To reduce the risk of cardiovascular disease and diabetes among Oklahoma state employees.

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1 E Nancy A. Haller, MPH, CHES, Manager, State Wellness Program M PLOYEES To reduce the risk of cardiovascular disease and diabetes among Oklahoma state employees. To suspend or decrease the rising costs of healthcare premiums paid by state government. To improve our risk as a group and attract additional health care companies. Use of a scientific web-based interactive program with one-on-one telephone health education mentoring using behavior change techniques. A 12-month comprehensive program that includes: exercise training, proper nutrition, weight management, stress management, and smoking cessation.

2 Initial Health History Questionnaire (HHQ) Creation of short and long-term goals Individualized action plan One-on-one telephone mentoring Web-based health educational modules and audios Ongoing support through and telephone Strict tracking adherence 12-week and 1-year follow-up evaluations with physician-based clinical assessments Cash incentives offered through state agencies choosing one of the following incentive programs: Gold $500 Silver $300 Bronze $100 A waived visit to Primary Care Physician with waived lab work for fasting lipid profile and fasting glucose Discount to fitness center membership

3 Participants are evaluated on clinical effectiveness at baseline, at 12-weeks, and at 1-year. Participants are referred to their personal physician for: fasting lipid profile fasting glucose blood pressure resting pulse rate height and weight measurements hip and waist measurements Participants that are directed back to their PCP at 12-weeks and at 1-year incur some costs. Participants completing Health History 2983 Average Age (years) 47 Males (%) 18.9 Females (%) 81.1 African American (%) 11.1 Asian (%) 2.0 Hispanic (%) 2.6 Caucasian (%) 82.0 American Indian (%) 2.5

4 Percent Elevated Systolic Elevated Blood Pressure Diastolic Blood Pressure Elevated Elevated LDL Cigarette Smokers Prevalence at Program Entry Elevated Blood Glucose Overweight Not Exercising Percent Elevated Systolic Elevated Diastolic Blood Pressure Blood Pressure Elevated Elevated LDL Obesity Cigarette Smokers Elevated Blood Glucose Prevalence at Program Entry Prevalence at Follow up Evaluation Percent Elevated Systolic Blood Pressure Elevated Diastolic Elevated Blood Pressure Elevated LDL Obesity Cigarette Smokers Elevated Blood Glucose Prevalence at Program Entry Prevalence at Follow up Evaluation

5 Percent Elevated Systolic Elevated Diastolic Blood Pressure Blood Pressure Elevated Elevated LDL Obesity Cigarette Smokers Elevated Blood Glucose Prevalence at Program Entry Prevalence at Follow up Evaluation Claims CVD Risk Factors Systolic BP (mmhg) Initial 12 Months Medical Diastolic BP (mmhg) Annual Plan Paid ($) 7, Annual Charge ($) 14, Triglycerides Dr. Visit Weight (lb) Hospitalization BMI (kg/m Outpatient Blood Glucose HbA1c (%) ER visit Pharmacy Annual Plan Paid ($) Annual Charge ($) , , Claims CVD Risk Factors Systolic BP (mmhg) Initial 12 Months Medical Diastolic BP (mmhg) Annual Plan Paid ($) , Annual Charge ($) , , Triglycerides Dr. Visit Weight (lb) Hospitalization BMI (kg/m Outpatient Blood Glucose ER visit HbA1c (%) Pharmacy Annual Plan Paid ($) Annual Charge ($)

6 All Participants Without CHD: Relative risk reduction = 13.0% Participants Without CHD and baseline 10-Year Risk >10%: Relative risk reduction = 24.8% Participants Without CHD and baseline 10-Year Risk >20%: Relative risk reduction = 39.1% Percent Much Better Somewhat Better About the Same Somewhat Worse Much Worse Prevalence at Program Entry Prevalence at 12 Week Follow up Evaluation Prevalence at 12 Month Follow up Evaluation Data Sources Benefits Administration System (BAS) for verification of employee health plan. Medical and pharmacy claims data from largest healthcare plan (Indemnity plan) for state employees. Analysis Compare monthly average claims of participants with state employees. Compare monthly average claims of participants before and after enrollment in OK Health program. Compare monthly average claims of participants by risk factors.

7 OK Health program participants Active state employees from 1/1/05 6/30/07 Enrolled in Indemnity Plan from 1/1/05 6/30/07 Completed 12-months in OK Health program 331 participants were included State employees Active state employees from 1/1/05 6/30/07 Enrolled in Indemnity Plan from 1/1/05 6/30/07 17,089 state employees were included $300 $258 $250 $200 $224 $208 $150 $143 $100 $50 $ /2007 Participants State Employees $100 $90 $75 $66 $60 $77 $50 $25 $ /2007 Participants State Employees

8 Anti-lipidemic Drugs 15.6% Increase Anti-hypertensive Drugs 9.0% Increase Anti-diabetic Drugs 7.0% Decrease Change in Use of Anti-lipidemic, Antihypertensive and Antidiabetic Drugs (~12 Months) $400 $373 $350 $300 $250 $200 $150 $100 $209 $158 $211 $105 $168 $173 $124 $50 $0 A B C D /2007 $200 $150 $146 $113 $109 $100 $75 $62 $80 $50 $29 $33 $0 A B C D /2007

9 Each risk factor increased or decreased was associated with a commensurate change in 1.9% productivity loss over time and estimated to be $950/year/risk changed. OK Health program participants (~12 months; n=1,580): Physical inactivity Blood pressure BMI Total cholesterol Cigarette smoking Total -363 risks -118 risks -88 risks -61 risks -14 risks -644 risks Productivity-related savings = $32.27/employee/mo Degreed Professional Trained and Certified [ACSM and/or CHES] Continuing Education Background ranges from RN, Dietitian, Exercise Physiologist, Health Psychologist, or generalist Health Educator

10 OK Health participants significantly decreased their cardiovascular risk during one year in the program. Participants utilized more pharmacy claims due to more appropriate medication use and enhanced compliance. Savings from medical utilization will need data analysis for greater than two years. Our goal as a mentor is to help prevent or manage CVD and other chronic diseases. By partnering with participants in setting goals and integrating healthy lifestyles, participants can achieve optimal health and well-being. Our website: Contact: Nancy A. Haller Our phone number: ext. 120 & 125 EM PLOYEES