# Presentation: 075717

## Community Initiative on Cardiovascular Health and Disease(CICV) A Public-Private Partnership

**	****	****  **
**	****	****    ****State Heart Disease and ****	****	****	**** Stroke Prevention Program**
**                                 ****September 19, 2007**

## Presenter

- William L. Bruning, JD, MBA
- 	President & CEO
-     Mid-America Coalition on Health Care
- _[bbruning@machc.org](mailto:bbruning@machc.org)_
- 	One West Armour Blvd, Ste 204
- 	Kansas City, Missouri 64111
- 	816.753.0654

## Today’s Objective

- To discuss:
- Employer concerns around worksite health
- An employer-driven community approach to addressing the cardiovascular health of its citizens
- Public Health’s possible roles in this process

## 29 years of collaboration to improve the quality of health care in the Greater Kansas City Region

**Our Mission**
-  To improve the health of employees and their families
-  Promote employee and community wellness
-  Develop strategies for containing health care costs
-  Serve as a community resource in generating and communicating
-    health care information

## Mid-America Coalition on Health Care

- Employer-driven – fully collaborative
- 501(c)(3) – non-profit
- All stakeholders
- Employers, Hospitals, Health Plans, Physicians, Government, and Public Health
- 60 members – over 400,000 lives
- 30 years of Collaboration: “ A contact sport!”
- History of strong Public Health relationships

## Mid-America Coalition on Health Care

- National Initiatives from Local Collaboration
- Patient ID Card design – Adopted by WEDI, MGMA and health plans across the country
- Swipeable Patient ID Card Technology – WEDI’s national pilot
- Hospital Quality Report replicated state-wide – cited by CMS
- Community Initiative on Depression – Nation’s leading approach, in conjunction with American Psychiatric Assn
- Value-Based Benefits – NBCH’s national pilot, helping employers “fully load” the benefits of wellness investments

## What are Employers concerned about?

- Employers pay for 65% of health care
- Health care costs – twice inflation in a good year
- Medical Safety and Quality
*To Err is Human*
- Evidence-based Medicine
- Systems complexity – employers pay for it
- Motivating employees to reduce health risks
- High cost diseases and health issues
- Cardiovascular (Diabetes, Obesity), Mental Health, Asthma, Musculoskeletal

- Community Initiative on Cardiovascular Health and Disease

## Community Initiative on Cardiovascular Health and Disease

- 14 Employers - 400,000 lives - 2005-2009
- All Stakeholder Collaboration, including:
- Employers, Chamber of Commerce, IHPM, NBCH
- Public Health: CDC, States of Kansas and Missouri
- Providers, AAFP, AHA
- Regional and National Health Plans
- Pharmaceutical Industry
- Focus on Primary and Secondary Prevention
- Hypertension, Cholesterol, Smoking, Inactivity, Nutrition, Metabolic Syndrome

## Why Cardiovascular Disease and Stroke?

- Heart disease is the leading **cause of death** in the United States
- The leading **cause of disability** and death for American businesses
- The cost of cardiovascular diseases and stroke in the United States for 2007 is estimated at** $431.8 billion**

## Why Cardiovascular Disease and Stroke?An evolving interest

- 1999 Employer BRFSS Survey of eight Coaltion members
- 27% had three or more CV risk factors
- National success of the Community Initiative on Depression
- 2004 Coalition Strategic Planning Survey
- Kansas City area statistics
- The 2004 death rate due to coronary heart disease was 152/100,000. This was the #1 cause of death
- Public Health in Kansas and Missouri interested in engaging employers on work site issues (through HDSP programs)

## CICV Goals			

- Improve **Work site** CV wellness and secondary prevention outcomes for employees.
- Reduce health care and lost productivity costs.
- Coordinate employer efforts with **Clinical** projects of providers, health plans and public health.
- Improve **Community **awareness of how to be a “heart healthy consumer.”

## CICV Structure 

**CICV Structure**** **

- 2005  Mid-America Coalition on Health Care

**CDC**

**State Dpt.’s of Public Health**** **

## CICV Employers

- American Academy of Family Physicians
- American Century Investments
- Blue Cross and Blue Shield of Kansas City
- Butler Manufacturing
- Center School District
- Cerner Corporation
- Hallmark Cards

- JE Dunn Construction Group
- City of Kansas City, Missouri
- Saint Luke’s Health System
- Sprint Nextel
- State of Kansas
- UnitedHealthcare of the Midwest
- University of Kansas Hospital Authority

## CICV Funding 

- Employers
- Kansas Department of Health and Environment
- Missouri Department of Health and Senior Services
- Sunflower Foundation
- Pharmaceutical Companies
- Technical and financial resources

## CICV – the role of Public Health 

- CDC – *Heart-Healthy and Stroke-Free Worksites*
- Provided the Toolkit and technical assistance
- Pilot-tested Toolkit with 14 employers to get feedback and insights into employer concerns
- States
- Kansas Department of Health and Environment
- Missouri Department of Health and Senior Services
- Provided technical and financial resources
- Translated first-hand exposure to employer processes into replicable lessons for the HDSP program

## CICV Work Site Component

- Phase I – Information Gathering
-      (January - June, 2005)
- Phase II – Employer Buy-in and Baseline Surveys
-     (Fall 2005 – Summer 2006)
- Phase III – Goal Setting and Worksite Interventions
-      (Fall 2006 - 2007)
- Phase IV – Worksite Interventions and Measurement
-     (2007-2008)

## CICV Work Site Component:

- Baseline Surveys (2006, re-measured 2009):
- Leadership Survey
- H*eart Healthy Lifestyles Employee Attitudinal Survey*
- Employer Worksite Wellness Environment Inventory
- Cardiovascular Health Plan Benefit Design Survey
- Productivity Measurements
- Available health risk Data
- “Connecting the Dots”
- Medical Claims Analysis
- Health Risk Appraisals
- Medical Screenings

## Work Site Interventions  

- Employers have adopted dozens of different interventions in response to their Baseline Surveys
- Increasing **Leadership** support
- Building a heart-healthy **Environment**
- Enhancing tools to measure **Risks**
- Improving employee **Motivation**
- Developing a Return on Investment (**ROI**) strategy
- Improving the use of **Data**
- Value-based **Benefits**

## CICV Work Site Component:The Value-Based Benefits Project

*Helping employers “fully load” the return on their wellness investment by aligning benefits and removing barriers to care*
- Educating employers
- Finding and correlating all relevant Data
- Designing a Data Dashboard
- “Dream Reports” for vendor Data Integration
- Templates for messaging to leadership & employees
- Value-Based Insurance Design
- Developing a replicable national pilot for the National Business Coalition on Health

## CICV Clinical Component

- Phase I – Project identification, foster collaboration, and education of stakeholders
-      (2005 - 2006)
- Phase II – Market assessments: Identify barriers and best practices
-     (2006)
- Phase III – Provider toolkit development and strategic planning
-      (2006 - 2007)
- Phase IV – Implementation and Provider Education
- (2007-2008)

## Coordination of Care: Navigating the System

- Coordination of Care: *Navigating the System*

-           Dispatch

- Paramedic

- Triage

-   Chest Pain Coordinator

- ED Physician

- Lab, Radiology, etc

-   Interventional       Cardiologist

- Cath Nurse(s)

-          Cath Tech

-   Floor Nurse

-      Hospitalist

- Cardiologist

-     ED Nurse

- CM,
- Discharge

-    Pharmacy

- Nutrition, RT, OT

- Inpatient Rehab

- Outpatient Rehab

- Medical Director

-       Educator

-       Therapist

- PCP

- Nurse Practitioner

-     Office
-   Manager

- Cardiologist

- Office Manager

- Nurse Practitioner

- HR

-  Supervisor

**Health Plan**

**Home**
** ****Health**

**Pharmacy**

- Nurse

## CICV Clinical Component:How will things be different?

- Improved adherence to AHA/ ACC guidelines for heart attack care.
- Improved communication across provider settings to decrease adverse events and duplicate tests.
- Increased provider and consumer understanding of the importance of coordinated care, and strategies to improve this.
- Engagement of employers can impact both provider reimbursements and return to work issues.

## CICV Community Component

- Leveraging Employer engagement to improve community health
- Employer to Employer education
- Chamber of Commerce “Town Hall” meeting
- Series of membership and community presentations
- National rollout and presentations
- Supporting local public health efforts
- Health Dept, Parks and Rec, School of Urban Planning
- Possible Public Campaign
- By-Stander CPR

## Next Steps?

- Employers assess successes and failures of CICV
- Plan a third Community Initiative – perhaps diabetes or obesity
- Work with Kansas and Missouri to replicate in other communities
- Work with CDC to compile employer “tips” and assist replication in other states

## What does all this mean for Public Health?

- Face it – collaboration is tough, it takes time
- Employers don’t value “public health” but they highly value its services
- You have to have employer trust and respect first, be at the table when the “teachable moment” arises
- You have to speak “employer-ese” and understand workplace concerns

## Questions?