# Presentation: 687084

## Putting Prevention First:   Business Perspectives

- Joel Bender, Ph.D., MD, Corporate Medical Director
- General Motors Corporation
- April 15, 2003

## Why the Interest in Prevention

- Largest non-government health care payer
- 1.2 million covered lives
- 189,000 employees
- 425,000 retirees
- 175,000  <65 years
- 250,000  65+ years
- $4.5 billion cash spent for health care in 2002
- $1.4 billion for prescription drugs

## GM Prevention Portfolio

- Occupational health
- Diabetes Disease Management Pilot
- Community initiatives
- located in five GM highly populated areas
- Wellness and health promotion (LifeSteps)
- Largest employee wellness program in the nation
- covers _all_ employees, _retirees_ and adult dependents

## Change in Risk Prevalence

- *among those who know their values for  biometric measurements both times.

**Current Smoker**
**Physical Activity <1 time/week**
**High Blood Pressure***
**Cholesterol >239***
**HDL <35***
**>10% over healthy wt. Range**
**Safety Belt Usage <90%**

**Overall****	****	****	****	**
**  ****0-2 risks****	****53.6%****	****+7.7%****	****70.4%****	****+2.8%**
**  ****3-4 risks****	****30.5%****	****-3.8%****	****21.7%****	****-2.5%**
**  ****5+ risks****	****15.9%****	****-4.0%****	****7.9%****	****-.3****%**

**On-Site**

**Mailed**

## Excess Self-Reported Major Diseases Associated with Excess Risks

***Low Risk***

**Percent with Disease**

***Med Risk***

**Age Range**

***High***

**Musich, McDonald, Hirschland, Edington. Disease Management & Health Outcomes 10(4):251-258, 2002.**

## Self-Reported Diabetes 

***0-1 Risks***

- Self-Reported Diabetes
- Associated with Levels of Body Mass Index (N=38,841)

**Percent with Diabetes**

***2-3 Risks***

**BMI Range**

***4-4******+ ******Risks***

**Musich, Lu, McDonald, Champagne, Edington. Accepted for publication by *****American Journal of Health Promotion***

## Diabetes ManagementWorksite Pilot

## Diabetes Management Pilot Program

- Free to employees, confidential and voluntary
- Promotes improved quality of patient care
- In-plant screening, testing, follow-up program
- free follow-up HbA1C, lipid profiles, BP testing
- Diabetes education classes, support groups
- Engage primary care physician
- Interfaces with health plans/carriers
**	****	****	**

## Diabetes Management Pilot Program

***Systematic, Integrated Wellness Team***

**Primary Care Physician**

**GM Health Services**
**Diabetes Program**

**Diabetes Education**
**through**** Multiple Resources**

- Data Tracking & Mgt through UM HMRC
- HRA
- Wellness Data
- Health Services

- Plant
- Employees

## GM Partners with Community Stakeholders

- Community
- Initiatives

## Geographic Dispersion

- GM has health care enrollees in nearly every major U.S. Zip code
- 127 HMOs offered
- 30 million transactions with:
- 200 carriers
- 4,300 hospitals
- 36,000 pharmacies
- 241,000 doctors

- 9 communities account 	for 61%  of spending

## Community Initiatives: Improve quality care in the community

- 	Improve quality of outcomes
- Increase collaboration/cooperation
- Address variation in provider practice patterns — driving toward best practices

## Community Initiatives

- Preventive focus
- ‘Just a Bit Gets You Fit” Campaigns
- “Motown in Motion”
- 	emphasis on increasing physical activity
- 	collaborative effort with common message
- 	Using various methods to measure impact
- Quality of care focus
- Michigan Quality Improvement Consortium formed to provide & implement evidence based guidelines for
- 	Ischemic Heart Disease, Diabetes, Others

## Wellness and Prevention

- A Look at
- LifeSteps

## Wellness and Prevention

- LifeSteps:  largest corporate wellness program
- Improve health and well-being of GM family
- help identify controllable health risks
- improve overall health knowledge
- modify lifestyles
- Track and measure program impact

## LifeSteps Results

- 850,000 Health Risk Appraisals
- Half of participants have decreased at least one health risk factor

- *N=7,806 actives in the intensive LifeSteps program

## High Risk Adds Cost

- The percent of total costs attributable to excess risks is 24 percent
- Participants with low-risk status are the lowest (base) risk cost

**Annual excess medical cost =  ****$450 M**

## What We Have Learned

- Improving health status of the community makes a difference
- Improving quality of care is a priority
- Agree – there is a national obesity crisis
- Excess risk factors increase prevalence of diabetes
- prevent diabetes – focus on diet and exercise
- make the workplace diabetic friendly

## What We Have Learned

- 	Wellness and prevention improve bottom line

## Slide 20