Special Report: Disease Management
Cardiovascular program merged with wellness
DM module targets coronary artery disease
A cardiovascular disease management (DM) program that targets employees with coronary artery disease has been merged into an existing wellness program at Northeast Utilities (NU) in Berlin, CT, and early returns indicate that each program is being strengthened by the other.
The DM program was designed by Cardium Health Services of Simsbury, CT. The existing wellness program at NU, WellAware, was designed by Pro-Fitness\HealthSouth, a Nor-walk, CT-based subsidiary of Birmingham, AL-based HealthSouth.
"Northeast Utilities and Pro-Fitness\Health-South have been doing business for eight or nine years," explains Tom Sabia, chief operating officer of Pro-Fitness\HealthSouth. "We’ve established two on-site corporate fitness centers of about 10,000 square feet each." About 800 of NU’s 9,000 employees, spread out over a tri-state area, are dues-paying members.
The WellAware program itself is in its fifth year, notes Sabia. "We began with a needs assessment, conducted a modifiable claims audit of health care costs, and looked at which were lifestyle-related," he notes. "Then, using proprietary software, we determined which were modifiable. About 30% were lifestyle-related, and 40% of those were modifiable. We decided that over four years, we could probably impact 20% of those modifiable claims."
Using that number as a budget projection, the company designed and developed a program focusing on several identified areas: weight, sedentary behavior, cholesterol, blood pressure, and smoking. Health risk appraisals were conducted, and an incentive structure was created for the program.
"Partway into the program, NU and Cardium got together," recalls Sabia. "They did a pilot program, which was really successful and got a lot of fantastic comments. We were asked to look at it from a programming basis, [and] said, Absolutely, this is fantastic stuff!’ Now, we’re even pitching it to our other clients."
How the program works
Cardium Health Services was founded in 1996 and began working with NU in 1998. "We identify individuals who have a diagnosis of coronary artery disease," notes Mark Matthew Fulco, MPA, senior vice president at Cardium.
Cardium identifies those individuals by searching for specific medical claims codes as confirmation. "We also work closely with the wellness program, the disability insurance group, and claims administration," Fulco adds. "We cast a pretty broad net to find individuals who have had a coronary event. We try to find those with a recent event, so we can turn things around in good fashion."
When the program is introduced, correspondence goes out to employees through company newsletters and posters, directing them to contact a counselor or to log on to the Cardium Web site (www.cardiumhealth.com) or the company intranet. "The pass codes are client-specific," explains Fulco. "Employees can look at the program, take a quick screening to see if they are eligible; and if they are, they then sign up. A counselor will contact them within 24 hours. If they do not qualify, they are directed to other value-added programs."
Specifically identified employees usually get a letter from the company’s medical director. They are invited to participate. If they agree, Cardium will obtain their medical release and begin to work with the employee’s physician.
"We want to learn about their treatment plan for the patient, so we can integrate it with what we do," Fulco observes. "We get a high level of buy-in from the docs, because we both have the same goal of delivering an excellent outcome."
Using a proprietary software system to cre-ate what Fulco describes as "a true electronic record," Cardium creates a profile of the individual employee in order to customize the DM program. "For example, we talk about social matters and lifestyle — even to the point of who prepares the employee’s meals, so we can talk with them," he says. The employee is assessed from a clinical, medical, and social standpoint. "We also assess readiness to change, and willingness to accept recommendations," says Fulco. "All of this is inputted into our system and drives the pathway."
Patient specifics
Using protocols approved by organizations such as the American Heart Association as a foundation, Cardium then adds overlays that are specific to the patient. "When we have a smoker, we will risk-stratify that through the computer," says Fulco. "Then, we look at how willing they are to change, based on the assessment. The pace of the program is also based on readiness and willingness to change. Then, we will administer the program and monitor the employee’s progress. If they’re not doing well with a particular intervention, we will continue to try others until we achieve success."
The Cardium program includes diet and exercise plans and medication compliance. In addition, there are specific modules targeting diabetes, smoking cessation, and so on. "Our goal is 50% reduction in rehospitalization," Fulco asserts. "So far, we’ve been very successful with all of our clients."
Elizabeth Monahan, MA, program director for WellAware, has played an instrumental role in integrating the Cardium program into her existing offerings. A comprehensive wellness program, WellAware includes both employees and spouses. The HRA is a key component, as are health education and fitness activities. The program incorporates technology such as on-line guidebooks and videos.
"I definitely think there is a fit in terms of our common goal of hopefully reducing health care costs," she notes. "From NU’s perspective, there’s a fit because we are able to capitalize on Cardium’s ideas. On the other hand, WellAware was already up and running and had an established reputation with the employees. So it made sense for it to fit within the overall program. People get it; it’s a health-enhancing activity."
From an administrative standpoint, if Cardium has any questions or is having difficulty identifying potential participants, Monahan is their first point of contact. "I’ve been here for 10 years, so I know a lot of people," she explains. "In fact, one of the things that made the proposal more appealing to NU management was that we could support the administration of the Cardium program. And in terms of promotional communications, we already had site contacts set up; that network already existed."
"We have ongoing communications with the wellness department," adds Fulco. "We review the successes, and see if there are ways to improve the program. For example, during one brainstorming session, we discussed the fact that we had had great success with our smoking cessation module, and had received requests from employees who were not in the coronary disease management program. Elizabeth asked if we would consider offering it as a stand-alone program. We said yes, and now we have that program in place."
On the other side of the coin, while WellAware is incentive-based, the Cardium program is not. "The incentive structure is the mortar behind our program," notes Sabia. "NU has 67 location; if you want parity, you must make a major effort to get information out. Incentives encourage communication because every time somebody participates in a program they get rewarded, either through a response letter or a $150 check."
"We’ve talked with Cardium about their participants being eligible for the same incentives," says Monohan. "One thing we’re trying to learn is how to better mesh the programs so we don’t confuse employees. I have a feeling we’ll go that way and use participation in the Cardium program as an additional incentive."
The success of the pilot program was one of the key selling points for formal implementation, recalls Monahan. "We didn’t want to identify specific people, so we just sent out a mass communication to solicit enrollees. We let employees know about the program through our sitewide e-mail and through our on-site advocates." About 15 employees signed up, and none of the participants has had an additional hospitalization or a new coronary incident, Monahan notes.
The full program was launched in January. "About 140 people are enrolled and participating, and another 150 are pending," Monahan says.
She adds that her staff have already learned valuable lessons from the Cardium experience. "It has reinforced the idea that stress is a key issue," she notes. "Cardium is now trying to put together a stress management module. Also, we’ve gained additional information about employees’ attitudes about nutrition."
"Another reason we like the Cardium program so much is that its approach is the same as ours: identifying and helping high-risk employees," adds Sabia. "We hope we will soon see another opportunity to wave the flag with Cardium; we all just met to strategize ways to enhance participation."
He adds that a program like this, by its very nature, must be handled in an "easy-does-it" fashion. "The way this is done is highly sensitive; you’re dealing with a small percentage of the population," he explains. "You don’t want to make waves; it’s a slow buildup’ kind of thing. You have to get claims to identify people, and then very carefully contact them in a confidential way and follow up with phone calls."
As for Cardium, they are now beginning a new venture with the South Carolina Local Government Assurance Group, a self-funded health insurance program sponsored by the Municipal Association of South Carolina. "This will be one of the first forays into wellness/disease management for a cooperative of municipalities," Fulco observes.
• Elizabeth Monahan, Northeast Utilities WellAware Program, 107 Selden St., Berlin, CT 06037. Telephone: (860) 665-5867 E-mail: [email protected].
• Tom Sabia, Pro-Fitness\HealthSouth, 40 Richards Ave., Norwalk, CT 06854. Telephone: (203) 853-6478. E-mail: [email protected].
• Mark Matthew Fulco, Cardium Health Services, 34 Hopmeadow St., P.O. Box 1085, Simsbury, CT 06070. Telephone: (860) 408-1300, ext. 303. Fax: (860) 408-9100. Web site: www.cardiumhealth.com.
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