1. Blueprint VA: Industry Council for Healthcare Employee Wellness August 12, 2013 1

2. Chronic Disease in VA 13% of Virginians report having fair to poor health in general. Lenowisco, Crater, and Mount Rogers lead all health districts for highest adult current smoking rate (> 29%). The state adult smoking rate is 18%. Cumberland Plateau has the highest percentage of adults reporting smoking allowed in the home (45%). Southside has the highest percentage (45%) of adults living with children who report living in homes where smoking is allowed. The state rates of smoking allowed in the home and smoking allowed in homes where children live are, respectively, 24% and 18%. 25% of employed adults in Virginia report that smoking is allowed in indoor work areas and, therefore, are not protected from secondhand smoke exposure in the workplace. In Southside, Piedmont, and Cumberland Plateau health districts, at least 45% of adults report working in places where smoking indoors is allowed. Two-thirds (62%) of Virginia adults are at an unhealthy weight (i.e., overweight or obese). Crater, Three Rivers, and Eastern Shore lead all health districts with the greatest percentages (>72%) of adults who are overweight or obese. 50% of Virginians do not get enough physical activity. Pittsylvania-Danville, Roanoke City, and Crater health districts lead all health districts for percentage of adults not adequately meeting recommendations for moderate activity. Three-fourths (74%) of Virginians do not meet the daily requirements for eating five or more servings of fruits and vegetables. Southside, Chickahominy, Western Tidewater, and Pittsylvania-Danville lead all health districts with rates above 80%. 18% of Virginians report having a physical, mental, or emotional problem that limits their usual activities. Cumberland Plateau and Lenowisco have the highest percentages of adults reporting activity limitation and are among the top three districts with the highest rates of arthritis (Eastern Shore being the third district). Compared to other health districts, Cumberland Plateau, Alleghany, Crater, and Southside consistently have high rates of hypertension (high blood pressure), high cholesterol, and diabetes, which are all risk factors for cardiovascular disease.

3. CHRONIC DISEASE IN RICHMOND CITY HEALTH DISTRICT, 2010

4. 4 13% of Virginians report having fair to poor health in general. The state adult smoking rate is 18%. Two-thirds (62%) of Virginia adults are at an unhealthy weight (i.e., overweight or obese). Current obesity rate is 30%. 50% of Virginians do not get enough physical activity. Three-fourths (74%) of Virginians do not meet the daily requirements for eating five or more servings of fruits and vegetables. Cumberland Plateau has the highest age-adjusted rate of death from heart disease (213 per 100,000), which is double the state rate (102 per 100,000). Southside has the highest rate of death from cerebrovascular disease (67 per 100,000), which is 60% greater than the state rate (42 per 100,000).

5. $ Diabetes & cardiovascular disease make up 1/3 of health care costs American Diabetes Association. "Economic Costs of Diabetes in the U.S. in 2007". Diabetes Care. Vol. 31, No. 3, pp. 1-20; American Heart Association. "Heart Disease and Stroke Statistics 2010 Update". Circulation. 5

6. $ The combined cost of the two diseases is more than $606 billion each year American Diabetes Association. "Economic Costs of Diabetes in the U.S. in 2007". Diabetes Care. Vol. 31, No. 3, pp. 1-20; American Heart Association. "Heart Disease and Stroke Statistics 2010 Update". Circulation. 6

7. CVD, Diabetes & Obesity Diabetes = #1 Risk Factor for Cardiovascular Disease Obesity = #1 Risk Factor for Developing Diabetes 7

8. 1 in 10 adults in the United States has been diagnosed with diabetes "Diabetes Basics." Diabetes Statistics. American Diabetes Association, n.d. Web. 11 June 2012. 8

9. 1 in 3 adults is pre-diabetic 9 www.cdc.gov/features/diabetesalert/

10. 1 in 3 adults has been diagnosed with cardiovascular disease Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012: published online before print December 15, 2011, 10.1161/CIR.0b013e31823ac046. 10

11. Average cost for one person to manage cardiovascular disease for a year $ 5,693 Wang G, Pratt M, Macera CA, Zheng ZJ, Heath G. Physical activity, cardiovascular disease, and medical expenditures in U.S. adults. Ann Behav Med 2004;28:88-94. 11

12. Average cost of a stent procedure $ 18,560 Health Care Costs To Top $8,000 Per Person." CBSNews. CBS Interactive, 04 Mar. 2009. Web. 11 June 2012. 12

13. Average cost of coronary bypass surgery $ 63,648 Healthcare Blue Book." Healthcare Blue Book. N.p., n.d. Web. 11 June 2012. 13

14. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdfhttp://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf Mottillo S, et al. The metabolic syndrome and cardiovascular risk. J Am Coll Cardiol 2010;56(14):1113-32. Relationship between CVD and Diabetes Adults with diabetes have 2- 4x higher death rates due to heart disease and stroke than adults without diabetes. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdfhttp://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf Mottillo S, et al. The metabolic syndrome and cardiovascular risk. J Am Coll Cardiol 2010;56(14):1113-32. 2-4x People with prediabetes have an increased risk of developing diabetes, heart disease, and stroke. 14

15. Relationship between CVD and Diabetes Centers for Disease Control and Prevention. National Diabetes Fact Sheet: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdfhttp://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf Mottillo S, et al. The metabolic syndrome and cardiovascular risk. J Am Coll Cardiol 2010;56(14):1113-32. Just over 1/3 OF U.S. ADULTS meet the criteria for metabolic syndrome (MetS), a cluster of CV risk factors related to overweight/obesity and IR (abdominal obesity, hypertension, dyslipidemia, dysglycemia)

16. Summary Of VA Employees In Past 2 Years Sample Size: 68,477 (46,001 with Biometrics) 16

17. VA Employees (cont) 17

18. Disease Risk Levels In Employees 18

19. Diabetes Risk 19

20. Hidden Risk in VA 20 All HbA1c and GLUC was normal All had normal lipid panel

21. Main Drivers of Health Care Costs 21

22. Critical Conditions in Employee Populations 22

23. Employee Wellness: Cost 23

24. Prominent Issues Aging population Increased chronic disease (heart disease, diabetes, cancer and obesity) Age adjusted rate for heart disease is decreasing, but events are happening at an earlier age Dissatisfaction with health insurance, continual rising costs Business impact of ACA VA is not ranked in top 10 states for any of the health indicators – impact on attracting business and maintaining resources Under 19 20 to 44 45 to 64 Over 65 Changes in Virginia’s Population by Major Group (Actual and Projected) 24

25. Primary Recommendations All out war on disease – public education on health risks & impact to life support and promotion of health – all ages State support of best practices for employer programs Insurance Reform- “value based” health insurance N Engl J Med 2011;365:2088-97 25

26. Secondary Recommendations Employers Share what works Bring HC Providers into the loop of Employers Initiatives Measure, Quantitate 26