nico pronk, ph.d. vp and health science officer, journeywell senior research ... · 2012-07-25 ·...

JourneyWell proprietary and confidential, ©© 2008 JourneyWell

Community Health ActionsCommunity Health Actions

Nico Pronk, Ph.D.Nico Pronk, Ph.D.VP and Health Science Officer, JourneyWellVP and Health Science Officer, JourneyWellSenior Research Investigator, HealthPartners Research FoundationSenior Research Investigator, HealthPartners Research FoundationHealthPartnersHealthPartnersMinneapolis, MinnesotaMinneapolis, Minnesota

St. Croix County Community Health Improvement Plan 2009St. Croix County Community Health Improvement Plan 2009--2014, 2014, February 2010February 2010

Copyright ©JourneyWell, 2009

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OutlineOutline• Setting the context

– What do we mean by “health”?– What do we mean by “prevention”?– A macro-view of the community

• The role of behavior– The impact of a few simple behaviors

• The “causes of the causes” of health risks– Determinants of health

• Creating healthy community– Active stakeholders– Business and industry as a key partner

• Approach to engaging business and industry– The Triple Aim

• Open dialogue


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Health, Prevention, and Connections


4

What Do We Mean by What Do We Mean by ““HealthHealth””

“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease of infirmity”

-- WHO, 1948


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What Do We Mean by What Do We Mean by ““HealthHealth””

No DiseaseDisease

Wellbeing

No WellbeingIllness Continuum

WellnessContinuum

Optimal Health


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What Do We Mean by What Do We Mean by ““PreventionPrevention””

Tertiary prevention is intended to reduce, mitigate, or limit the progress or exacerbations of diagnosed disease and is an important aspect of therapeutic and rehabilitative medicine.

Tertiary

Secondary prevention is intended to cure patients and reduce the more serious consequences of disease through early diagnosis and treatment. It is directed at the period between onset of disease and the time of diagnosis, and aims to reduce the prevalence of disease.

Secondary

Primary prevention intends to limit the incidence of disease by controlling causes and risk factors.

Primary

Primordial prevention addresses the underlying conditions that may lead individuals or populations to become exposed to causative factors for disease—it is intended to prevent the occurrence of risk factors in the population. The goal is to address social and environmental conditions that create health damaging exposures and susceptibilities among the population.

Primordial

Brief DescriptionLevel of Prevention

Source: Pronk, NP. Editor. ACSM’s Worksite Health Handbook, 2nd Edition, 2009

Hea

lth a

nd C

are

Con

tinuu

m


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How Would How Would ““PreventionPrevention”” be Applied?be Applied?

Care Continuum

No Disease Disease

Hea

lth a

nd W

ellb

eing

Con

tinuu

mHealth

No Health

Tertiary Prevention

Primordial Prevention

Primary Prevention

Secondary Prevention

Sources: Adapted from: Manderscheid, R. National Health and Health Care Reform presentation, 2009. Pronk, NP. Editor. ACSM’s Worksite Health Handbook, 2nd Edition, 2009


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MicroIndividual

Gender, SES,Race

MesoRelationships

Family, Peers,

Groups

ExoCommunitySchools,

Neighborhoods,Workplace

MacroSocietal

Social Policy, Norms

A Socio-Ecological View


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““Ask YourselfAsk Yourself””

• In your world, how often do you think people…– say “health” but mean “care”?– say “prevention” and imply “early

detection?”– fail to see their own roles in health [and

health reform]?


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The Role of Personal BehaviorThe Role of Personal Behavior

• Does it matter? Or is it all genetics?


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Determinants of HealthDeterminants of Health

Behavioral patterns

40%

Genetic predisposition

30%

Health care10%

Social circumstances

15%

Env ironmental exposures

5%

The single greatest opportunity to improve health lies in personal behavior

Source: Schroeder, S. N Engl J Med 2007;357:1221-1228.


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Actual Causes of Death in the U.S.Actual Causes of Death in the U.S.

Source: Mokdad, A.H. JAMA 2004;291;1238-1245 [Errata, JAMA 2005;293:293-294].

0 5 10 15 20

Illicit Drug use

Sexual behavior

Firearms

Motor vehicle

Toxic agents

Microbial agents

Alcohol

Poor diet and physical inactivity

Tobacco

%

2000

1990

4 Behaviors cause nearly

40% of all deaths in the U.S. (year 2000)


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Optimal Lifestyle Metric Optimal Lifestyle Metric (OLM)(OLM)

• Being physically active

• Not smoking

• Eating 5 fruits and vegetables each day

• Drinking alcohol in moderation


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Optimal Lifestyle Adherence, Health,

and Costs


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Optimal Lifestyle Metric

• OLM behaviors cluster and show a significant degree of inter-correlation

• Adherence to OLM behaviors has been associated with– Improved functional health– Increased compliance with clinical preventive services– Lower overall mortality– Lower cause-specific mortality (cardiovascular causes)– Increased longevity– Lower 11-Year incidence of stroke

• Despite its association with positive health outcomes, OLM adherence is low in the population– Between 5% and 8% in the U.S. population– Approximately 10% among employed populations


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Adherence to OLM and New DiseaseAdherence to OLM and New DiseaseDifference in 2Difference in 2--year incidence of new disease between people who year incidence of new disease between people who

adhere to OLM and those who do not adhere to OLM and those who do not

(% fewer new cases of disease)(% fewer new cases of disease)

-15 -17

-24

-43 -45

-66

High BloodPressure Cholesterol Cancer Back Pain

HeartDisease Diabetes

Source: HealthPartners Health Assessment database, 2007


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Adherence to OLM and Emotional HealthAdherence to OLM and Emotional HealthDifference in emotional health concerns among employees who adheDifference in emotional health concerns among employees who adhere to re to

OLM and those who do not OLM and those who do not (% fewer people having this health concern )(% fewer people having this health concern )

-47

-74-81 -82

-93

DepressionStress

Concerns

EmotionalHealth

Concerns

Poor or FairGeneralHealthStatus

High Risk forDepression


Hea

lth

…and w

hat about

cost?


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Lifestyle Adherence and Health Care CostsLifestyle Adherence and Health Care Costs

• Difference in annual health care costs between the two risk profiles = 49%

– “Low-Risk” profile • BMI of 25 kg/m2

• Never-smoker• Physically active

– “High-Risk” profile• BMI of 27.5 kg/m2

• Current smoker• No physical activity

Source: HealthPartners Research Foundation Study. JAMA 1999;282(23):2235-2239

WhiteWoman White Man

Non-WhiteWoman Non-White

Man

$3

,99

4$

5,93

9

$3

,12

3$

4,64

4

$5,

26

6$

7,8

32

$4

,117

$6,

123

Low Risk High Risk


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Adherence to OLM and Adherence to OLM and Productivity LossProductivity Loss

Impact on excess health-related productivity loss – Absenteeism– Presenteeism

Based on 33,956 employees (Sample company, assuming $50,000 average salary, expressed as per person per year productivity loss in 2009 dollars)


$4,049

$3,644

$2,621

$1,342

$890

OLM 0 OLM 1 OLM 2 OLM 3 OLM 4

($)

“the costs of Doing NothiNg is too high”


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““Ask YourselfAsk Yourself””

• In your world, how difficult do you think it is to implement programs that address these 4 behaviors? – What percentage of the community do you believe

adhere to all of these relatively simple behaviors at the same time?

– Which behavior(s) do you think is the one that gives employees the most trouble?

– Which behavior(s) do you think may be mosthelpful to support changes in other behaviors?


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The Determinants of Health

Addressing the “causes of the

causes”


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Social Social Determinants of HealthDeterminants of Health

Source: Wilkinson R, Marmot M. Social Determinants of Health. The Solid Facts. Copenhagen: WHO Regional Office for Europe, 2003.

Top Ten:• The social gradient• Stress• Early life• Social exclusion• Work• Unemployment• Social support• Addiction• Food• Transport

Notable Observations:• Access to health care is not

among the top ten• Health care alone may not

be able to counteract the impact of these factors…

• …only 10% of the health determinants is ascribed to health care access

• Ergo,…the nation’s heavy investment in the personal health care system is a limited future strategy for promoting health

Sources: Schroeder, S. N Engl J Med 2007;357:1221-1228.Kottke TE, Pronk NP. Taking on the social determinants of health. Minnesota Medicine2009;Feb:36-39.


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Business and Industry as a Partner


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Community Health and Business and Industry

• Adults spend a substantial portion of their waking hours in the workplace

• Frequent and sustained messages can reach employees and dependents

• Setting facilitates the introduction of social support networks

• Companies benefit through healthy and more productive people

• People benefit trough lower costs (medical) and more productive lives (QOL)


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The Triple Aim

Population Healthand Productivity

ROI andAffordability

ExceptionalExperience

“Sweet spot”

Simultaneously achieve exceptional experience,

population health improvement, and ROI


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Approach to the Approach to the Triple Aim in Triple Aim in

Business:Business:The JourneyWell The JourneyWell

ModelModel

Source: IHI and JourneyWell

1. DESIGN

2. EXPERIENCE

3. HEALTH &PRODUCTIVITY

4. ROI

•Comprehensive•Evidence-informed•Person-centric

•Participation•Satisfaction•Willingness to refer

•Modifiable behavior•Quality of life•Human performance

•Reduced Utilization•Productivity improvement•Cost-effectiveness/ROI


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Where Does Health Impact Where Does Health Impact ““ValueValue””??

Sources: Hemp, P. Harvard Business Review, October, 2004Leutzinger, J. In: Pronk, N. (Ed). ACSM’s Worksite Health Handbook, 2nd Ed., 2009

Medical Costs

Non-Medical Costs

Medical andPharmaceutical24%

Presenteeism63%

Absenteeism6%

Short-term Disability6%

Long-term Disability1%

Workers’Compensation<1%

(Less) Tangibles:

• Decision quality• Stamina, resilience, vitality• Happiness• Interpersonal skills • Interpersonal relationships• Attitude• Company loyalty• Morale• Recruitment• Retention


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Individual

Group / Population

Organizational

Environmental

Health assessment Competitions

Social networks

Onsite classes

Seminars

EAPSelf-care

Health fairs

Implementations, Communications, Reporting, Data Management, Legal Support

Behavior change programs

Biometrics

Organizational assessment for best practices

Incentives program

Communications plan

Policy development

Leadership

Supportive activity around legislative action in the community

Employer coalitions

A Macro View

Culture of Health Initiatives


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What Works?

• Systematic Review Findings from the Task Force on Community Preventive Services (AJPM 2010;32(2S):S223-S300)– Assessment of Health Risk with Feedback

• Insufficient evidence– Assessment of Health Risk with Feedback PLUS health education

• Recommended– Work-based incentives and competitions to reduce tobacco

• Insufficient evidence– Work-based incentives and competitions to reduce tobacco PLUS

heath education• Recommended

– Smokefree policies to reduce tobacco use• Recommended


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• Essential Elements of Effective Workplace Programs and Policies for Improving Worker Health and Wellbeing– Organizational Culture and Leadership– Program Design– Program Implementation and Resources

What Works?


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What Works?

A Field Resource

To connect worksite health research and practice.

To provide a framework that supports integration of worksite health promotion into a broader set of health promoting strategies (incl. environmental, cultural, and organizational).

To provide access to information that illustrates an explicit connection between worker health and business performance.


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Multi-Level, Multi-Component, Comprehensive, and Integrated Approaches

• Leverage integration– At multiple levels– Across multiple strategies– Using online tools and enabling

technologies

• Connect individuals to groups and populations (networks)

• Modifiable and QOL health scores as indicators of individual and population health improvement

Environmental

Organizational

GroupInter-Individual

Individual


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Environmental

Organizational

Inter-individual

Individual

Community connected

Organizationallyrelevant

Personally relevant

Financially rewarding

Socially rewarding

Simple Possible

Leve

ls o

f Inf

luen

ce

Make Being Healthy…

Exceptional Customer and User Experience

OutcomesHealth

ProductivityFinancial ROI

Comprehensive, Multi-Level, Multi-Component Programming


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JourneyWell Case StudyJourneyWell Case Study

93% program satisfactionEXPERIENCE

Source: ACSM’s Worksite Health Handbook, 2nd Edition, 2009

• Tobacco use 37%• Physical Activity (% meeting Guidelines) 58%• Fruits and Vegetables 89%• Alcohol use No change (99% all years)

• OLM from 19.1% (2004) to 27.5% (2007) 44%

HEALTH &PRODUCTIVITY

ROI

•Demonstrated 3:1 ROI in 2.5 years


35

Thank You!Thank You!

“Both in importance and in time, health precedes disease. Therefore we ought to consider first how health may be preserved and then how one may best cure disease.”

--Galen, circa 85 AD

nico pronk, ph.d. vp and health science officer, journeywell senior research ... · 2012-07-25 ·...

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