1. Community Initiative on Cardiovascular Health and Disease Health Policy Forum on Cardiovascular Health and Wellness September 29, 2006 Marti Macchi, MEd Director, Special Studies Kansas Department of Health and Environment

2. Today’s Objectives Why Worksites Private/Public Partnership The CICV Project Next Steps

3. Why Worksites? Most people spend more of their waking hours at work than anywhere else Worksite organizational culture and environment are powerful influences on behavior Heart disease, stroke and multiple risk factors are costly to employers Productivity, absenteeism and presenteeism cost concerns of employers

4. Employees’ Hearts  About 1 in 4 Americans have a cardiovascular condition.  Heart disease and stroke-related costs in the United States for 2005 are estimated at $393 billion, and are expected to rise by the year 2010. American Heart Association. Heart disease and stroke statistics: 2005 update. Dallas, TX; 2005

5. In 2002, U.S. employers paid an average of $18,618 per employee per year for all health and lost productivity costs. Parry T. Integrated Benefits Institute; 2004 GH – Group health (employees and dependents) WC – Workers compensation STD – Short term disability LTD – Long term disability *Unpaid leave (incidental absences) – unpaid leave associated with an employee’s or dependent’s serious health condition, as permitted under the Family Medical Leave Act Figure 1 Legend

6. Source: Business Roundtable questionnaire of 131 CEOs of companies with a combined workforce of more than 10 million employees and $4 trillion in annual revenue. Percentages do not equal 100% due to rounding. CEOs: What cost is your company’s biggest concern in 2005? What is keeping executives up at night? Source: Mercer Health and Benefits Consulting 2006

7. Public-Private Partnerships Building Blocks of Success Heart Disease and Stroke Prevention

9. CAUSES of DEATH Kansas, 2003 Note: Other CVD deaths were deaths due to essential hypertension, atherosclerosis and other circulatory diseases defined by ICD-10 codes I00-I99. Source: 2003 Kansas mortality data. Office of Health Care Information. KDHE.

10. Causes of Death Missouri, 2004

11. The Partnership  Public Health (partial project funding source through the HDSPP funding from Centers for Disease Control and Prevention)  Kansas Heart Disease and Stroke Prevention Program  Missouri Heart Disease and Stroke Prevention Program  CDC, CMS  Mid-America Coalition on Health Care (non- profit/non-governmental)  Private Organizations  For-profit – private large employers both health care and non-health care industries (14 employers)

12. The Coalition Mid-America Coalition on Healthcare Public Health Private Industry

13. Mid-America Coalition on Health Care Key to linking Public Health with multiple large employers An employer-driven coalition – 501(c)(3) – non-profit Number of employers/stakeholder organizations In existence for almost 30 years Mission: To improve the health of employees and their families Promote employee and community wellness and illness prevention Develop strategies and initiatives for containing business health care costs Generate and communicate health care information to the community Membership 60 members (large and small employers)

14. Mid-America Coalition on Health Care  Activities Break down barriers Focuses employer energies Reduces health system complexities Develop model programs and informs stakeholders Serves as a national model

15. Employers Worksite Employers Health Plans Worksite Assessments Oct 05 – May 06 Interventions Fall 06 – May 08 Measurement Late 2008 Clinical Employers Stakeholders Coordination of Care Barriers Assessment Jan – Dec. 05 Interventions Jan 06 – May 08 Measurement Late 2008 Community Employers Public Public Need Assessment Jan – May 06 Interventions May 06- May 08 Measurement Late 2008 Mid-America Coalition on Health Care Community Initiative on Cardiovascular Health and Disease 2005  Mid-America Coalition on Health Care

16. What is the Community Initiative on Cardiovascular Health and Disease Worksite

17. Project Objectives Increase employee participation in employer/plan programs Increase knowledge of CV risks, prevention strategies and individual CV health status Improve long-term health of employees Assess the continuum of care Reduce overall employer health care costs

18. CICV Phases and Timeline Phases I, II, III and IV Phase I – Information Gathering (Literature review, Research Design: Jan – June, 2005) Phase II – Employer Buy-in and Baseline Assessments (Fall 2005 – Summer 2006) Phase III – Goals, Objectives and Implementation (Fall 2006 - 2008) Phase IV – Measurement (2009)

19. Phase II: Baseline Assessment Tools 1. Productivity Measurement 2. Medical Claims Analysis 3. Health Risk Appraisals 4. Medical Screenings 5. Leadership Survey 6. Heart Healthy Lifestyles Employee Attitudinal Survey 7. Employer Worksite Wellness Environment Inventory 8. Cardiovascular Health Plan Benefit Design Survey (CDC Heart-Healthy and Stroke-Free Worksites Toolkit)

20. Heart Healthy Lifestyles Employee Survey To measure employees ’: 1. Knowledge of signs and symptoms of heart attack and stroke and heart disease risk factors 2. Attitudes about employer Involvement in health improvement 3. Health behavior most likely to improve and barriers 4. Perceptions of worksite health improvement support, including leadership, management and co-workers. 5. Preferences for receiving and use of employer health improvement information. 6. Attitudes about health benefits

21. Demographics Response rate: 7,404 (22.4%) 65% female Age Under 35 = 31% 35-54 = 56% 55 and older = 14% Ethnic 83 % Non-Hispanic 3% Hispanic 15% No Response Race 85% White 6% Black/ African American 3% Asian, Native Hawaiian, American Indian 7% No response

22. Demographics, cont. Education High School or Less = 5.1% Some College or Trade = 18.9% College Degree or beyond = 76% Position Non-Manager = 74% Manager = 26% Smokers – No = 93% Exercise 3 times per week or more – 60% Overweight – 49%

23. Knowledge 60% and 76% of respondents were able to identify five or more signs and symptoms correctly for heart attack and stroke, respectively. 75% of respondents were able to identify the majority of heart disease risk factors.

24. Employer Involvement

25. Support

26. Health Benefits

27. Information

28. What’s Next ? Reporting Plan Individual Employer Report Integration Plan Combined with other CICV Employer assessment activities. (e.g. Benefit Design, Environment Inventory) Use results to: Identify and design CICV Employer interventions. Identify community resources to address findings (e.g. American Heart Association and Public Health)

29. CICV Phase III Establish Goals, Objectives and Benchmarks (F06) Intervention Design: Connecting the Dots (F06) Based on Employee Survey and other assessments Incorporated into existing employer wellness plans Create an evaluation plan (i.e. Phase IV) Implementation (Early 07 – Fall 08) Individual and group activities Total Time Frame: Fall 2006 – Fall 2008

30. Connecting the Dots Intervention Design Productivity Measurement Medical Claims Analysis Health Risk Appraisals Medical Screenings Leadership Survey Heart Healthy Lifestyles Employee Attitudinal Survey Employer Worksite Wellness Environment Inventory Cardiovascular Health Plan Benefit Design Survey

31. CICV Phase IV Measurement, Measurement, Measurement “Score Cards” Improvement in baseline assessment scores Environment Inventory Benefit Design Leadership Creation of Replicable Model Time Frame: Early 2009

32. Lessons Learned Up To This Point: Public-Private Partnerships can work Be willing to learn from each other Don’t assume employer viewpoints or concerns “Private” Partnership Language “Realism” of the project Length of time MACHC role in bringing Public Health and private companies together

33. Contact Information Marti Macchi, MEd Director, Special Studies Kansas Department of Health and Environment Office of Health Promotion 1000 SW Jackson, Suite 230 Topeka, KS 66612 (785) 291-3743 MMacchi@kdhe.state.ks.us