively getting some walking,
some physical activity, not smoking, eating healthier--
that they can actually postpone the age of this onset of
morbidity and compress it into a shorter time.
Their life expectancy can be increased by reducing health
risks, their quality of life can be increased, but then
they can "Live healthier longer and die more suddenly at
lower cost," or experience-- using a sports metaphor--
sudden death in overtime.
The reality is that it has been shown over a 30-year timeframe
that this does occur.
The political trends: We've seen the Affordable Care Act and the
National Prevention Strategy focus on aligning incentives
among consumers and providers and employers around improving
population health management and higher quality and lower costs
with some of the initiatives of the
accountable care organizations (ACOs), and
the patient-centered medical home (PCMH).
Just as a very brief reminder, ACOs are models that make
physicians and hospitals more accountable, outcomes-oriented,
and performance-based, with a goal to improve the value of
health services, control costs, and improve quality.
Similarly, Patient Centered Medical Home (PSMH) is more
about developing a primary care physician relationship and
whole-person and whole-population oriented
integrated and coordinated care--again, aligning incentives
around better clinical outcomes.
The cultural trends driving population health management
include a phenomenon in which I think that health is
becoming the new green.
In addition to the interest we have, as a society, in
a sustainable external environment,
I think there is an increasing interest in the sustainability
of our internal personal health environment.
There are the whole social networking game theory
applications that are innovating a lot of the
health care industry and motivating people to
maintain better health.
And with the mobile wireless technology that is transforming
the health care industry and the mobile apps, smartphones,
what's interesting is mobile technology is the world's
most ubiquitous platform.
In fact, more people have access to cellphones worldwide than
drinking water, electricity, or a toothbrush.
And we know from studies that are projecting where
this will be, that by 2020 it's suggested around
160 million Americans will be monitored and treated
remotely for at least one chronic condition.
There are those of you interested in the movement of
the mobile wireless apps that are underway.
There may well be a time where doctors even prescribe
evidence-based mobile health apps because it allows perpetual
connectivity and communication with consumers, with patients--
helping translate information into knowledge and knowledge
into action and getting reminders and notifications.
What about the financial trends?
Well the problem we all are aware of is the cost crisis.
But for the most part, it is caused by the
health crisis in our society.
Seventy-five percent of U.S. health care costs--
of the over $3 trillion now spent in health care annually--
is related to chronic diseases.
For every Medicare dollar spent, 96 cents are related to these
chronic diseases, and for Medicaid, it's 83 cents.
Dr. Dee Edington is a renowned researcher and has over 300
peer-reviewed medical journal articles of his research and
published books.
But the bottom line is that as health risks go,
so go health costs.
The great thing is, though, that as you reduce health risks
you can reduce health costs.
That's an important phenomenon that's driving the business
value of population health management.
We can always remember from the past the Benjamin Franklin
quote, that an ounce of prevention is worth
a pound of cure.
What we also recognize is that the bigger problem to
employers is the total cost impact of poor health.
By that, what I mean is we were able to do some research and
publish some studies documenting that for every
$1 of medical/pharmacy costs the employer pays out for their
employees, on average there are also $2 to $3 of these
health-related productivity costs: absenteeism, short-term
and long-term disability, or presenteeism, where
the worker is present but not performing as well because of
a health risk or a health condition
that's not well managed.
In fact, in that study, we looked at the top 10 medical
conditions driving medical/pharmacy costs and
see the typical top 10, with cancer being at
the top of that list.
But when you add in the costs of presenteeism and absenteeism,
it's a different top 10 list, with depression being the
number one medical condition with the highest total cost for
the employer community.
So it's an element of functional outcomes that we need to include
with financial outcomes when looking at the efficacy of care.
In fact, in one of the case studies I was able to be
involved with, in a public company, 58,000 employees,
the CFO estimated that there were eight days, per employee,
of health-related absenteeism and presenteeism.
And he asked the question, "If they got back one day per
employee per year of that current lost performance,
what would it be worth to that company?"
And for them, it is worth $18.8 million to their
EBITDA, or bottom line.
They traded at a 13 times multiple in
Wall Street, so that translated into a $240 million estimated
market cap increase.
They had 292 million shares outstanding, so it was
an increase of 84 cents in per share value if they could get
one day back per employee per year out of the eight days
currently lost to health-related absenteeism and presenteeism.
So the solution is really focusing on evidence-based
population health management.
We know that preventive medicine is a key component of that,
because CDC has shown that 80 percent of heart disease and
type 2 diabetes and 40 percent of cancer are preventable if
people just stopped smoking, ate healthy, and exercised.
Now, the thing is, we all know that.
Our grandmothers told us that.
But the challenge is, it says easy and does
hard for too many people.
And in fact, some people think more of the health of their pet
than they do themselves.
Therefore, what we see in the industry is this need and this
focus on overarching whole population health management
that includes primary, secondary,
and tertiary prevention.
Primary prevention--keeping the healthy people healthy.
Secondary prevention--earlier detection and diagnosis through
evidence-based screening.
And tertiary prevention--early intervention with evidence-based
care management to reduce morbidity complications and
costs of people with chronic conditions.
As an example, there is obviously a need for better
diabetes population health management.
Now, 86 million Americans have prediabetes.
Yet, 77 million are unaware.
Of the 29 million Americans that have diabetes,
8 million are undiagnosed.
You can see on down the line the challenges that we have in
really effectively treating and controlling and diagnosing
people with diabetes, as well as preventing those that have
prediabetes from developing diabetes.
We have examples in the literature that talk about
evidence-based population health management.
This is an example of the study that I was able to do with
Dr. Edington and others.
We analyzed the health risk assessments, blood test
screening results, blood pressure, and weight measured,
at baseline and after two years of a workplace wellness
personalized preventive plan.
We were able to show that there was a net/net movement out of
the high-risk segment of the population, out of the moderate
risk, and into a lower health risk category.
In fact, of the people that started out high health risk--
and this is defined as there are 15 individual health risk
factors, like blood pressure and fasting glucose, etc.
If you have five or more of those 15 risk factors that are
high, then you are in a high-risk category.
If you have three or four that are high out of the 15 you are
in medium risk, and if you have zero to two,
you are in low risk.
Of those starting out as high risk, after two years on their
personal preventive plan,
45 percent moved down to medium risk and 18.5
percent moved all the way from high to low risk.
So this is significant and is effective.
But I wanted to make sure it was clinically significant and not
just categorically significant.
So of, for instance, people that have elevated high-risk blood
pressure (meaning higher than 140/90), there were
923 people at baseline out of the 7804 people in the study
that had elevated blood pressure.
After two years on the preventive plan,
81 percent of those people, 744 of them, came down out of
the high-risk blood pressure category, and actually their
mean blood pressure rating was 123/77, which is normal.
So, it was clinically significant.
And the vast majority of those people were doing it without
medication, through lifestyle management.
There were similar findings related to fasting blood glucose
reductions and BMI and HDL and cholesterol.
As an example of population health management,
we also looked in detail through the claims data.
This is an example of an employer that spends over
$125 million a year in medical/pharmacy claims
costs on their workforce.
We analyzed what we call gaps in care, and for instance,
in that population, there were 1638 people that had diabetes.
Well, 525 of those had not had a hemoglobin A1C test in
the last 12 months.
So this helps target and know who to reach out to in working
with them to see their physician and close those gaps in quality.
As an example, there were 299 people for whom we had
medical/pharmacy claims data for one year prior to their
intervention of being on the diabetes care management
program, and then those data after
three years on the program.
You can see a dramatic reduction in hospital inpatient days per
thousand and per member per-month costs.
In fact, when you look over time, the three-year cumulative
cost savings, even after taking into account the cost of
the diabetes care management program,
the three-year cumulative savings was
$5.6 million on 299 people with diabetes.
And think how much those people appreciated not having to be in
the hospital as much either.
So in summary, again you will get the slides and can look at
it in more detail, but I think there are unique features and
benefits for each stakeholder related to population health
management--for the member patient, for the employer,
for providers, hospitals, and for public-private partnerships.
The overarching issue is that population health management,
when it is done well, and is evidence-based and
comprehensive, would help reduce the burden of risk and
illness in our entire society.
It would help unleash financial and clinical resources through
the enhanced capacity of physicians and hospitals.
It would help improve the health and performance of our nation's
workforce; it would help lower health care costs and,
ultimately, enhance the vitality of our nation's economy.
I wish you well, and now I will turn it over to
Dr. Jeanette May.
Dr. May.
Thanks, Ron, and thank you to the NDEP program for their
leadership role in this topic, and thank you to everyone
on the call today.
I will say that there are a lot of folks on the line, and
that is so exciting to see so much interest in the topic of
population health and public-private partnerships.
My name is Jeanette May.
I am going to spend the next few minutes talking about population
health, a culture of health, and public-private partnerships.
Ron really focused on--and I thought the data was amazing--
on the effects of poor health-- I really love the iceberg slide.
I'm going to focus more on the value of good health and
how bringing multiple stakeholders together
can really enhance that.
I have been actually involved in public-private partnerships and
healthy community efforts for probably over 20 years.
Most recently, I have been honored to be named the
principal investigator for a Robert Wood Johnson Foundation
grant that was given to the Health Enhancement Research
Organization, more informally known as HERO.
So HERO is a research think tank that is really focused on
health and wellness in the employer space.
But, as we all expand our thinking around population
health, so has HERO, which has really moved forward and
expanded its initiative into a couple of new areas around
healthy workplaces and healthy communities.
I will spend a few minutes talking about those initiatives,
but first, why are we expanding the way we think?
Well, it was clear from Ron's slides and the information that
he was able to share with us, that there is a good reason to
think differently about population health and to
look more at a holistic view that really kind of
lends itself to collaboration.
I was really excited that Ron mentioned Dee Edington and
some of the work that he has done in the area of
health and wellness.
As you know, Dee has spent decades working in this space,
and I was looking at some blogs this morning, and I saw that
Dee just hosted a blog.
I don't want to share the whole thing because it's quite long,
but it's about health and wellness and the direction that
we're all taking with this holistic view of
population health.
I do want to share a verbatim quote that comes from that blog.
Dee goes on to say, "Wellness works, so does
wellbeing and culture in collaborative ways.
We believe in collaboration, not competition, evolution,
not revolution, and cooperation, not going it alone."
I think that's really important when we look at this
health care landscape and as we begin to recognize the
value of public-private partnerships in creating
a healthy climate and culture and the impact that
this healthy climate and culture can have,
not only on individuals living, working, and playing in that
community, but other stakeholders who also
live and work in the community as well.
So the diagram here that I have in front of you represents all
stakeholders that touch and influence a community and that
community's health and wellness.
This was taken from the county health rankings, which is
an initiative also that was supported by
Robert Wood Johnson Foundation.
And it's clear here that there are many, many stakeholders
that touch and influence the health and wellness of
a community, and I think that's really important to understand.
And as Ron's last slide pointed out, there's value not only to
those community members of creating a culture of
health and wellness in a community, but there's also
value to all of those stakeholders
around the circle here.
A great example is, up to the left of the slide 48,
you see "health care".
Clearly, health systems that are located within communities and
are engaging employees who live and work in that community want
healthy employees in their workspace.
But also, they would probably benefit from
healthier patients coming in as well.
There's a healthy patient coming in with less comorbidity and
less risk, it's very likely that patient will recover from
whatever they're in the hospital for quicker,
with less complications.
And we can use that same scenario really for any of
the stakeholders around this diagram.
As I talked about earlier, I think as we speak about
population health and about expanding our holistic view,
it's really creating an evolution for many of
the stakeholders represented on this slide.
I thought this next slide was a great example of an evolution
for one of those stakeholders.
This is the business case development and evolution for
employers and businesses engaging in community health.
At the very left is the lowest level, years ago,
employers engaged in community health from
a compliance-driven [perspective], but to the
right of the evolution, we see businesses actively
engaged in healthy community efforts that benefit the
community, but also, as Ron clearly showed us,
also drive or enhance that business's performance.
So I think it's really important to understand that all
stakeholders--as we expand our thinking around population
health--are going through a similar evolution.
Certainly, public health, which was represented earlier in the
last diagram, is going through its own evolution as it's seeing
a more holistic view of health in the populations
that they serve, and how this lends itself, again,
to collaborations with all stakeholders living and
working in that community.
So, as I mentioned earlier, I'm the principal investigator on a
Robert Wood Johnson Foundation grant, with HERO,
that really looks at the culture of health
in communities across the country.
One of the first things that we did was to do a scan of the
environment to understand what kinds of public and private
partnerships are going on throughout the country and
how they're engaging and what kind of impact that we have.
I think what we learned very quickly was that the idea of and
the potential of public-private partnerships are prevalent in
many, many initiatives, even beyond the work that
we're doing at HERO with RWJF.
I've tried to present some of these efforts that we learned
about through our environmental scan and through other ways
that we've looked at healthy community efforts.
I want to chat about just a few of these, but I would
encourage folks who are on the phone today to go and
look at the different websites for a lot of these entities,
because there really is some amazing work going on in
the public-private partnership space.
Toward the top, there is the Robert Wood Johnson Foundation
culture of health, and that is part of our
own work within HERO.
So Robert Wood Johnson has focused its efforts around the
culture of health and is looking at ways to enhance a culture and
climate of health in communities so that individuals living and
working in those communities can make healthy choices and
that the healthy choice is really
the easy choice for those individuals.
All of us really are in the health and wellness space, and
making the healthy choice is not an easy thing.
I love the picture that Ron showed earlier of the individual
walking his dog while driving a car.
It's not easy to make healthy choices.
I've got a great example.
I live in a very, very rural area in the Midwest.
As is typical of small, Midwestern towns, we see about
six months of cold weather, and we have
a very aging population.
As a result, we have older adults who cannot find a place
to get out and exercise or take a walk on a regular basis,
especially during those six months of the year when,
literally, we see temperatures of 30 below and more.
So the public health department got together with the business
coalition and a few other folks in town to figure out
how we could tackle this problem in a collaborative way,
recognizing that we're a small Midwestern town with no malls--
so mall walking is out of the question.
We have no YMCA.
We do have a workout facility, but that costs money and many
older adults are on fixed incomes.
So lo and behold, through these collaborative efforts,
public-private partnerships, bringing businesses in the
community together with public health and the local hospital,
we started chatting about other venues where older adults could
walk, again, making the healthy choice the easy choice,
making the choice to exercise easy for these older adults.
Through a lot of discussion and a lot of collaboration,
we created a partnership with some of the local large home
improvement stores where they have very big aisles,
they have very long hours, and we found that five times around
the home improvement store is about a mile.
So we invited the retirement center's older adults to come
and do walking clubs within these home improvement stores.
So even though that's a small example, those are the kinds of
things that we have seen across the United States--
public-private partnerships coming together to solve
problems and to make the healthy choice the easy choice for
folks living and working in communities.
That is just one example.
Let me talk a little bit about-- down there toward the left of
the slide, on the bottom, is the Clinton Health Matters.
Clinton Foundation is working with, I believe,
five or six communities across the United States developing
very strong public-private partnerships to enhance the
health, culture, and climate of communities that
all look very different.
It's an amazing initiative, and I would encourage everyone to go
to their website and check out what they're doing.
There is the Institute of Medicine's Population Health
Roundtable that is really exploring this holistic view of
population health and what it means for
our health care landscape.
I think some of the reports that have been coming out of
the Roundtable have really helped us not only
understand what is really included in population health,
but also how important it is to come together as
a multifactorial stakeholder group and tackle population
health issues on a broader scale.
There's also a lot of work going on--some folks may have heard of
Bluezone Prevention Partners.
They also work in small communities looking at wellbeing
and prevention and trying to help folks find the right
partners to move forward.
My goal in showing this was to help you understand that this is
really a movement, a movement toward enhancing health at a
population level through public and private partnerships and
that it's a win-win for everyone.
I think some of Ron's slides, especially the last slide that
he had, really demonstrated the value to those stakeholders
engaging in these initiatives.
As I mentioned earlier, the Health Enhancement Research
Organization has several initiatives currently
going on in this space.
I want to talk about a few of those.
The first one is healthy workplaces and
healthy communities.
The goal of this topic is to create a website that will offer
lots of really great information to employers and to other
stakeholders interested in engaging in these kinds of
efforts, culture of health and healthy community efforts.
This is the landing page for this new website.
The website is not live yet;
I believe it will go live very shortly.
The goal of this website is to offer best practices,
case studies, some thought- provoking discussions, and
a lot of really great resources that will help
employers and other stakeholders to come together to work on
healthy community efforts.
When we were doing our environmental scan, we saw so
many great resources that really would help folks become
engaged and really have an impact through these kinds of
efforts, things that come out of the Federal Reserve,
the Collective Impact Model, and so many others.
One goal of this website is to bring all those great resources
together, almost as a one-stop shop, so that folks can take
a peek at everything that would help them enhance their
current collaboration or create some new efforts
within their communities.
The second initiative, and the one that I am spearheading as
the principal investigator, is a process that looks at
exploring the role of measures in culture of
health efforts around the country.
This is our work, HEROs work with Robert Wood Johnson
Foundation, and it's a three-phase effort.
The first phase of the project, and I touched on this a few
minutes ago, was an environmental scan of
what's currently going on in the health care landscape
around public and private partnerships to address
healthy community efforts and culture of health efforts
across the United States.
We had an opportunity to see so many amazing efforts and to
meet and chat with so many great folks from all different
stakeholder sectors about how they're
engaging in these efforts.
And we put that together in a pretty comprehensive report that
gives the lay of the land on what's going on in culture of
health and healthy community efforts across the country.
That is available on the HERO website and I also believe it's
available on the Robert Wood Johnson Foundation site as well.
Through that first phase, we were able to identify subject
matter experts who were working in these efforts and had
a sense of what worked well and where they were struggling, or
where there were challenges or barriers.
Our goal was to take a look at the measures because,
ultimately, we want to identify measures that resonate with all
stakeholders in these efforts.
We want to help to engage those stakeholders early on in the
process of creating these collaborations and then creating
measures that will encourage those stakeholders to stay
through the implementation and add value to the collaboration
but also to that individual
stakeholder's organization as well.
And so, through our environmental scan,
we identified three groups of subject matter experts.
We worked very iteratively with those SME groups to bounce ideas
for measures off of those folks and tweak those measures, so
that at the end of our second- phase report we had a series of
measure concepts that could be used in culture of health and
healthy community efforts to initially engage employers and
other stakeholders in these efforts, but also could be
used to measure the impact of those efforts.
Those measures would specifically resonate back with
the employers and the other stakeholders.
We did find that there were challenges in engaging all the
stakeholders, especially when there wasn't a common language,
and that measures that were currently used in these efforts
didn't resonate with stakeholders around the table.
So we clearly see this as an opportunity to enhance
public-private partnerships and
help move the entire effort forward.
That second report has just been completed, and we are entering
phase three of our work with the
Robert Wood Johnson Foundation now.
Our phase-three work is to begin to informally test the measure
concepts that we identified in phase two.
These are concepts that can be embedded in culture of health
and healthy community efforts to help those efforts engage
multiple stakeholders across the board.
We are going around the country, interviewing different sites,
and asking folks to work with us to informally
test these measure concepts.
So hopefully, by the end of the year, we'll have a final set of
measures that these healthy community public-private
partnerships can utilize as they're engaging stakeholders
and moving forward in their efforts to create healthy
cultures and climates in the communities where everyone
lives, works, plays, and prays.
We're very excited about our work with the Robert Wood
Johnson Foundation, and I think it's exciting that
HERO has partnered with RWJF and so many others to
help move this work forward.
I can't thank you enough for taking time to listen and
hear about our work.
Please visit our website and see some of the great reports that
we have been creating as a part of this work.
I think I will hand it back to Pam now.
Thank you so much, Dr. May and Dr. Loeppke.
Now, I want to talk about some of the resources, and
we will also have time for some questions and answers as well.
NDEP has developed many resources for people with
diabetes, for providers, and for consumers, and everything is in
the public domain.
We would love for you to come visit our website.
Our first website is the Diabetes at Work website, and
let me repeat that all of these slides and recording of
this presentation will be posted on the Diabetes at Work website
as well as the general NDEP website.
We have some clearance issues at CDC, so it may be a couple of
weeks, but we will be sending all of the participants a link
as soon as these slides are posted.
The Diabetes at Work website actually is 10 years old.
It was established because folks said we needed to unite the
world of diabetes care and the world of the worksite and
businesses, because at that time there really wasn't anything
that spoke to the needs of folks at the worksite.
So then a couple of years ago we said,
"Well, this needs a major revision."
So we asked a whole bunch of experts in many
different sectors to help us.
As I said, Dr. Loeppke was the chair of this.
They brought us topics, they brought us things that
we wanted to cover, and we'll go over the details in a minute.
This is one website we would love for you to go to,
the Diabetes at Work website, and give it a spin.
The other is the general National Diabetes Education
Program website, where you can find all types of materials on
topics from behavior change to nutrition.
We have information for providers.
We have all types of tear-off sheets to educate consumers,
let's say about their eyes,
about their teeth, about their feet, etc.
So we would love for you to come visit.
We also have a website about the primary prevention of diabetes.
As Dr. Loeppke mentioned, we can prevent type 2 diabetes in folks
who have prediabetes, folks who are at very high risk.
We also have to remember that prediabetes is a risk factor for
cardiovascular disease, as well.
So please come and visit
our general resources website, as well.
Here is our Diabetes at Work website.
As Dr. Loeppke mentioned, depression is one of the
major contributors to decreased productivity.
We just happen to have on our Diabetes at
Work website a continuing education (CE) program.
Somebody asked if there was CE credit for
this presentation, and no, there's not.
But there is a presentation on diabetes and depression at
the worksite that does offer continuing education credit, and
you can access it through the diabetesatwork.org website.
I wanted to bring that up because that was a question
we received in the chat.
If you look at the Diabetes at Work website,
we tell people, what is the website for?
What do we want people to find here?
It's a resource for things from CDC National Diabetes
Education Program, but we're also trying to be almost like
a clearinghouse to connect people with other programs
such as NIOSH, the National Institute for
Occupational Safety and Health.
CDC has a National Healthy Worksite program, as well.
So we have compiled many links to help people look at various
resources that can help them either establish
a program at their own worksite or have
resources for programs that are already established.
When we asked the folks who registered how they got
materials, many said that they worked with contractors,
with vendors, some said that they get their resources
online, and some actually have
occupational medicine professionals onsite.
This website can help everybody because it will have resources
that you can download and you can even put your own logo on
if you would like to.
We will be continually updating it with
news articles, new numbers, etc.
We have resources, like a "game plan" fat and
calorie counter that's very popular.
People want something so that they can track their progress.
We have lesson plans about foot care.
We have lesson plans about nutrition.
We will be developing more lesson plans with
the occupational health nurses to serve their needs, as well.
We also have a new feature, Ask the Expert.
Our stakeholder group folks are very loyal, and
for the past 10 years every question that has come into
Diabetes at Work has been answered by a real person.
So if you do have questions,
eventually somebody will answer those questions.
We have information about diabetes basics, from the
definition of diabetes, how to prevent type 2 diabetes,
the emotional health of folks with diabetes, and
also diabetes in pregnancy, because at some worksites
that might have a lot of women of childbearing years,
certainly diabetes during pregnancy,
gestational diabetes, is an issue.
We have information about that as well.
We have materials so that you can plan a program.
You want to understand your environment.
You want to make a business case.
There are resources there for you.
We want to help you build your worksite wellness program.
So how do you develop a culture of health?
A culture of wellness?
What are some program activities that you can do, and
how can you connect with the community as well?
So we would really love for you to go on to the
National Diabetes Education Program's general website and
the Diabetes at Work website and just navigate, explore, and
see what you can find.
So, I would like to start out with some of the questions
we have received.
The first question is "How do you measure presenteeism?"
I believe Dr. Loeppke brought that up.
"Presenteeism" is when people are at work but they are not
performing at 100 percent.
So I'm going to turn it over to Dr. Loeppke.
Dr. Ron Loeppke: Thank you, Dr. Allweiss.
There are actually several validated instruments,
questionnaire tools that have been shown to
effectively measure presenteeism.
There are different ones.
One is from Dr. Ron Kessler at Harvard Medical School;
the tool that he put together, along with the
World Health Organization, is the HPQ instrument.
It stands for the Health and Work Performance Questionnaire.
There's also a tool by Dr. Kim Pelletier called the
Stanford Presenteeism Survey (SPS), as well.
Another one, by Dr. Deborah Lerner from Tufts University, is
called the Work Limitations Questionnaire, the WLQ.
And there are others.
These have been tested and validated with some objective
measures of workplace performance and have been
shown to be very effective measures of the impact of
presenteeism that an individual is experiencing.
Then you can see how various populations, over time--
sometimes pre-/post-intervention of an initiative--
could be measured in terms of presenteeism impact.
So, unless there're other questions, or you have other
input, Dr. Allweiss, I'll leave it at that.
Dr. Pam Allweiss: That's perfect.
In the Diabetes at Work web site we do reference
a couple of those, but we will collect these and
we will have the direct links for everybody.
So afterward, Dr. Loeppke and I will compile these links for
everybody and we'll put them under the presenteeism section.
The next question is "Would you speak to the lexicon challenges
among stakeholders so that communication is optimized."
I guess that's asking about some of the barriers that folks might
have--that communities and worksites might face.
I'll turn it over to Dr. May.
Dr. Jeanette May: Great question.
I think that's a really interesting question as well.
I took it to mean "How do we overcome the language barriers
that exist in these kinds of collaborations?"
The reason why I think that way is because we, actually HERO,
convened a variety of experts to talk about challenges and
barriers in creating the business case for
stakeholders to engage.
One of the findings of that convening was that language is
a challenge when you bring lots of
different stakeholders together.
So I have a master's in public health and I actually teach
public health for a master's program at a university, and
I also, early on in my career, worked in
a large integrated delivery system.
I can tell you, the language that is spoken in a health
system, the language that is spoken in a public
health department, and the language that is spoken in
an employer setting are all very, very different.
We interviewed different healthy community efforts around the
country and we asked them "What are the challenges that you face
when you try to bring stakeholders together?"
The number one concern was the idea of, "We think this is
a good measure, but they [other stakeholders] don't get
why this is an important measure."
It wasn't so much about the measure as it was
about the language.
I do believe--and there's a lot of really good research out
there on this topic--I really do believe that measures
can work to rally the troops around a common goal,
a common language.
I think that's why HERO was so excited to receive the grant
from Robert Wood Johnson.
Because we do believe that the right measures, ones that truly
resonate and are able to be understood by all the
stakeholders around the table in these efforts,
really will rally the troops.
They will eliminate a lot of those language barriers that
these stakeholders face when they come to the table with
different views and different ways they think about things.
So great question, thank you for that.
Dr. Ron Loeppke: Thank you for that response,
Dr. May, and just to add, it stimulated the thought that
really, in work--I've had an opportunity to do meetings
across different stakeholders, so talking with employers or
hospital health systems or health insurance companies or
individual patients and consumers and my practice
over the years, these other public and health department,
public-private partnerships-- a common framework that
I hear resonate is what Dr. Don Berwick talked about in terms of
a triple aim for our nation in terms of health.
I think everyone is familiar with that, but in essence,
the triple aim that he talks about is the fundamental
underpinnings of population health management.
That triple aim is 1) better health for the whole population,
2) better health care for those who have conditions that
need care, to generate better value, higher quality, and
3) lower cost.
When we think of all the different stakeholder roles,
that's a very common language and framework and a laudable
goal that each would benefit from, whether
they're an individual, a family, an employer,
a community, a state, or our nation.
Dr. Pam Allweiss: Thank you.
That was a wonderful summary.
We do have two more questions.
For Dr. May, "What were the three areas you identified in
phase two of HERO?"
Dr. Jeanette May: Great question.
These are measure concepts, so they are more areas than
they are actual formal measures.
They are in two buckets--one bucket has those measures that
incentivize folks to come to the table initially, and then
a bucket for those measures that encourage them to stay.
I will say that the first bucket focuses on measuring--
demonstrating commitment, having the right convener, and
understanding the strength of the collaboration and
the commitment to the collaborative effort,
as well as to health and wellness, in general.
Then the other bucket, which are some of the measures that
Ron touched on in his presentation--what are those
measures that resonate and hold value for all of the
stakeholders at the table?
We do believe that those vary based on the needs assessment
and the goals identified by those community collaborative
efforts, but ultimately they are about those high-level
quality-of-life, productivity, safety, and performance themes,
and some were in between.
They're about who in the community and who among those
stakeholders is committed to health and wellness and about
how can we utilize those employees to become advocates
and champions in the community effort.
But again, they're concepts right now, and
that's what we're exploring.
I would definitely say check back on the HERO website like
the third quarter of this year and we'll have a lot more
details for you on it then.
Dr. Pam Allweiss: Thank you.
And we will also post the HERO website on the national
Diabetes at Work website as well.
We have two questions.
"Do you have any curriculum for chronic disease management
population base?" Definitely www.improvingchroniccare.org,
Dr. Ed Wagner's program, has a lot on the chronic care model
and you can find information there.
Another question is "Is there a benchmark for developing
a results-oriented program that can definitively measure
change through data to demonstrate to stakeholders?"
Because this is very important, both of you can answer that.
Whoever wants to go first, take it away.
Dr. Jeanette May: Ron, be my guest.
Dr. Ron Loeppke: Okay.
One follow-on thought to the prior question about
chronic disease management, population health management.
There are some great resources out there.
The American College of Occupational and Environmental
Medicine does have educational resources and even some training
curriculum around health and productivity management and
population health management and will have increasing levels of
resources in the year ahead.
In addition, there's a textbook on population health management.
It's on one of my slides.
So when it comes out, the reference is on there, but
it's called, Population Health: Creating a Culture of Wellness.
Dr. David Nash is the editor-in-chief of that book.
Those are a couple of thoughts.
In terms of benchmarks, just one that I would offer
as a reference for later--it has a compilation of other
references built into it--is a published article
that came out in September.
Dr. Ron Goetzel was the lead author.
I happen to be one of the coauthors as well, but
many people put that together.
The title of the article was,
"Do Workplace Wellness Health Promotion Programs Work?"
It's in the Journal of Occupational and Environmental
Medicine and I will make sure I give you that, because
it helps establish the kind of benchmarking and
the kind of data elements and metrics that are encouraged when
you try to evaluate the impact of any pre/post intervention.
So with that I will turn it over to Dr. May.
Dr. Jeanette May: Sure, just to add that, from a community
perspective I do think that this is something that we are
working on, and I showed the landing page for the
HERO Healthy Workplaces, Healthy Communities website.
So no formal benchmarking exists, unless you look at
county health rankings from a community perspective, but
I do believe that HERO is working toward creating
a database, if you will, of best practices and
comprehensive case studies that will give the underpinnings and
the framework of some successful programs.
We hope, with measures included as well, that
folks can use these to demonstrate to stakeholders,
"This works. We think we've got it right.
Come on board and lend us a hand."
Dr. Pam Allweiss: Thank you so much.
Our time is up.
I want to thank our speakers.
I want to thank our audience, and I want to thank the
National Diabetes Education Program.
Please fill out the survey that you will
receive immediately after this call.
It helps us improve all of our programs.
If you do have any other specific questions,
please email me.
My email is on the last slide, pca8@cdc.gov, and
we will have one of our speakers answer the questions.
Thank you so much, everybody. Bye.