Raymond Fabius, MD Workplace Health Centers: Driving employee wellness and productivity through integrated workplace Health, wellness and fitness President

Raymond Fabius, MDRaymond Fabius, MD

Workplace Health Centers:Workplace Health Centers:Driving employee wellness and productivity through integrated workplace Driving employee wellness and productivity through integrated workplace Health, wellness and fitnessHealth, wellness and fitness

President & Chief Medical OfficerPresident & Chief Medical Officer

CHD Meridian HealthcareCHD Meridian Healthcare

Copyright © 2008 CHD Meridian Healthcare, LLC - All Rights Reserved2

Presentation Presentation overviewoverview

• There is a competitive advantage to having a wellness and fitness center at the workplace in the quest to create healthier, more productive workforces.

• In this presentation we will address workplace health and productivity and describe how integrating workplace health centers, wellness programs and fitness centers can create a competitive advantage by producing a fit, healthy and productive workforce.

Learning objectives:

1. Understand the advantages gained from collaboration of health centers, pharmacies, and wellness and fitness centers at the workplace.

2. Describe how workplace health, wellness and fitness centers benefit employees and their families.

3. Gain an appreciation of the outcomes possible from workplace health, wellness and fitness centers through a brief review of relevant published research.

4. Recognize how the current obesity epidemic makes employer commitment to workplace health, wellness and fitness centers particularly important today.

Brief workplace health updateBrief workplace health update


PRIMARY SERVICESOccupational HealthAcute/ Extended Episodic CarePrimary CarePharmacyPrevention/ Wellness

Fitness

ADDITIONAL SERVICES

• Physical Examinations• Disease Management• Disease Management Wellness

Care Coordination• Health Screening• Health Fairs• Health Coaching• Health Advocacy

• Compliance: OSHA , AED, CLIA and VIS

• Medical Surveillance• Workplace Safety• Return to Work Program• Ergonomics• Pharmacy Concierge Services• Specialty Pharmacy Services• Integrated PBM/ Mail Order Services• Physician Referral Network• Disaster Management• Travel Medicine• Disability Management, Including

STD, LTD & FMLA• Physical Therapy• Laboratory Services• Specialty Services Rotations• Woman’s Health• Medical Emergency Services• Substance Abuse Testing• Global Medical Leadership/

Direction

Creating integration & synergy with existing programs:Creating integration & synergy with existing programs:Adding wellness to workplace health centers scope of servicesAdding wellness to workplace health centers scope of services


““Migration & Integration” of workplace health services: Migration & Integration” of workplace health services: Yielding great improvements in productivityYielding great improvements in productivity

Risk Management Medical Management Population Management

25% 75%

Medical Surveillance

Exams

Injuries &Illness

WorkersCompensation

Ergonomics

OSHAReporting

DisabilityManagement

CaseManagement

Absence Management

Wellness/Prevention

PrimaryCare

Health Advocacy

DiseaseManagement

ReferralManagement

Pharmacy

% of Employer Healthcare Costs

Travel Medicine

UrgentCareEmergency

Preparedness

Emergency Response

EAPBehavioral

Health

Fitness

Dental

Physical Therapy


• Patient satisfaction• Access• Availability• Wellness programs• Trusted relationship

• Medical surveillance

• Injury & illness• Return to work

• Ergonomics

• Metric driven• Clinical excellence• Total population health• External accreditation

• Direct medical

• Cost avoidance• Reduced lost time

• Health advocacy

• Measurable ROI

Employer of Choice Worker Safety

Cost SavingsQuality Care

The value The value propositions propositions of workplace of workplace

healthhealth


Source DescriptionSite

ExperienceHEDIS

commercial

CES3rd Line Antibiotics Utilization (appropriateness) Threshold 90%

89% N/A

CES Pharyngitis Treatment82%

Peds, adults73%Peds

CES Outcomes

DB

Diabetics: HbA1c < 7.5 (threshold 50%) HbA1C < 7

72%64%

N/A42%

Outcomes DB

Hypertension: BP < 140/90 69% 60%

CESOutcomes

DB

Hyperlipidemia: Cholesterol: < 200 (threshold 50%)LDL: < 100

61%53% (all HL dx.)

N/A57% (only CV dx.)

CESPreventive Care Screening – WomenCervical, breast, colon, and others(threshold 80%)

69% compositeBreast: 70%

Cervical: 81%Colon m&f: 54.5%

CHD Meridian / HEDIS ScorecardCHD Meridian / HEDIS Scorecard


PUPY Annual Average Total Cost (2003-2006): All Members < age 65

$3,185.43

$3,450.56

$3,050.00

$3,100.00

$3,150.00

$3,200.00

$3,250.00

$3,300.00

$3,350.00

$3,400.00

$3,450.00

$3,500.00

Worksite Primary Care Patients Community Patients at CHD-PC/Rx Available Locations

PUPY Annual Average Total Cost (2003-2006): All Members < age 65

$3,048.82

$3,168.49

$2,950.00

$3,000.00

$3,050.00

$3,100.00

$3,150.00

$3,200.00

CHD-PC/Rx Available Locations No CHD PC/Rx Locations

Patients at locations where CHD Primary Care and Pharmacy is available cost on average $119.67 per year

less* than similar patients at locations where CHD Primary Care and Pharmacy is not available regardless of whether

they use onsite medical services

Patients who use worksite primary care cost on average $265.12 per year less* than patients at the same locations who use community primary care only

Worksite primary care and pharmacy delivers real savingsWorksite primary care and pharmacy delivers real savings

Risk adjusted* cost savings for patients who use Worksite Primary

Care (PC/Rx locations only)

Risk adjusted* cost savings for patients at 4 CHD-PC/Rx locations versus 4 similar

locations without CHD-PC/Rx

Preliminary Results


Q1 2007 Q2 2007 Q3 2007 Q4 2007 Total81.45% 83.38% 83.88% 82.97%

4.39 5.01 5.02 4.87

The average cost per visit of operating the facility in conjunction with CHD Meridian management

Net Savings: Total Health CenterSavings as a % of Cost AvoidanceSavings: Total Operating Expenses

Average Operating Cost per Visit (Total Op, Exp / A1)

Comprehensive ROI analysis of Goldman SachsComprehensive ROI analysis of Goldman Sachs (Continues to be Refined)Continues to be Refined)

Workplace Health Opportunities for Workplace Health Opportunities for IntegrationIntegration

Integration with Occupational Health & Integration with Occupational Health & Environmental Health & SafetyEnvironmental Health & Safety


Optimizing the health of the employer community: Optimizing the health of the employer community: Partnering with health and safety and medical leadershipPartnering with health and safety and medical leadership

MedicalSurveillance exams

Diagnostic testing

Acute care

H & SExposure management

Industrial hygiene

Workplace safety

Regulatory compliance

Ergonomics

Injury documentation

Accident investigation

Responding to the needs identified by Client’s H&S and Medical Leadership to

deliver the highest level of medical compliance and protect every worker from occupational illness and injury


Treating workplace illness

& injury

Key principles

• Assist employees in obtaining appropriate medical service as quickly as possible

• Select and monitor specialty physicians to ensure efficiency and communication

• Educate employees, their treating providers and plant supervisors regarding available modified or restricted duty programs

• Reduce absenteeism and disability related costs by facilitating an employee’s early return to work

• Track workplace injuries & illnesses to develop preventive programs

• Assess job functions and worksite ergonomics to identify safety issues

• Assure that employees receive their entitled absence benefits


Reducing the impact of worker’s compensationReducing the impact of worker’s compensation

$1,271,780

$761,152$703,708

$220,306

$356,009

$197,249$102,615

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

Pre-CHDM

1

Pre-CHDM

2

Year 1 Year 2 Year 3 Year 4 Year 5

Total Incurred Costs

443

158

71

25 12 5

0

50

100

150

200

250

300

350

400

450

500

Pre-CHDM 1


Severity Rates

2046

725

304

183 11639

0

250

500

750

1000

1250

1500

1750

2000

2250

Pre-CHDM 1


Lost Time Days

6.76.5

2.8

2.09

0.750.37

5

0

1

2

3

4

5

6

7

8

Pre-CHDM 1

Year 1 Year 2 Year 3 Year 4 Year 5 NationalAvg

Lost Time Accident Rates

Integration with Wellness & FitnessIntegration with Wellness & Fitness


WorkplaceSafety

ErgonomicsFitness

Personal Trainer Work

HardeningPhysical Therapist

Work ReadinessOccupational

Therapist

Injury at WorkPhysician /

Nurse

Return to WorkDisability

Management

Workplace fitness & health: Minimize days away from workWorkplace fitness & health: Minimize days away from work


Outcome Measure

Low-Risk (N=671)

Medium-Risk

(N=504)

High-Risk (N=396)

Excess Cost Percentage

Short-term Disability

$120 $216 $333 41%

Worker’s Compensation

$228 $244 $496 24%

Absence $245 $341 $527 29%

Medical & Pharmacy

$1,158 $1,487 $3,696 38%

Total $1,751 $2,288 $5,052 36%

Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002

Association of risk levels with several corporate cost measuresAssociation of risk levels with several corporate cost measures


0

125000

250000

375000

500000

Tobacco PoorDiet/Exercise

Alcohol Microbes Toxic Agents

Deaths Attributable to Various CausesFatal 5 and the Impact of Obesity/Poor Diet

1990 vs 2002 USA

400,000

435,000

300,000

400,000

100,00080,000

90,00076,000

55,00060,000

# of deaths

and %

8% 25%

(20%) (16%) (8%)

1990

2000

Mokadad, A Jama 2004; 291: 1238-1245


Greatest Cost Savings Opportunity Getting the Obese Group to Exercise

0

500

1000

1500

2000

2500

3000

3500

normal weight overweight obese

very active

active

sedentary

BMI, Physical Activity, and Health Care Costs; Wang et al; JOEM :Vol. 46, No. 5, May 2004, pp. 428- 436A Study done comparing HRA self reported data to claims information following over 20K ee’s in a manufacturing environment that including GM.

$500

Integration with Absence ManagementIntegration with Absence Management


MedicalDrug testing

Disability mgmt

Acute care

HRHiring & training

Work-life balance

Benefit design

Wellness & Health promotion

Return-to-work

Absence management

Responding to the needs identified By Human Resources and Medical Leadership to optimize employee health and productivity

Optimizing the health of the employer community:Optimizing the health of the employer community:Partnering with human resources and medical leadershipPartnering with human resources and medical leadership


NEW SCHOOL:

The Skill & The Will & NOT ILL

Health is Not a Cost! It is an Investment into Human Capital

Integration with Disease ManagementIntegration with Disease Management


51%

24%

12%

96%

75%

60%

100% 100%

0

0.2

0.4

0.6

0.8

1

Eligible Contacted Participated Retained forone year

Traditional DM Integrated DM

CHD-Meridian/Goodyear; and Lynch, et al. JOEM 2006;48:447-454

To bePublished

The power of The power of integration:integration:

Healthcare center Healthcare center drives improved drives improved

engagement & engagement & retention ratesretention rates


Chronic illness is better managed:Chronic illness is better managed:Workplace care vs. Community careWorkplace care vs. Community care

• Study Design – control vs. study groups

• Primary Care/ Rx Site

• Chronically ill patients 4X more likely to use CHD Meridian for primary medical care

• Chronically ill patients who utilize the Medical Center for primary care exhibit:

– More primary care visits - 24% more total office visits per year

– Less hospitalization - Inpatient admission rate reduced by 50%

– Less ER/hospital use - Hospital outpatient visits reduced by 42%

– Less need for referral - Community office visits are reduced by 36%

– Less prescriptions/More use of mail order - PBM scripts are reduced by 61%

Cross Sectional AnalysisPatients With A Chronic Disease

Annual Per Patient Healthcare Costs

$1,386

$1,621

$4,849

$6,394

$0 $2,000 $4,000 $6,000 $8,000

Use MedicalCenter

Do Not UseMedicalCenter

Medical Pharmacy

Medical claims costs reduced by 32% Pharmacy claims costs reduced by 17%

Total medical and Rx costs reduced by 29%

Integration with Consumerism & Integration with Consumerism & Health AdvocacyHealth Advocacy


Consumers need health advocacy:Consumers need health advocacy: Even presidents have difficulty selecting providersEven presidents have difficulty selecting providers

• Higher quality lowers cost

• Many consumers do not realize some doctors/hospitals are better than others

• Pareto Rule : 20% of covered lives spend 80% of the dollars and have choices

• By steering to high performance providers, costs will decrease and quality will increase

President Clinton could have benefited From a trusted clinician’s guidance!

HospitalRisk-Adjusted

Mortality Rate (RAMR)

Beth Israel 2.67

Columbia Presbyterian 3.93*

Lenox Hill 2.26

Mount Sinai 2.81

NYU Hospitals Center 1.95

Weil Cornell – NYP 0.95*

Westchester Medical Center 3.27

Surgeon RAMR

State Total 2.25

Smith, C 4.15Bill Clinton to have scar tissue removed

Six months after undergoing heart bypass surgery, former US President Clinton will return to the hospital this week to have a rare buildup of fluid and scar tissue removed from his chest.


Identifying best specialists & hospitals and directing employees to them Identifying best specialists & hospitals and directing employees to them Toyota presentation to IHPM Toyota presentation to IHPM

10%

0.00%

The CHD specialty referral rate is 40% lower than the

community referral rate.

4.00%

6.00%

8.00%

2.00%

10.00%

6%

2007 ActualBilled Charges

Paid January thru June

2007 ActualBilled Charges

Paid January thru June

%Using Best Hospitals 2006 vs 2007 %Using Best Specialists 2006 vs 2007


Integration with Workplace Integration with Workplace Primary Care & PharmacyPrimary Care & Pharmacy


Integrated primary care and pharmacy:Integrated primary care and pharmacy:Greater Use of GenericsGreater Use of Generics

• Much higher Generic Dispensing Rate for PC/ Rx

• Above industry average/ retail-PBM average

• Affects COMMUNITY providers as well

• Each % point of GDR ~ $100-$200K/ year incremental savings (depending upon volume)


Figure 2Antibiotic Line and Average Cost: Workplace Treated v.

Community Treated

0

10

20

30

40

50

60

70

% 1st Line % 2nd Line % 3rd Line Average Cost/Rx($)

Workplace Treated

Community Treated

Better Care – and a Potential Savings of $1.5 Million for Antibiotics Alone

Evidence-based prescribing practices generate valueEvidence-based prescribing practices generate value(recently published article in Journal of Health & Productivity – March 2007)(recently published article in Journal of Health & Productivity – March 2007)


Increased Compliance with Heart Disease medications for Patients Using CHD Primary Care and Pharmacy

74.69%74.23% 73.98%

71.34%

74.22%

72.70%

83.28%82.42%

84.27%

80.00%

82.65%

77.56%

60.00%

65.00%

70.00%

75.00%

80.00%

85.00%

90.00%

Community Only Patients

CHD PC/Rx Patients

15% Greater medication adherence15% Greater medication adherence CHD primary care & pharmacy users versus community care patientsCHD primary care & pharmacy users versus community care patients

Increased Compliance with Blood Pressure medications for Patients who use CHD Primary Care and Pharmacy

74.07% 75.00%

67.31% 67.31%

71.97% 72.76%

82.66% 83.49%

77.57% 77.50%

82.41% 82.83%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

ALPHA-ADRENERGIC

BLOCKING AGENTS

ANGIOTENSIN IIRECEPTOR

ANTAGONISTS

POTASSIUM-SPARING

DIURETICS

POTASSIUM-SPARING

DIURETICS(HYPOTEN)

THIAZIDEDIURETICS

VASODILATINGAGENTS,

MISCELLANEOUS

Community Only Patient

CHD PC/Rx Patient

Increased Compliance with Diabetes medications for Patients using CHD Primary Care and Pharmacy

70.48%72.20%

58.65%

70.64%

81.19% 81.82%

69.81%

81.73%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

BIGUANIDES FIBRIC ACID DERIVATIVES INSULINS SULFONYLUREAS


CHD PC/Rx Patients

Increased compliance with Heart Arrhythmia medications for Patients Using CHD Primary Care and Pharmacy

61.54%

68.99%

73.88% 74.23%

68.42%

73.98%72.15%

83.27% 82.52% 82.42%

76.32%

84.27%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

ANTIARRHYTHMICS,MISCELLANEOUS

CLASS IBANTIARRHYTHMICS

CLASS ICANTIARRHYTHMICS

CLASS IIANTIARRHYTHMICS

CLASS IIIANTIARRHYTHMICS

CLASS IVANTIARRHYTHMICS


CHD PC/Rx Patients


Medication patient safety: Significantly better than retail pharmacyMedication patient safety: Significantly better than retail pharmacy(Based on 1 million prescriptions filled over 5 year contract)(Based on 1 million prescriptions filled over 5 year contract)

• With a retail error rate recently reported in USA Today of 1/1000

- Expect 1000 errorsAt $2000 per ADE (IOM) = $2 Million4 Hospitalizations at 10,375 each (IOM)24 ER visits at $ 1444 each (IOM)

• With our error rate of 3/10000 (prior to implementation of new IT platform)

- Expect less than 300 = $600K- 1 Hospitalization

PATIENT SAFETY COST SAVINGS = 1.4 Million2% of all hospitalizations are due to medication misadventures

0

0.005

0.01

Error Rates Comparison

RetailRXPC/ RX


Integrating Care at the Workplace Leveraging the “Trusted Clinicians”

Physicians, Pharmacists, Nurse Practitioners, Nurses, Therapists, Sports Physiologists, Health Coaches, Care Managers, Personal Trainers

Wellness Screenings

Immunizations Health Coaching

HRA

Illness Drug ManagementBehavioral Health

Disease/Case Management

Environment Smoking Ban

Traditional Occ Health Safe Workplace

Cafeteria

Managing the Medical Community

Specialists Tests

Hospitals Treatment Options

Fitness Work Readiness

Ergonomics Work Hardening Return to Work

Documents

Raymond Fabius, MD Workplace Health Centers: Driving employee wellness and productivity through integrated workplace Health, wellness and fitness President