healthy living: your links to personal and professional success! · 2018. 2. 21. · healthy...

Healthy Living: Your Links to Personal and Professional Success!

Todd Whitthorne

President, ACAP Health

twhitthorne@acaphealth.com

Ownership Thinking, 2013

Times Have Changed

Times Have Changed!

Ozzie and Harriet Ozzy and Sharon

A Frightening Collision

Public Health Trends (obesity, diabetes, physical inactivity, etc.)

Affordable Care Act (Obamacare, ACA, PPACA)

Yikes!

You’re Kidding!

• For the first time in 1000 years,

future generations are likely to die at

a younger age than their parents

New England Journal of Medicine, 2005

• Why?

Chris Huckabee

Test Feb 2011 Total Cholesterol 285 HDL Cholesterol 57 LDL Cholesterol 179 Ratio 5.0 Glucose 94 Triglycerides 246 Blood Pressure 142/102 hsCRP (C-Reactive Protein)

Vitamin D 25 BMI 31.2 Waist Circumference 42 Weight 220.4 Treadmill Time 13:11 Fitness Category Very Poor

February, 2011

Chris Huckabee

February 2011, 220 lbs April 2012, 172 lbs

Chris’ Risk Factors

Test February 2011

April 2012

Total Cholesterol 285 192 HDL Cholesterol 57 82 LDL Cholesterol 179 90 Ratio 5.0 2.3 Glucose 94 98 Triglycerides 246 78 Blood Pressure 142/102 122/77 hsCRP (C-Reactive Protein)

2.06 0.71

Vitamin D 25 62 BMI 31.2 24.28 Waist Circumference 42 33.7 Weight 220.4 172.6 Treadmill Time 13:11 25:37 Fitness Category Very Poor Superior

If you have 100 employees, then statistically:

69 are overweight

36 of those are obese

12 have diabetes (3 don’t know it)

39 have prediabetes

33 have high blood pressure

17 have high cholesterol

If you have 100 employees, then statistically:

33 have high triglycerides

19 smoke

95 fail to get enough exercise

62 have sleep issues

77 struggle with stress

9 suffer from depressive issues

Now the question is....are you doing anything about it?....and is it working?

What’s Preventable?

• 80% of CVD and diabetes

• 60% of cancers

• 90% of obesity

74% of all health care costs are confined to these four conditions!

The Shape of Things to Come The World’s Expanding Waistline

The Economist, December 2003

Obesity Over Time Percentage of obese adults, ages 20 to 74

Centers for Disease Control and Prevention

Obesity Over Time Percentage of obese adults, ages 20 to 74

Centers for Disease Control and Prevention

18.4% Archives of Pediatrics & Adolescent Medicine, April, 2009

5% Severely Obese “Ominous trajectory” David Katz, M.D.

Circulation, September 9, 2013

Rate of Diabetes

• 2010 26 million diabetics

• 79 million prediabetics

Centers for Disease Control, 2011

• CDC projects that by 2050,

one in three adults could

have diabetes!

Annual Cost of Diabetes

• $2,669 Without Diabetes • $5,000 Pre-diabetics • $10,000 Diabetes without Complications • $12,000 Undiagnosed Diabetics • $30,000 Diabetes with Complications

United Healthcare studies, 2010

Diabetes Prevention Program (DPP)

• 3234 individuals at risk for diabetes

• 27 centers including PBRC

• 3 groups

– Placebo

– Metformin

– Lifestyle modification

• Goals: 7 percent weight loss through 150 minutes

per week of PA & dietary modifications

• Mean follow-up 2.8 years

New England Journal of Medicine, February 7, 2002

N Engl J Med, February 7, 2002

New England Journal of Medicine, February 7, 2002

DPP Results

Placebo Metaformin Lifestyle

-58% -31%

Metabolic Syndrome

Waist Circumference (Men >40”, Women >35”)

Triglycerides (>150 mg/dL)

Blood Sugar (>100 mg/dL)

Blood Pressure (>130/85 mmHg)

HDL Cholesterol

(Men <40mg/dL, Women <50 mg/dL)

AHA/ATP III

So here’s the problem…

Metabolic Syndrome increases

the risk of:

Diabetes 7 times

Heart disease 3 times

Stroke 2 times

Medical spend 4 times

Lost work days 2 times

Year Total

Screened % Mets Employees Screened % MetS

Spouses Screened % MetS

2,701 26%

2,701 26% * *

4,078 27%

2,834 21%

1,244 34%

4,329 22%

3,000 19%

1,329 29%

3,997 20%

2,737 19%

1,260 26%

3,562 16%

2,449 15%

1,113 18%

MetS Intervention Actual Case Study

Metabolic Syndrome Over Time:

With and Without Intervention

21% 19% 19%

0 1 2 3 4

With MetS Intervention

34% 35% 32%

30% 31%

0 1 2 3 4 P

Without Intervention

Metabolic Syndrome Over Time:

Monthly Cost of Healthcare

638 642 665 668

0 1 2 3

With MetS Intervention

567 631

710 781

0 1 2 3 4 P

Without Intervention

KFC Double Down

540 calories, 32 grams of fat

Denny’s Fried Cheese Melt

895 calories, 34 grams of fat

Denny’s Mac n’ Cheese

Big Daddy Patty Melt

1,600 calories, 99 grams of fat

Peanut Butter and Bacon Shake

Nutrition Facts 1720 calories 1060 calories from fat 118 grams of total fat 55 grams of saturated fat 1210 mg sodium 128 grams of sugar

Changing Gears

David Jacobson, New Yorker, 2012

Any history of physical activity in your family?

Get a Move On!

● 1,765 men and women examined at

Cooper Clinic in 1970s and 1980s

● Evaluated fitness using Balke treadmill

stress test

A.H.A. Prevention Conference, March 2010

Get a Move On!

• If you are fit in mid-life, you double

your chance of surviving to 85

A.H.A. Prevention Conference, March 2010

Dr. Jarett Berry Cardiologist U.T.S.W. Medical Center

• If you’re not fit in your 50s, your

projected life span is eight years

shorter than if you are fit

So What’s the “One Thing?”

If you had to pick one thing to

make people healthier as they

age, it would be aerobic

exercise.

Professor James Fries

Stanford University Medical Center

The One Thing

Changing Gears (again)

It’s Simple!

Price x Utilization = Cost

That’s it!

Growth of Health Care Costs

Towers Watson/NBGH

Value Purchasing Survey, March 2012

Change in Network Discounts

42% 44%

47% 47% 48% 49% 51%

54% 57%

2004 2005 2006 2007 2008 2009 2010 2011 2012

Change in Average Network Discount Facility IP & OP

• National carrier

change in facility

network discounts

since 2004

Diminishing Discount Value

100 100 100 100 100 100 100 100 100 100 100 100

104 114 125 139 157 167 178 181 185 193 207 218

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Hospital Retail Price vs Actual Cost

Markup

Source: MedPAC analysis of American Hospital Association Annual Survey of Hospitals

The Physical Impacts of Obesity

Normal joint force Joint with increased pressure due to obesity

Where Does Obesity Hurt?

Shoulder (rotator cuff) Wrist (carpal tunnel)

Where Does Obesity Hurt?

Cost of Obesity in Workers Comp

• Matched-pairs framework, N= 2 million+

• 36 states, nine injury years

• Obese claims vs. non-obese claims

2.8 times more expensive at one year

4.5 times more expensive at three years

5.3 times more expensive at five years

Laws and Schmid 2010 National Council on Compensation Insurance

Obesity and Medical Cost

18.5-24.9 BMI (Recommended)

30-34.9 BMI (Obesity class I)

35-39.99 BMI (Obesity class II)

≥40 BMI (Obesity class III)

Medical Claim Cost Workers Comp Cost Workers Comp Lost Time

Obesity and Medical Cost

100% 118%155%

Obesity, Medical, and Workers Comp Cost

100% 118%155%

Obesity, Medical, Workers Comp, and Lost Time

100% 118%155%

Obesity Dramatically Increases the Risk of Total Joint Replacement

(relative to the risk for people of healthy weight)

“Obesity and Joint Replacement”

Pearls and pitfalls: Orthopaedics and Obesity

$20,027

$173,874

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

$180,000

$200,000

Hospital Billed

Medicare Paid

DRG 470- Major Joint Replacement of Lower Extremity w/o Major Complicating Conditions

$20,027

$173,874

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

$180,000

$200,000

Hospital Billed

Medicare Paid

Marion Community Hospital

Hannemann University Hospital

Wayne Memorial Hospital $37,304

Regional Hospital of Scranton $38,266

Community Medical Center $41,741

Moses Taylor Hospital $44,966

Marion Community Hospital

Hannemann University Hospital

Wayne Memorial Hospital $37,304

Regional Hospital of Scranton $38,266

Community Medical Center $41,741

Moses Taylor Hospital $44,966

$1,361

$4,402 $4,595

$5,591

$9,219

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

DRG 0377-Level II Cardiac Imaging

In-Network Contracted Rate Variance

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

Knee Surgery Cardiac Surgery

$57,504

$73,280

$29,377

$46,444

Surgery In-Network Rate Variance

Non-Preferred Preferred

$1,000

$1,500

$2,000

$2,500

$3,000

MRI CT Scan GI Scan

$1,942

$2,580

$1,240

$640 $544 $527

Imaging In-Network Rate Variance

Non-Preferred Preferred

Sample Client Results

Client Industry

Active

Employees

Utilization

Total Cost

Savings

Months

To-Date ROI**

Trucking Company 12,634 13.72% $3,642,428 12 4.8

Restaurant/Retail 6,438 21.89% $4,251,440 24 5.5

Energy Company 5,422 10.77% $1,051,713 6 6.3

Energy Company 4,601 39.56% $5,478,323 16 14.8

Technology/Manufacturing 3,595 20.28% $1,998,213 22 5.0

Education/Consortium 2,708 18.61% $1,165,894 15 5.7

Retail/Wholesale 2,605 13.86% $561,560 7 6.1

Manufacturing 2,238 33.91% $2,096,770 22 8.5

Transportation 1,492 21.05% $542,796 13 5.6

Retail/Wholesale 1,475 17.42% $799,746 12 9.0

Education/Colleges 920 21.20% $366,295 6 13.0

Manufacturing 848 10.61% $303,471 10 7.1

Architect/Engineers 619 21.65% $397,810 9 14.1

Finance/Insurance 412 51.46% $947,347 18 25.4

Finance/Banking 402 32.84% $311,230 12 12.8

*Analysis performed as of 1/3/2013

**Return on Investment is presented as a ratio of Total Cost Savings compared to the total annualized price of the program

Do You Have a Wellness Program?

Is It Working?

R.O.W....Return on Wellness

Is your program working?

Towers Watson/NBGH, 2012

Strong, positive ROI

Modest, positive ROI

Small, positive ROI

No positive ROI

Don’t know

Don’t measure

$3,432$4,130

$6,664

$9,221$10,095

$2,025$2,741 $3,601

$5,445

$7,268

$1,247 $1,515 $1,920$3,366

$4,319

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

<35 35-44 45-54 55-64 65+

0-2 Risks3-4 Risks

5+ Risks

The Impact Cost Increases with Risk Factors & Age

StayWell data analyzed by Univ of Michigan

(N=43,687)

A Successful Wellness

Program MUST:

● Objectively assess goals: healthy

culture vs. bottom line?

● Include data assessment:

demographics, claims history, H.R.A.,

biometric screenings

● Integrate Wellness with Benefits

● Rely on experts regarding HIPAA,

GINA, ADA, ERISA etc.

The position we occupy is not

as important as the direction

we are moving in.

Leo Tolstoy

1828-1910

Contact Information

Todd Whitthorne

twhitthorne@acaphealth.com

214-706-5471

@twhitthorne

healthy living: your links to personal and professional success! · 2018. 2. 21. · healthy...

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