Cost Justification of WFI

Transcription

1 Cost Justification of WFI Kerry Kuehl MD, DrPH, MS Professor of Medicine Chief, Health Promotion & Sports Medicine Director, Human Performance Laboratory Oregon Health & Science University Portland, Oregon

2 Objectives Discuss Firefighter Morbidity and Mortality Review Wellness Impact on Healthcare Costs Present New Study On Cost Justification of Wellness Fitness Initiative (WFI)

3 What Kills Us Cardiovascular Disease is leading cause of death in U.S. (597,689/yr). Cancer is second leading cause of death (574,743/yr). These two account for >50% of all deaths. Can healthy lifestyles prevent these diseases? Morbidity and Mortality Weekly Report (MMWR). 62(08);155. March 1, 2013.

4 Why Wellness? 2 in 5 Americans use tobacco products 3 out of 4 eat unhealthy diet 4 out of 5 do not get enough physical activity 7 out of 10 are overweight 6 out of 10 are sleep deprived 1 out of 4 do not wear seatbelts Human behavior accounts for >70% of healthcare costs

5 Preventable Causes of Death Tobacco 467,000 deaths/yr High Blood Pressure 395,000 deaths/yr Obesity 256,000 deaths/yr High Blood Sugar 240,000 deaths/yr High Cholesterol 213,000 deaths/yr U.S. Mortality Rate = 2.5 million deaths per year

6 The U.S. Problem Despite the world s highest healthcare costs, the U.S. remains one of the unhealthiest nations in the world 50th in life expectancy 72nd in overall health

7 Background The overall economic impact of work-related injury-illness is high. Fire Service personnel are at increased risk for musculoskeletal injury, cancer, and cardiorespiratory illness. Occupational injury-illness leading cause of disability and early retirement.

8 WHAT ARE DRIVING UP COSTS? Direct Costs - Tip of the iceberg Indirect Costs Iceberg Insurance Costs Time Lost Replacement Costs Presenteeism Costs Over 100 misc costs impact employer

9 Background NFPA Firefighter Injuries in United States, Karter and Molis, 2014

10 Injury Injuries at the fire ground decreased from 67,500 in 1981 to 29,760 in 2013 for a decrease of 56%. The number of fires decreased 57% same time. Firefighter injuries decreased due to decrease in number of structural fires. Rate of firefighter injuries (per 100 fires) remained same.

11 Injuries per 100 Structural Fires From Karter, NFPA Midnight to 6 AM 6 AM to Noon Noon to 6 PM 6 PM to Midnight (most fires are afternoon and early evening, but injuries are greatest in early morning

12 Injury Physical fitness and fatigue are most important factors in strain/sprain and back injury. Firefighters should engage in aerobic exercise and proper fitness training program to reduce injury. Dr. David Frost s research show firefighters reduce injury and improve occupational performance through proper functional movement enhancement training program.

13 Publications

14 Fire Fighter Cardiac Risks High LDL-cholesterol Low HDL-cholesterol Diabetes High blood pressure Less than 3d/w exercise Higher saturated fat diet Less than 5 servings F&V/d Overweight or obese 65% > 3 risk factors 40% > 4 risk factors

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16 Sleep Deprivation: Heart Disease Those with heart attacks were twice as likely to work long hours. Deep sleep needed for repair of cardiovascular system due to oxidative stress and inflammation. Averaging less than 6 hours of sleep/night is comparable to smoking a pack of cigarettes a day.

17 Sleep Deprivation: Obesity Studies have linked sleep deprivation with obesity. Lack of sleep produces hormonal changes that promote weight gain. Being sleep deprived increases your risk of sleep disorders, which can be a vicious cycle because it causes you to gain weight and makes worse.

18 Night Shift Work Linked to FF Cancer WHO concludes working night shift and firefighting increases colon and prostate cancer. Disruption of sleep impedes production of melatonin, suppresses immune system damaging genes leading to abnormal cellular proliferation. Lancet Oncology December 7, 2007

19 What Can You Do Get More Sleep!

20 WFI Background The IAFF/IAFC Wellness-Fitness Initiative (WFI) developed by a task force from 10 cities in Austin, Tx (IAFF Local 975), Calgary, ALB (IAFF Local 255), Charlotte, NC (IAFF Local 660), Fairfax Co., VA (IAFF Local 2068), Indianapolis, IN (IAFF Local 416), Los Angeles Co., CA (IAFF Local 1014), Metro Dade Co., FL (IAFF Local 1403), New York City, NY (IAFF Local 94/854), Phoenix, AZ (IAFF Local 493), and Seattle, WA (IAFF Local 27).

21 Why WFI To identify and manage high health and safety risks for firefighter. For screening of early disease: to apply best of firefighter occupational testing and treatment. Short Term: to prevent injury and illness. Long Term: to reduce CVD and cancer. Firefighter benefit: to retire healthy. Management benefit: Positive ROI?

22 Cost of Wellness?

23 Current Budget Fire Apparatus Fire Fighter Maintenance 70% 5% Repair 30% 95% TOTAL 100% 100%

24 Balance Sheet: $$ OUT WFI Cost Justification EKG stress test physical exam laboratory tests body weight/% fat PFT s Costs of Testing strength flexibility pulmonary functions nutrition Behavioral health Costs of Follow up (evaluation abnormal results) WFI Program Costs and Return On Investment Many benefits are long-term and won t show up on a short term economic analysis.

25 Balance Sheet: IN This image cannot currently be displayed. Short and Long Term Benefits of WFI WHAT IS THE BOTTOM LINE? Reducing Illness/Injury Decreasing Costs

26 Review of Literature Evidence accumulated over the past three decades shows that well-designed and wellexecuted programs that are founded on evidence-based principles can achieve positive health and financial outcomes.

27 Review of Literature Chapman et al AJHP, 2012: participants of workplace health promotion programs have 25% lower medical and absenteeism expenditures. Baicker et al Health Affairs 2010: Worksite Wellness ROI = $3.27 saved for every $1.00 invested, over 3 yrs.

28 Review of Literature

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30 Cost Justification WFI Original objective was to assess economic impact of the WFI Compare Injury and Illness Costs prior to and after implementation of WFI

31 Personnel WFI % in 1997 WFI % in 2004 Austin 1032 CONTROL CONTROL Calgary 983 CONTROL CONTROL Fairfax Co % 100% Indianapolis % 100% LA County % 100% Miami-Dade 1900 Variable CONTROL Phoenix % 100% Seattle 1015 Variable CONTROL

32 Work Comp Claims Claim Date WFI Control Totals 3,033 2, Totals 3,210 3,023 Percent Change +5% Increase +22% Increase* *p<.05

33 Grand Total Projected Line of Costs if no IAFF/IAFC WFI Average Line of Costs IAFF/IAFC WFI Implemented 2000 ars

34 LIMITATIONS Fire department missing data WFI dosage effect confounded by participation rate and degree of implementation WFI Program costs estimated External influences (911, funding, etc)

35 But need better proof.. Need A better Study

36 WFI New Study Contact 10 original WFI Task Force members now. Contact additional Non WFI Task Force departments that are implementing WFI. Contact additional departments with tracked data but not implementing any component of WFI. Project Aim: Assess and compare WC claims, costs, total incurred costs, Missed days between WFI and non WFI departments. Drill down for indirect costs.

37 Cost Justification Overview

38 WFI Implementation Sites Limited WFI Control Sites Tracking Data WFI Sites Austin, TX Charlotte, NC Calgary, ALB El Paso, TX Fairfax, County, VA Miami Dade County, FL Indianapolis, IN Milwaukee, WI Los Angeles County, CA Orange County, CA New York, NY Portland, OR Oklahoma City, OK Seattle, WA Phoenix, AZ Snohomish County, WA

39 Outcome Measures Mean Occupational WC Claims, Lost Work Days, Total Incurred Costs, and Average Cost Per Claim compared between WFI and Control sites. Costs will be adjusted to 2014 values using the Medical Care Consumer Price Index.

40 ROI Analysis Panel on Cost-Effectiveness in Health and Medicine for worksite wellness analyses. Investment Benefit divided by Investment Cost Track WFI intervention cost and expenditures. WFI program costs include personnel, equipment, supplies, facilities, contracts, insurance.

41 OHSU Protected Cloud Storage

42 Top Ten Time Loss & Medical Payments by Body Parts Average FY BACK UNKNOWN CHEST 33% SHOULDER(S) 21% KNEE(S) 2% 4% ABDOMEN 5% 4% 7% 10% HIPS 6% 8% MULTIPLE PARTS MENTAL EAR(S)

43 Year # claims Days Lost Total Incurred Average Cost Per Claim Pre WFI $1,785,050 $7, $1,588,454 $6, $1,980,556 $7, $2,332,567 $7, $2,196,855 $8, $2,568,221 $8, $3,996,235 $10, $3,562,443 $9, $3,788,316 $10,011 $8,195 WFI start $1,788,456 $6, $1,688,789 $6, $1,499,186 $5, $1,245,985 $5, $1,548,334 $6, $1,874,221 $6, $2,550,207 $6, $2,640,059 $6, $2,364,208 $7,175 $6,386

44 Mean Baseline Results (Males) WFI Firefighters Non WFI Firefighters Age (years) Years of Work BMI Body Fat (%) Waist Circumference (in) Glucose (mg/dl) Triglycerides (mg/dl) Blood Pressure (mm/hg) 128/76 135/84 Metabolic Syndrome 24% 32%

45 IMPACT Difficult economic times is when need to implement firefighter wellness program Firefighter is department s most important resource and greatest savings is conferred on preventing illness and injury. Study will demonstrate level of economic benefit of WFI

46 Take Home Summary Study results will be published in the cost justification chapter in the WFI 4 th edition. Includes updated health and safety references on programs and studies. Prevention of illness and injury is only way to curtail skyrocketing healthcare costs. Not an asset it is essential!

47 THANK YOU Kerry Kuehl MD CAROL DEFRANCESCO MA RD SENIOR RESEARCH ASSOCIATE

48 New Study: Free PHLAME Program

49 NUTRITION, FITNESS & SLEEP SESSIONS Evidence based and proven to work