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Healthy Living: Your Links to Personal and Professional Success!
Todd Whitthorne
President, ACAP Health
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)
2.06
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
11
7.8
4.8
0
2
4
6
8
10
12
Placebo Metaformin Lifestyle
Dia
bete
s C
ases
per
100
per
son-
yrs
-58% -31%
-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
2008
2,701 26%
2,701 26% * *
2009
4,078 27%
2,834 21%
1,244 34%
2010
4,329 22%
3,000 19%
1,329 29%
2011
3,997 20%
2,737 19%
1,260 26%
2012
3,562 16%
2,449 15%
1,113 18%
MetS Intervention Actual Case Study
Metabolic Syndrome Over Time:
With and Without Intervention
26%
21% 19% 19%
15%
0 1 2 3 4
Pe
rce
nt
Wit
h M
etab
olic
Syn
dro
me
Year
With MetS Intervention
34% 35% 32%
30% 31%
0 1 2 3 4 P
erc
en
t W
ith
Me
tab
olic
Syn
dro
me
Year
Without Intervention
Metabolic Syndrome Over Time:
Monthly Cost of Healthcare
638 642 665 668
0 1 2 3
PEP
M A
vera
ge C
ost
Year
With MetS Intervention
567 631
710 781
874
0 1 2 3 4 P
EPM
Ave
rage
Co
st
Year
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%
0%
10%
20%
30%
40%
50%
60%
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
0
50
100
150
200
250
300
350
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Re
tail
Pri
ce
Year
Hospital Retail Price vs Actual Cost
Markup
Cost
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?
Knees
Back
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
0%
20%
40%
60%
80%
100%
120%
140%
160%
180%
200%
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)
100%
118%
155%
191%
Medical Claim Cost Workers Comp Cost Workers Comp Lost Time
Obesity and Medical Cost
0%
200%
400%
600%
800%
1000%
1200%
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)
100% 118%155%
191%
Medical Claim Cost Workers Comp Cost Workers Comp Lost Time
Obesity, Medical, and Workers Comp Cost
0%
200%
400%
600%
800%
1000%
1200%
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)
100% 118%155%
191%
100%
236%
347%
755%
Medical Claim Cost Workers Comp Cost Workers Comp Lost Time
Obesity, Medical, Workers Comp, and Lost Time
0%
200%
400%
600%
800%
1000%
1200%
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)
100% 118%155%
191%
100%
236%
347%
755%
100%
430%
729%
1194%
Medical Claim Cost Workers Comp Cost Workers Comp Lost Time
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
DRG 470- Major Joint Replacement of Lower Extremity w/o Major Complicating Conditions
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
DRG 470- Major Joint Replacement of Lower Extremity w/o Major Complicating Conditions
Moses Taylor Hospital $44,966
$1,361
$4,402 $4,595
$5,591
$9,219
$682
$728
$-
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$10,000
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L C
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DRG 0377-Level II Cardiac Imaging
In-Network Contracted Rate Variance
$0
$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
$0
$500
$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
Rate
Total Cost
Savings
Total
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
$0
$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
