1. Heart and Mind Connections: Integrated Strategies for Greater Health Workgroup Kick-off Meeting

2. 2 Agenda I.Business Risk/Opportunity II.Workgroup Mission III.Program Goals IV.Review of Tasks V.Next Steps

3. 3 Business Risk/Opportunity  Human cost: No 1. killer of Americans and a leading cause of disability  Financial costs: Key contributor to rising health care and disability expenditures and a prime cause of decreased productivity  Heart disease is often associated with mental health diagnoses.  In these cases of co-morbidity, the mental health conditions may not be properly diagnosed or may be undertreated.  An integrated cardiovascular/behavioral health program must address the strong connection between heart health and mental health. Heart Disease

4. 4 About Heart Disease and Mental Health  Depression, anxiety, hopelessness, pessimism, hostility and anger have all been linked to heart disease. 1,2,3  Depression and anxiety disorders may affect heart rhythms, increase blood pressure, alter blood clotting, and lead to elevated insulin and cholesterol levels. These risk factors often predict, and are a response to, heart disease. 4  People with heart disease are more likely to suffer from depression than otherwise healthy people; conversely, people with depression are at greater risk for developing heart disease. 5  Those who have heart disease and who are depressed have an increased risk of death after a heart attack compared with those who are not depressed. 6

5. 5 Fighting Heart Disease: The Role of Behavioral Health Experts  Emotional, psychological and behavioral intervention and support is essential in helping to prevent or manage heart disease.  Behavioral experts can: identify and manage behavioral health contributors that can impact heart health, such as depression, anxiety and chronic stress support those who are living with heart disease promote and sustain a healthy lifestyle

6. 6 Workgroup Mission Senior leadership approved the creation of a multi- functional workgroup to:  recommend an integrated cardiovascular/behavioral health program for our organization  implement and promote the program  continuously monitor the program’s effectiveness and make adjustments as necessary  evaluate and report on program success

7. 7 Program Goals Address the connection between heart health and behavioral health issues by offering programs that:  Educate individuals on the lifestyle habits that put their heart health at risk  Support individuals who are changing their behavior for improved health  For individuals living with heart disease, encourage compliance with their treatment plan and support them in dealing with the stress and emotions surrounding their condition  Help individuals identify the signs of depression, anxiety and chronic stress, and know when to seek help for them

8. 8 Review of Tasks  Assess programs and resources currently available through internal departments and vendors  Assemble supportive programming  Design a communication strategy  Provide recommendations to senior leadership

9. 9 Assess Current Programs, Resources  Internal Health and safety Medical Food service Fitness center ?  Vendors/partners Health plan(s) ValueOptions ?

10. 10 Service Options Offered by ValueOptions  Standard: 24/7 assessment and referral Employee assistance program (EAP) Stress-reduction counseling Depression screening Intensive case management Support for family and support systems Primary care physician (PCP) behavioral health consultation Educational programs  Enhanced services: Lifestyle coaching Tobacco cessation Nurse line Integrated care

11. 11 Assemble Supportive Programming  Making lifestyle change Identify modifiable behaviors to target Provide information and services to motivate and sustain behavior changes for each  Living with heart disease Reach out to individuals with information and services to support them in coping with emotions and in complying with an individualized treatment plan  Managing depression, anxiety and chronic stress Provide screening tools and information on recognizing signs, coping strategies and resources for professional help

12. 12 Design a Communication Strategy  Support program goals  Plan frequent outreach  Use varied mediums  Make a long-term commitment  Consistently promote key messages

13. 13 Provide Recommendations  Program goals  Current programs  Suggested new programs  Resource request (staffing and financial)  Timetable  Measures of success

14. 14 Identify Next Steps

15. 15 Sources 1 Williams R.B. Neurobiology, cellular and molecular biology, and psychosomatic medicine. Psychosom Med, 1994; 56:308-315. 2 Denollet J., Brutsaert D.L. Personality, disease severity, and the risk of long-term cardiac events in patients with a decreased ejection fraction after myocardial infarction. Circulation. 1998; 97:167-173. 3 L.D. Kuzansky, K.W. Davidson, and A. Rozanski. The Clinical Impact of Negative Psychological States: Expanding the Spectrum of Risk for Coronary Artery Disease. Psychosom Med, May 1, 2005; 67(Supplement_1):S10-S14. 4 National Heart, Lung and Blood Institute 5 Nemeroff CB, Musselman DL, Evans DL. Depression and cardiac disease. Depression and Anxiety, 1998; 8(Suppl 1): 71-9. 6 Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation, 1995; 91(4): 999- 1005.