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									Work Site Solutions and Wellness Programs

               Premila Mary Kumar
               Senior Clinical Manager
        Health and Wellness Education Programs
                    Facts about Obesity

 Recent estimates state obesity accounts for $117 billion per
    year in national healthcare expenditures
   2/3 of American adults are overweight or obese (BMI >25)
   14% of adolescents 12-19 years old are overweight
   300,000 deaths each year are related to obesity
   Obesity on verge of surpassing smoking as #1 cause of
    preventable death
   Obesity is a factor in increase of disability
   Diabetes rates will double worldwide by 2030
          Increase in Overweight, Obesity and Severe Obesity
                    Prevalence Among U.S. Women*

                                       1988 to 1994                   1999 to 2000
      Weight Category
                                      Prevalence (%)                 Prevalence (%)
                                            51.2                            62
         (BMI > 25)
                                             26                             34
         (BMI > 30)
       Severe Obesity
                                              4                            6.3
         (BMI >40)

Source: CDC, National Center for Health Statistics, National Health and Nutrition Examination
Survey. Health, United States (Table 70) 2002. Flegal et. al. 2002;288:1723-7. *Ages 20 to 74
for overweight and obesity prevalence and ages 20 and older for severe obesity.
          Increase in Overweight and Obesity Prevalence (%)
               Among Women by Racial / Ethnic Group

  Racial / Ethnic           Overweight                Obesity
     Group                  (BMI > 25)              (BMI > 30)

    Black (non-
                                 78                     50.8

                                71.8                    40.1

   White (non-
                                57.5                    30.6

Source: CDC, National Center for Health Statistics, National Health and Nutrition Examination
Survey. Health, United States (Table 70) 2002.
                   Causes of Obesity

 Greater calories consumed than used
 Sedentary lifestyle
 Genetics
 Metabolism
 Behavior
 Environment
 Cultural influences
 Socioeconomic influences

**National Center for Chronic Disease Prevention and Health Promotion
Conditions Affected by Obesity

                   Diabetes Mellitus
                   Arteriovascular
                    Disease (CAD, CVD,
                    HTN, Hyperlipidemia)
                   Heart Failure
                   COPD
                   ESRD (DM, HTN)
                   CA (many forms)
    Healthcare Implications of Obesity

 65% of Americans are overweight or obese
 Additional expenses for employers
     Disability
     Absenteeism
     Presenteeism
     Orientation
 Impact on children
     1st generation that will not outlive their parents
     Unchecked, the cost of healthcare in our children’s
      generation will be staggering
                  Who’s in Control of Your Health?

Contributing Factors to an Individual’s Health Status

                                                               Life style be haviors
                                                               Environme nt
                                                               Ge ne tics
                     10%                                       Acce ss to Care
   20%                                      50%

    Source Centers for Disease Control and Prevention (2000)
    Retrieved August 11, 2003, from http//
                                                              How Health Impacts Business Costs
                                                              The Payback from Behavior Change


                                             $400       Absence
        Annual Costs Per Employee Per Year

                                             $350       Medical








                                                    Allergy   Arthritis   Asthma   Any Cancer Depression/                            Hyper-    Migrane/   Infections
                                                                                                                Diabetes   Heart
                                                                                               Sadness                               tension   Headache
                                                                                               Mental Illness              Disease

Source: Goetzel, Long, Ozminkowski, et al. JOEM 46:4, April ,2004)
       What has
Horizon BCBSNJ Done?
 Horizon –BCBSNJ Wellness Programs
 Employee   Health Center
 Pharmacy Concierge Services
 Onsite LabCorp laboratory services
 Onsite Fitness Center
 Mobile Mammography
 Free Flu vaccines for all employees
 Employee Assistance Program
    Horizon –BCBSNJ Wellness Programs

   Healthy food choices offered in the cafeteria
   Disease Management Programs
   Lactation Rooms
   Employee Discount Program
   Web MD online resources
   Shape it Up Program in Schools
   Horizon Health Kiosk Program
   “Horizon Walks for Health”
     Community / Corporate Wellness Program
Horizon Health Kiosk
  Better health through awareness
         In our continuing dedication to Making Healthcare Work,
         Horizon Blue Cross Blue Shield of New Jersey is making
         it easier for you to take an active role in managing and
         enhancing your overall health and well-being through
         the Horizon Health Kiosk.

                                                 A barcode is used to access the
            any medical
          Mhypertension,conditions, such
         as             can be affected          System. The system recognizes
         by the way you live your life. It is    and welcomes the user, prompting
         not only beneficial to live a heart-    you to select an ID and password.
         healthy life, but it is important to    This allows measurement
         manage your own health                  data to upload into a private,
         conditions and monitor your             protected graphical health chart,
         vital signs.                            viewable from any computer. at
         The Horizon Health Kiosk
         provides the information, resources     You can access health information,
         and tools to help you become aware      obtain information about medical
         of, and actively involved in, the       conditions you may have and record
         management of your health and any       and track changes important to you
         risk factors you may have. It has an    and your physician in choosing and
         interactive touch-screen with color     monitoring treatment. You can also
         graphic display, allowing you to        learn various ways to make positive
         measure:                                health changes to your lifestyle.
                                                 Charts and reports may be printed to
         • weight.                               help you discuss lifestyle
         • blood pressure.                       modifications and treatment changes
         • heart rate.                           with your physician.
         • body fat.
         • BMI.                                  The Horizon Health Kiosk is one
         • blood oxygen levels.                  more way we’re Making Healthcare
                                                 Work for our members.
                   Health Risk Assessment and Analysis

        Interview-style input

                                                   Immediate Results / Comparison to
                                                   Universe of peers

Horizon generates output for use in               Highlights Risk Factors and Action
Disease Mgmt, Prevention, Group                   Steps
Reporting, etc.                    Confidential
        Weight Management Health Education Program

   Welcome Kit with Tape Measure, Caloric Counter / Diary,
    Pedometer etc
   Tape Measure to assess waist circumference and waist:hip ratio
   Educational Materials
   Access to Registered Nurses, Registered Dietician, Social Worker &
    Certified Diabetes Educators
   Onsite Lunch & Learn programs
   Quarterly Educational Mailings
   Newsletters discussing hot nutritional topics
 Discount exercise programs
 Cook Shops at Employer worksite
 Weight Management Health Education Program Outcomes

 Weight loss or reduction
 Reduction in Body Mass Index (BMI)
 Waist circumference
 Clinical Metrics : Cholesterol, Blood Sugar,
  Blood pressure & A1c
 Number of ER or Inpatient admissions due to co morbid
                            Weight Loss/Waist Measurements

  • Overall, about 50% of members who have
    participated in the Weight Management
    Health Education Program have lost weight,
    and a third have lost 11 pounds or more.                              50%                     Amount of Weight Lost
        - Members who received written
          materials or have been contacted by a                           40%                                 35%         36%
          Care Specialist are more likely to say
          they have lost weight.                                          30%

  • About forty percent of members have                                   20%
    measured their waist since participating
    in the Weight Management Education                                    10%
        - Of those members, nearly 70% say                                 0%
          they noticed a decrease in their                                               1 to 5             6 to 10       11+
          waist measurement and 40% had                                                                 Pounds Lost
          a decrease in their clothing size.

Q9a: Since you began participating in the Weight Management Health Education Program, have you lost weight?
Q9b: Since you began participating in the Weight Management Health Education Program, how much weight have you lost?
Q9c: Since participating in the Program, have you measured your waist?
Q9d: Have you noticed a decrease in your waist measurement?
Q9e: Have you had a decrease in your clothing size?
                                      Members Overall Health/Absenteeism
              Over 60% of members believe they are in very good health and rarely get sick, miss
               work/school or daily activities.
              Almost three-quarters (74%) of members currently work full or part-time outside of
               the home.
              And of those members, almost none (99%) have missed any days at work because of
               any weight-related health problems in the past four weeks.

                                               Members Overall Health
        I think I am in very good health and I rarely
       get sick and miss work/school or daily activities

            I occasionally get sick, but I still go to
         work/school or carry out other daily activitites

              I occasionally have to miss work/school or
                 other daily activities because of illness

             My/child's health significantly interferes with
                                 my life

        I frequently have to miss work/school or other
                daily activities because of illness

                                                                      0%         20%        40%         60%   80%   100%
Q13: How would you describe your overall health?
Q14: Do you currently work full or part-time outside of the home?
Q15: In the past 4 weeks did you miss any days at work because of any weight related health problems?
                           Proposed Horizon Service Delivery Model
                                   Coordinated Approach

                                                                                 Decision Support &
                                                                                  Health Advocacy
                       Nurse Line

                                                                                  Lifestyle Behavior
                     On Site Clinical                                                 Change (*)

                                                    Integrator / Navigator /
Participant                                                                          Management

                                                                                                            Claims /
                                                                                        Case               Modeling
                     High Risk/Acuity                                                Management

                   Moderate Risk/Acuity
                                                                                       EAP /
Health Risk                                                                       Behavioral Health
                      Low Risk/Acuity

 * includes health coaches and web based and telephonic programs                     Warehouse:            ROI
                                                                               Comprehensive Reporting &
             In Conclusion
Lifestyle change and education promotes
decreased prevalence of obesity
     Diet

     Exercise

     Behavior Modification

 Improves overall health
 Decreases healthcare costs
Questions or Open Discussion?

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