Slide Title Coaching and Methodology Differentiators About This Slide Our coaching formula makes us different Three Key Points for Audience Our coaching program is designed to be high touch and personalized, because changing a lifestyle involves adapting to a new behavior until it becomes a habit. We know that participants who have a positive experience will more likely stick with the changes. Our customized programs are built using evidence-based medicine, setting goals and implementing action plans. We see ourselves as a extension of an individual ’s healthcare team. When necessary, we will consult with an individual’s doctor. We track progress, collecting and analyzing both quantitative and qualitative data throughout entire interaction. We also conduct quality audits to ensure ongoing delivery of high-quality programs.
Neil F. Gordon, INTERxVENT
MaRSBusiness of Aging Conference April 30, 2012
AgendaDr. Neil Gordon, Founder INTERVENT INTERVENT Overview Global vs Canadian Corporate Wellness / Disease Management Program Uptake Outcomes / ScienceDr. Dorian Lo, EVP, Pharmacy and Healthcare at Shoppers Drug Mart Case Study: Why Shoppers Drug Mart Implemented a Health / Wellness Program Shoppers Drug Mart Employee Program Overview Results ChallengesConclusion
INTERVENT Founder Founded INTERVENT in 1997Dr. Neil Gordon Used evidence-based research and clinicalled INTERVENT’s nationally recognized organizations and guidelines from Founder national/international expansion Past director of exercise physiology at the world renowned Cooper Research Institute in Dallas, TX Former clinical professor of medicine at the Emory University School of Medicine in Atlanta, GA Past Chairman of the American Heart Association Committee on Exercise, Cardiac Rehabilitation and Prevention Devoted over 30 years to the prevention of cardiovascular disease and other chronic illnesses Published over 100 scientific manuscripts and 8 books on prevention/disease management
INTERVENT Overview INTERVENT is a global lifestyle management and chronic disease risk reduction company based in Toronto, Canada and Savannah, GA, USA. INTERVENT develops, licenses and provides evidence-based programs for the prevention and management of multiple chronic diseases. Mission: To help significantly improve individual and population-based measures of health while simultaneously reducing health care costs and enhancing productivity
The Evolution of INTERVENT Programs originally based on research available in the early 1990s, especially the Stanford Coronary Risk Intervention Project (SCRIP). After completion of original research study in Dallas, TX, INTERVENT USA, Inc. was founded in 1997; INTERVENT Canada was subsequently launched in 2007. Since 1997, considerable time and effort has been spent developing, testing and successfully implementing INTERVENT’s evidence-based, technology-enabled, outcomes-oriented, comprehensive lifestyle management and chronic disease risk reduction programs.
A Treatment Platform that builds… Risk Intervention Management Assessment Options Areas • Nutrition • Weight Management Evaluation and Follow-up Self-help • Physical Activity Intervention • Stress Management (web/mail) • Tobacco Cessation Numerous • Diabetes•Health Risk Assessment •Stratification Program • High touch Modules • Integrated with web- based program Health Coach • Formal, structured, Assisted Intervention systematic approach (telephonic/web/on-site/mail) • Personalized support
1st Level 2nd Level of Stratification of Stratification (Industry Standard) (INTERVENT) Lower Lower Risk Intensity 0-2 Risk Factors Intervention 59% 35% Moderate Moderate Population Individual Intensity HRA stratification Risk 3-4 Risk Factors stratification Intervention 32% 30% Higher Risk Higher 5 + Risk Factors Intensity 9% Intervention 35%Level 1 = risk for future direct and indirect health care-related expenditure (“health risk stratification”);Level 2 = intensity of lifestyle health coaching required to facilitate risk Key: reduction in moderate/higher-risk individuals and to keepapparently healthy individuals healthy (“intervention intensity BOB Datastratification”)
Referrals to Allied Healthcare ProvidersConsent to have EAP make an outbound call
Physician Summary ReportPartnering with C-CHANGE to ensure concordance with Canadian guidelines
Lifestyle Management Programs: Key Steps Be sure that the Lifestyle Management Program that you select incorporates all of the following essential components: 1. Identification of At-Risk Individuals 2. Risk Factor Determination 3. Goal Setting 4. Action Plan Formulation (guideline-based) 5. Action Plan Implementation 6. Referrals to Allied Health Care Providers (MD; Pharmacist; CDE; EAP) 7. Follow-up Evaluation and Progress Reports 8. Compliance Enhancement/Tracking 9. Aggregate Outcomes Assessment 10. All of the above should all be evidence-based…
Coaching Methodology • Incorporates multiple behavior-change techniques: e.g., stages of change, motivational interviewing, single concept learning theory Coaching • Educational kits, audios, eating and exercise diaries and on-line materialsPhilosophy support the foundation for behavioral change • Comprehensive goals and action plan linked to health risk factors • Dedicated health coaches assigned to participants; pull in specialists as needed Emotional • Wellness Vision Support • Focus is on the individual • Evidence-based medicine approach • Formal, structured, systematic approachInterventions • Nature and intensity of intervention individualized based on multiple factors, including risk status and readiness to change Progress • System supports tracking of qualitative and quantitative results • Follow-up reports utilized during the program allow the participant to Tracking track their progress along the way • Quality audits help ensure delivery of a high-quality program Quality • Calls tracked and recorded
Interventions Driven by Hard Science (with documented outcomes)Approximately 100 published scientific abstracts or manuscripts documenting benefits in terms of multiple risk factors, clinical variables, self-reported health status and ROI (Including numerous publications in peer-reviewed medical journals and independent third- party research) Key scientific manuscripts include: 1. Comparison of single versus multiple lifestyle interventions: Are the antihypertensive effects of exercise training and diet-induced weight loss additive? American Journal of Cardiology 1997;79:763-767 2. Comprehensive cardiovascular disease risk reduction in a cardiac rehabilitation setting. American Journal of Cardiology 1997;80(8B):69H-73H 3. Comprehensive cardiovascular disease risk reduction in the clinical setting. Coronary Artery Disease 1998; 9:731-735. 4. Innovative approaches to comprehensive cardiovascular disease risk reduction in clinical and community-based settings. Current Atherosclerosis Reports 2001; 3:498-506 5. Effects of a contemporary, exercise-based rehabilitation and cardiovascular risk reduction program on coronary patients with abnormal baseline risk factors. CHEST 2002; 122:338-343 6. Effectiveness of 3 models for comprehensive cardiovascular disease risk reduction. American Journal of Cardiology 2002;89:1263-1268 7. Effectiveness of therapeutic lifestyle changes in patients with hypertension, hyperlipidemia, and/or hyperglycemia. American Journal of Cardiology 2004; 94: 1558-1561 8. Effect of comprehensive therapeutic lifestyle changes on pre-hypertension. American Journal of Cardiology 2008; 102; 1677-1680. 9. Health-risk appraisal with or without disease management for worksite cardiovascular risk reduction. Journal of Cardiovascular Nursing 2008; 23: 513-518. 10. Clinical effectiveness of lifestyle health coaching: Case study of an evidence-based, technology-enabled, outcomes oriented, comprehensive program. 2012 (In Review).
Scientific Evidence INTERVENT U.S.A.Percent change in 10-year Framingham CHD Risk Score in higher-risk employees Source: Published in Journal of Cardiovascular Nursing, November 2008
Scientific Validation INTERVENT U.S.A.Percentage of participants who achieved goal levels in classic CVD risk factorswithout medications within three months of initiating the program Source: Published in American Journal of Cardiology, December 2004
Drug use among INTERVENT compliers**No statistically significant differences between baseline vs. follow-up rates. Follow-up assessed at 12 weeks Gordon NF; Am J Cardiol 2002; 89:1263-68
Return On Investment INTERVENT U.S.A. State of Oklahoma Pilot: Average Health Care Claims Per Employee in 2002 vs. 2003 $2.30 savings for every $1 spent Non-INTERVENT Participants INTERVENT ParticipantsNotes: INTERVENT Program was implemented in January 2003. Participants enrolled in the INTERVENT Program in 2003 and completed a full year of service and evaluations. Analysis performed, in part, by Milliman Consultants and Actuaries.
Return On Investment INTERVENT Canada 138.4 minutes per week gain in exercise among sedentary employees 35.7% improved medication compliance ROIpresenteeism $4.42 for every $1 spentGamma-Dynacare Medical Laboratories Employee Case-study
Meta-Evaluation of Worksite Health Promotion Economic Return Studies: 2012 Update Chapman LS. Am J Health Promo 2012; 26: TAHP-1-TAHP-12• Meta-evaluation of 62 economic return on investment studies of multi-component worksite wellness/health promotion• Average duration of follow-up = 3.83 years• Number of study subjects = 546,971• Key findings: % Change in sick leave absenteeism = -25.1% % Change in workers’compensation costs = -40.4% % Change in disability management costs = -24.2% % Change in health costs = -24.5% Cost:Benefit Ratio = 1:5.56 (i.e., ROI = 556%)
US Companies Use ofDisease Management Programs
Shoppers Drug MartSelect Data from HRA and LifestyleHealth Coaching Summary Analyses
Shoppers Drug MartDr. Dorian Lo, Executive Vice President, Pharmacy and Healthcare atShoppers Drug Mart Previous positions include: • President, Shoppers Drug Mart Health Solutions • Medco Health Solutions, Chief Medical Officer, Health Plans • McKinsey & Company • Boards: Society of Aging of New York, Chilton Memorial Hospital Foundation • MBA (Wharton) and MD (University of Western Ontario)
Why did Shoppers Drug Mart Implement a Program?The program allowed us to further invest into our employees’health.• “Walk-the-Walk”of promoting good health and counseling• Supports our culture of Caring• Demonstrate SDM as a Top Employer• Use health information to stratify patients for disease management and holistic employee care
What Did We Hope to Achieve?Shoppers had the following goals:• Improve productivity through decreased absenteeism and better employee health• Improve intermediate outcomes and select clinical end-points• Improve employee satisfaction
Description of the Program• First Step: Health Risk Assessment (HRA) • Phase 1 – offered to Corporate Head Office ~ 1200 employees • Phase 2 – rolled out to Allied Business Units ~ 500 employees • Integrated with flex benefits insurance program • Integrated Lab Results• Second Step: Referrals • Referrals to Certified Diabetes Educators and Employee Assistance Program • Coached programs for higher risk employees • On-line lifestyle management programs• Encouraging Success • Optimum points and other incentives • 76% of employees started an HRA • 96% completion rate
Our Workforce: Mainly Women BU 1 BU 2 BU 3 ALL BOB Completed 832 110 261 1,203 -- HRA (Number) Male 373 479 33 (30.0%) 73 (28.0%) (n & %) (44.8%) (39.8%) (49.6%) Female 724 459 (55.2%) 77 (70.0%) 188 (72.0%) (n & % ) (60.2%) (50.4%)(BU = Business Unit; ALL = All BUs combined; BOB = Book of Business)
Our Workforce: Average Age of 40 y.o. BU 1 BU 2 BU 3 ALL BOB Age 42.3 M 37.1 M 39.1 M 41.5 M 43.4 M (Years) 40.5 F 41.8 F 37.7 F 39.9 F 42.9 F Males – 18.4% 7.3% 8.0% 15.1% 23.4%Age 45 or Older Females – 3.8% 10.9% 5.0% 4.7% 8.3%Age 55 or Older
SDM Employees were at lower risk than INTERVENT’s book of business 1st Level 2nd Level Lower Lower Risk of Stratification of Stratification Intensity 0-2 Risk Factors (Industry Standard) (INTERVENT) Intervention 59% / 79% 35% / 59% Moderate Moderate Population Individual Intensity HRA stratification Risk 3-4 Risk Factors stratification Intervention 32% / 18% 30% / 23% Higher Risk Higher 5 + Risk Factors Intensity 9% / 3% Intervention 35% / 18%Level 1 = risk for future direct and indirect health care-related expenditure (“health risk stratification”);Level 2 = intensity of lifestyle health coaching required to facilitate risk Key: reduction in moderate/higher-risk individuals and to keepapparently healthy individuals healthy (“intervention intensity BOB;stratification”) Shoppers Drug Mart
Our various business units had similar Wellness Scores 80 79 78 78 77.6 77.6Wellness Score 77 76.4 76 75 74 73 BU 1 BU 2 BU 3 ALL
78.3% of Participants are at a higher than desirable risk for CVDOnly 21.7% of participants are at a desirable risk for cardiovasculardisease. This is a concern but this is not a surprising observation. BU 1 BU 2 BU 3 ALL Known CVD, Heart Failure, and/or 4.1% 2.7% 3.4% 3.8% Diabetes One or More Potentially Modifiable 73.6% 78.2% 75.9% 74.5% CVD Risk Factors Total at Higher Than Desirable Risk 77.7% 80.9% 79.3% 78.3% for CVD Mean 10-Yr Risk for Coronary Heart 4.3% 2.0% 3.2% 4.0% Disease 10% or Higher 10-Yr Risk for 7.7% 0% 0% 6.6% Coronary Heart Disease
Weight remains the main risk factorPrevalence (%) of Six Major Modifiable Risk Factors Among HRAParticipants by Business SectorsBusiness Current Prehypertension Abnormal Prediabetes Overweight PhysicalSector Cigarette or Hypertension Cholesterol or Diabetes or Inactivity Smoker and/or Obese TriglyceridesBU1 8.2% 25.5% 12.6% 5.0% 54.6% 39.3%BU2 14.5% 36.4% 10.9% 2.7% 58.2% 41.8%BU3 8.0% 23.4% 7.7% 2.3% 42.9% 48.3ALL 8.7% 26.0% 11.4% 4.2% 52.4% 41.5%
Stress is another main risk factorPrevalence (%) of Other Select Risk Factors, Chronic Conditions orNegative Health Behaviors Business Great Deal Poor Sleep Apnea or Medications Medications Asthma Sectors of Stress Eating Evidence of for Anxiety for (Home/ Habits Another Sleep Depression Work) Disorder BU1 41.3% 32.7% 31.0% 3.5 3.4 6.9 BU2 44.5% 45.5% 32.7% 3.6% 5.5% 12.7% BU3 39.1% 43.7% 28.3% 3.8% 4.2% 10.0% ALL 41.1% 36.2% 30.6% 3.6% 3.7% 8.1%
High interest from our employeesWeight Management (%) 70 60 50 Percentage 40 35.9 30.9 30 25.5 26.3 20 10 0 Somewhat Interested Very Interested Shoppers Drug Mart Book of Business
High interest from our employeesExercise Training (%) 70 60 48.3 50 Percentage 40 34.9 29.4 29.1 30 20 10 0 Somewhat Interested Very Interested Shoppers Drug Mart Book of Business
High interest from our employeesSmoking Cessation (%) 70 60 47.7 50 Percentage 40 36.2 30 23.9 26.8 20 10 0 Somewhat Interested Very Interested Shoppers Drug Mart Book of Business
High interest from our employeesNutrition (%) 70 60 49.0 50 Percentage 40 35.2 29.6 29.9 30 20 10 0 Somewhat Interested Very Interested Shoppers Drug Mart Book of Business
High interest from our employeesStress Management (%) 70 60 50 Percentage 40 32.8 30.8 30 28.1 22 20 10 0 Somewhat Interested Very Interested Shoppers Drug Mart Book of Business
Intermediate outcomes have improved for participants
% of at risk participants has decreased through coaching Prevalence of Potentially Modifiable Risk Factors Participants at Baseline + Follow-up (n=75; average follow-up=~20 weeks) 80 78.6 70 60 59.5 55.7 50 53.7Percentage 45.9 Prevalence at 40 41.5 41.9 Program Entry 37 36.8 30 33.8 Prevalence at Follow-up 20 22.7 Evaluation 18.2 10 12.0 12.0 0 Elevated Elevated Elevated LDL Obesity Cigarette Elevated Stress Systolic BP Diastolic BP Cholesterol Smokers Blood Glucose
Shoppers Drug Mart ConsiderationsEmployers need to balance investments vs the importance ofqualitative employee health & wellness.• HR and CFOs are reluctant to pay for programs until ROI is proven in Canada HRA and disease management reinvestment is typically combined with a restructuring of benefits offering Canadian studies are needed to establish ROI for employers• Should Government subsidize DM since these activities can reduce their medical expenditures US studies show that most of the impact from DM relates to hospitalization and overall burden from chronic care• Incentives and convenience are required to drive strong participation (including on-site health clinics to collect lab results)
Conclusion• HRA is a key enabling step in managing health and wellness since it provides health data• HRA’s use is in deriving positive ROI from interventions• Employers can utilize existing research and their own data to judge overall benefits of DM initiatives and to ensure programs are targeted and customized to their employees’ needs
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