# Presentation: 445080

## BNL’s Wellness and Benefits Initiative&Some things you can do to improve your health and help reduce benefits costs

***Joe Falco, M.D., M.P.H., Manager, OMC***
***Michael Thorn, R.N., M.B.A., Manager, Health Promotion Program***
***Jai Subramani, M.D., M.P.H., Staff Physician, OMC***
**[Members, BNL Wellness/Benefits Work Group]*** *

## BNL’s Wellness and Benefits Initiative

- Established in 2007 by HR Manager Bill Hempfling
- Joint effort of OMC, OMC’s Health Promotion Program and HR’s Benefits group
- Purpose:  To address 2 important, related problems:
- Spiraling cost of health benefits
- Considerable burden of health risk factors and disease in BNL population

## Magnitude of the problem—Health Care Costs and Burden of Illness in the BNL Workforce

- Each year, BNL spends over $40 Million on health care costs, including $10 Million on prescription drugs.
- The growth in these costs exceeds inflation: >10% this past year and >10% on avg. for coming year (CIGNA/Aetna 19%, HIP 9%, VYTRA 2%)
- These costs contribute substantially to the cost of doing business at BNL and are a burden to our employees due to premium costs and premium increases.
- _More than the financial costs are the burden of pain & suffering_
- Every year, a few _current_ BNL employees die or are permanently disabled by  potentially preventable diseases; e.g.– cancer, heart disease
- 15,000 days spent sick/year from chronic or acute conditions.

## One approach to this problem: Encouraging screening and prevention

- _Screening for_:
- Modifiable disease risk factors (obesity, cholesterol)
- Precancerous growths (cervix, skin, colon [polyps])
- Diseases when still curable or treatable (or before they cause complications)
- Cancers (breast, colon, cervical, skin)
-  Hypertension (high blood pressure)
- Diabetes
- Osteoporosis
- Then take _preventive measures_ based upon screening results.

## Screening Saves lives:Example:  Cancer Screening *

- _Breast Cancer_:  At least 15% reduction in mortality with regular mammograms starting age 40
- _Cervical cancer_:  >90% reduction in incidence of invasive cancer with regular PAP tests
- Similar reduction in mortality
- _Colon Cancer_:  >50% reduction in incidence and mortality with screening (colonoscopy)

- *-Source: Guide to Clinical Preventive Services, 2008

##  And yet, BNL Claims data shows employees and family  members are not consistently going for recommended screening.Example:  cancer screening rates*

| Cancer Type | Screening Rate** |
| --- | --- |
| Breast Cancer | 70% |
| Cervical Cancer | 67% |
| Colon Cancer | 49% |

- **-Based upon recommended method & schedule of screening

- *-Based upon CIGNA claims data

## Low rates of breast and cervical cancer screening indicate that some employee’s spouses are not going for recommended screenings

- Remember to encourage your spouse to get screened !

## A few details on recommended cancer screenings for average-risk adults

## Colon Cancer

- _Starting age 50 (age 45 for African Americans)_
**Colonoscopy every 10 years  -or-**
**Sigmoidoscopy every 5 years plus fecal occult blood test (FOBT)**
**FOBT alone if unwilling/unable to have colonoscopy or sigmoidoscopy  (FOBT is less sensitive and specific, and doesn’t detect precancerous abnormalities such as polyps).**
**But Regular FOBT alone associated with 1/3rd reduction of colon cancer mortality risk**
**Recent evidence that virtual colonoscopy (CT scan) may be as sensitive as regular colonoscopy**
**Has advantages and disadvantages**

## Breast Cancer

- Mammogram every 1-2 years, starting around age 40
- Benefits of screening increase with age
**esp. age 50 and above, and extending beyond age 70 (until life expectancy shortened by other illness)**
_***Male employees***_***:  Remember your adult female loved ones—encourage and remind them to get screened regularly***

## Cervical Cancer

- PAP test at age 21 or within 3 years of start of sexual activity (whichever comes 1st)
- _Frequency:_ Yearly, but can be reduced to about every 3 years after 2-3 normal PAP tests or after age 30
- Can discontinue after age 65 if last 2-3 PAPs were normal
- Can discontinue after hysterectomy if done for benign condition
_*Male employees*_*:  Remember your adult female loved ones—encourage and remind them to get screened regularly*
- _Note on Prevention_:  New HPV Vaccine (Gardasil)  recommended for 11-12 year old girls (most effective if given when not yet sexually active)
- Can reduce risk of Cervical Cancer by 70%.
*Ask your pediatrician about the vaccine if you have pre-adolescent or adolescent girls.*

## OMC Offers Many Recommended  Adult Health Screenings as part of routine OMC exams (voluntary/mandatory): Convenient and No Co-Pay

- FOBT (Fecal Occult Blood Test)

- (Weight)

- (Cholest/
-  Triglyc.)

- _Source_:  Joint recommendations Of Amer. Cancer Society, Heart & Diabetes. Assns.

## And Special Free Screenings offered periodically by the OMC Health Promotion Program

- Skin cancer (dermatologist)
- Prostate cancer (urologist)
- Foot problems (podiatrist)

## Additional non-cancer screenings recommended in older adults

- Men age 65– ultrasound screening for abdominal aortic aneurysm (bulging of aorta) if risk factors
- Smoking
- Family history
- Women age 65—screening for osteoporosis
- Screen earlier ~age 60– if any risk factors
- Especially if lighter weight (<70 kg)
- Bone mineral density by DEXA scan (special x-ray)
- (Men can also get osteoporosis– usually  about 10 years later than women)

## Sleep Apnea Screening if

- Daytime sleepfulness
- Sleep partner notes heavy snoring, long pauses in breathing/struggling to take a breath
- _Risk factors_
- Overweight/obesity
- Large neck size (Men _>_ 17 in., Women _>_ 16 in.)
- _Screening methods_
- Screening questionnaire (EAP)
- Sleep study if questionnaire (+)

## Conclusion

- Age- and gender-appropriate screening and preventive services
- Save Lives
- Preserve Good Health
- Save you and the Lab Money (prevention is cheaper than treatment)
- Be sure to get the recommended screenings—they are generally covered under our health plans (but always ask)
- Make sure family members do, too
- Take advantage of OMC’s free screenings for employees

## Sources of Info on Screening & Prevention

- OMC web site:  _[www.bnl.gov/hr/occmed](http://www.bnl.gov/hr/occmed)__ (including Health Promotion and EAP web sites)_
- Centers for Disease Control and Prevention:  _[www.cdc.gov](http://www.cdc.gov/)__ (good source of vaccine info)_
- “Guide to Clinical Preventive Services” by the U.S. Preventive Services Task Force (Google the phrase– URL is too long!)
- American Cancer Society:  _[www.cancer.org](http://www.cancer.org/)_
- American Academy of Pediatrics _[http://www.aap.org/](http://www.aap.org/)__  (Recommended schedule of vaccinations and well-child visits)_

## This was the 1st in a series of 3 talks.  HR & OMC hope to present a couple of brief talks on the following related topics

- _HR- Benefits Group_ (DiMeglio, Bittrolff, Romero):
- Optimally utilizing your Health Benefits and Prescription Drug Plan to save yourself and the Lab $.
- Useful web resources at the different health insurance web sites.
- _Employee Assistance Program (EAP)_ (Losinno):
- Breadth of services available on-site and thru CIGNA Behavioral Health– well beyond just mental health and substance abuse issues.
- De-stigmatizing EAP services.