The Journey towards Total Wellbeing A Health System s Innovative Approach

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1 The Journey towards Total Wellbeing A Health System s Innovative Approach Company Profile Wellness A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity World Health Organization, 1948 One of the largest employers in South Florida, Miami Children s Health System re-launched its corporate wellness program in 2013 with a strategic vision of helping its employees and spouses achieve optimal health through an integrated total wellbeing approach. This industry-leading health system partnered with Interactive Health and United Health Care (UHC) to create a strong triad of expertise and experience to improve health and lower the cost of care. Reward Measure Today, the Healthy Lifestyles Program utilizes a 3-step scientific methodology to measure, motivate and reward participants for participation and achieving health goals. Critical to the success of this program is the strategic integration of targeted program resources available to the participant through Miami Children s Health System, UHC and Interactive Health. The Healthy Lifestyles Program is open to Motivate all Miami Children s employees, both insured and uninsured, and their spouses. In 2016, lower premium rates and other financial incentives were used to motivate and reward members for participating in the program. Other incentives were integrated, such as $0 copays for medication, consultation, condition monitoring and more for participating in diabetes and pregnancy programs. Success Quantified Critical to evaluating success of the program is assessing the actual participant health outcomes. In 2016, 86% of the total eligible population participated in the Healthy Lifestyles Program health evaluation, or roughly 4,200 individuals. By attaining the participation of the vast majority of the intended population, Miami Children s Healthy Lifestyles Program is able to establish a valid baseline measurement of health; set goals; connect many employees and spouses to personalized care; and drive results. Year over year trend data reveals that the program is already impacting change. Of those individuals who learned of their condition and received a goal to improve based on their last health evaluation, significant improvement was made in 4 key areas that specifically impact health risk conditions such as diabetes, stroke and heart disease. These 4 key areas are blood pressure, triglycerides, LDL cholesterol and glucose. Repeat participants showed between 59% and 88% improvement in these 4 key areas. Furthermore, Miami Children s aggregate Personal Health Score has remained in the low risk category for the last three years and 72% of the members with the highest risk scores have had the most significant improvements in health scores. 1

2 A cohort population of Miami Children s participants that screened in both 2015 and 2016 were compared to a cohort of over 29K members that also work in the healthcare industry, drawn from Interactive Health s book of business for the same period. Similar trends were observed in both groups, specifically 90% of the members in the low to no health risk category remained there and 40% of those members in the high risk health category moved to a lower risk health category. Beyond the positive outcomes outlined above, Miami Children s Health System sees the wellness program as a key influencer in the positive medical trend occurring after the re-launch of the Healthy Lifestyles Program in As members became more educated and accountable for their health and could identify risk at the earliest stage, the Health System saw a reduction in per employee per year ( PEPY ) medical claim costs of over 19% from 2014 to Miami Children s states that they have never seen such a dramatic drop in year over year medical trend and attribute the decline, in part, to the success of the wellness program. These results are further affirmed by the calculation of cost avoidance, net of all program fees, related to reduction in specific health risk conditions for the Miami Children s population. Miami Children s Health System has been rewarded for its efforts by being recognized as a 2016 Healthiest Companies in America by Interactive Health. The organization achieved a low health risk status across their organization while sustaining greater than 80% employee participation in their wellness program. Miami Children s credits the success of its Healthy Lifestyles Program to buy-in from senior leaders, as the expectations were stressed from the beginning that the program required their support. From the top, down, the vision of helping employees with their health is gaining momentum and the culture is changing. Janet Lara Vital, Director of Total Rewards and Wellness, states, Employees realize that wellness is a critical initiative for the organization and they are more engaged, knowledgeable and personally accountable because of these efforts. Innovation to Continue the Journey Miami Children s Health System is committed to the continued growth and enhancement of the Healthy Lifestyles Program s wellbeing offerings. The data derived from the program thus far has been valuable in strategically planning for continued cost reduction and future programming based on need. For example, based on recent Healthy Lifestyles Program data, a dietitian was added to the staff to specifically support improved nutrition for employees and participants. To further enhance the program, a key companywide initiative in 2016 was launched because of a collaborative effort among the leadership team at Miami Children s Health System, Dr. Steven Melnick, 2

3 PhD, MD, Chief, Department of Pathology and Clinical Laboratories at Nicklaus Children s Hospital, and Interactive Health. The team analyzed participant data and identified opportunities to enhance the comprehensive biometric testing panel to emphasize the nutritional elements of an individual s health. The Healthy Lifestyles Program health evaluation is designed to detect a wide range of potential health issues, including cardiovascular disease risks (high cholesterol, high blood pressure, and diabetes), liver and kidney disease, anemia and certain types of cancer. The key stakeholders felt that obtaining additional nutritional markers to further identify potential risks in these areas could be critical to improving health. The result of this collaboration was the incorporation of the TOP (Test-Optimize-Perform) test developed by Dr. Melnick to enable adults to reach optimal health by enhancing their nutritional, physical and psychological wellbeing. While individual tests are available for a variety of nutritional markers, this innovative proprietary blood test integrates a unique combination of lab tests and health assessment information to provide rapid and unique insight into common nutritional deficiencies, disorders and diseases with a single health evaluation. Conditions such as anemia, diabetes, obesity, cardiovascular disease and other nutrition-influenced disorders are further evaluated with the goal of more precisely identifying consequences of poor nutrition at early stages, thus providing a more specific prevention and intervention strategy for participants. The TOP test was offered in 2016 to Miami Children s employee and spouse population. These enhancements were seamlessly incorporated into program execution due to Interactive Health s proprietary ActiveEngine TM capabilities, which provides a platform for program customization for both employers and participants TOP Test Results The data from the TOP test was assessed and produced insightful and exciting results. Two key areas of findings are related to anemia and pre-diabetes/diabetes. Other important observations involved the prevalence of vitamin D deficiency and systemic inflammatory conditions in this population. As it relates to anemia, a more comprehensive strategy for identifying and intervening with risk of anemia is a clear finding. Assessment of low hemoglobin alone captured 3.89% of the population as atrisk for anemia with 67% of these individuals reporting no history of anemia. However, with the inclusion of ferritin, vitamin B12 and vitamin B9 (Folate) in the TOP test an additional 9.9% of the population was identified for further risk evaluation. Consequently, including tests of nutritional markers creates valuable health risk information for members and their physicians regarding management of potential anemia and nutritional opportunities, which has direct impact on participant wellbeing. 48% of participants were identified at risk of pre-diabetes or diabetes due to comprehensive Hemoglobin A1c ( HbA1c ) testing. Remarkably, 73% of this population had a normal fasting blood glucose and would not have been identified without the HbA1c testing included in the TOP test. Diabetes can have a major impact on employee productivity and health care costs. Additionally, individuals at a prediabetic stage are at risk for developing diabetes, therefore, a huge opportunity exists for a preventive course of action within this risk group. The addition of HbA1c testing for the entire Miami Children s 3

4 screening population allowed the program to identify and engage more members, and especially those members who are high value for reducing the future cost of healthcare. Despite living in South Florida, a meaningful vitamin D deficiency was found in 66% of participants thus making intervention strategies applicable to a large percentage of the population. Further research will be conducted to assess how vitamin D might impact other health risk factors in this population, including investigation of connections specifically with BMI and HbA1c data. Finally, an association between HbA1c and hs-crp was evident in connection to systemic inflammation. This relationship highlights the risk of potential complications of diabetes as early as the pre-diabetic stage. Utilizing biomarkers of inflammation (hs-crp) and oxidative stress (GGT and homoceyteine) allowed for a more thorough health risk profile, subsequent intervention opportunities and more aggressive prevention regimens for conditions including cardiovascular disease, diabetes, obesity and metabolic syndrome. Since these are all broad-based conditions, typically impacting large segments of society, more precise identification of health risks associated with these and other diseases enables more effective intervention, prevention and reduction of healthcare costs. Intervention Strategy Effectively connecting individuals at risk with their physician and to intervention resources are core components of the Healthy Lifestyles Program. Nearly 77% of members screened were referred to a physician as compared to 41% in 2014 indicating that with the addition of the TOP, more members are learning about their health and getting connected to care. In addition, 254 members (6%) received a critical outreach call with a 74% engagement rate with this critical risk group. 2,249 members (54%) qualified for condition specific outreach and the engagement rate for these condition management calls was 59%. The condition specific outreach group represents members that are not yet critical, but are atrisk for the following conditions: pre-diabetes, newly discovered diabetes, out of control diabetes, metabolic syndrome, hypertension and high cholesterol. Of note, the population identified for critical as well as condition-specific outreach is almost double the norm, compared to Interactive Health s book of business. This is a directly beneficial result of the TOP test providing additional actionable insights about health risk and health improvement opportunities. Education and intervention resources help to amplify the various coaching experiences, motivating participants to address the risks identified through the Healthy Lifestyles Program, now further enhanced with the TOP test. Monthly meetings are held with key stakeholders from Miami Children s Health System, Interactive Health and UHC to continually collaborate on ways to leverage and seamlessly integrate all available resources to assist participants in meeting their goals. A sampling of additional resources available to participants includes a dedicated Nurse Liaison who proactively reaches out to at-risk participants; an in-house Dietitian; a diabetes support group and diabetes program for atrisk individuals with automatic enrollment; weekly corporate newsletter with a wellness spotlight; personalized communications; personal health reports with recommendations; and pinnable user specific web content. 4

5 Next steps in the Journey Continuation of the TOP test with the Miami Children s population is an exciting element of expanding the Healthy Lifestyles Program, but it doesn t stop there. The Healthy Lifestyles Program at Miami Children s Health System continues to evolve with the addition of programs to target key conditions such as obesity utilizing state of the art technology and tools to assist in reducing risk. In addition, the Health System is motivated to continue to analyze all data and share their success with the public via speaking at national industry conferences and publishing articles in leading wellness and peer review journals. Finally, and most importantly, Miami Children s Health System and Interactive Health are actively working toward introducing the TOP test in a format appropriate for the pediatric population. In addition to the important work of identifying nutritional and broader health improvements for children, in the context of a startling rise in the rates of diabetes and obesity among the youngest members of our population in the US, this work will provide an avenue for optimal health for the entire family. 5

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