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  Helping Corporations reduce health care cost while by optimizing employee health with simple on site biometric testing, weekly phone conferences, as well as personal coaching and online tracking.
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  • 1. Focusing on the Root Cause of your Healthcare Costs: Unhealthy Lifestyles Dr. DiSiena, DC, QME, IDE, FICA, CLE Autumn R. Hargrove, Certified Lifestyle Educator Present:
  • 2. Is this how you feel… <ul><li>About your employee healthcare costs? </li></ul>
  • 3. “ Chronic disease is now the principle cause of disability and use of health care services and consumes 78% of health expenditures”….We have not trained our doctors to deal with this problem nor provided them adequate therapeutic tools to meet the needs.” JAMA 2004;292:1057
  • 4. Most Chronic Health Problems Are Preventable Circulation. 2004;109:3244-55 <ul><li>Cardiovascular disease, cancer and diabetes account for nearly 2 of every 3 deaths in the US </li></ul><ul><li>Primarily caused by unhealthy lifestyle habits </li></ul><ul><li>Cost of $700 billion per year </li></ul><ul><li>“ While healthcare costs skyrocket, the national investment in prevention was estimated at less than 3% of the total annual healthcare expenditures.” </li></ul>
  • 5. Other Lifestyle-related Conditions <ul><li>High blood pressure </li></ul><ul><li>High cholesterol </li></ul><ul><li>High blood sugar </li></ul><ul><li>Overweight/Obesity </li></ul><ul><li>Arthritis </li></ul><ul><li>Chronic low back pain </li></ul><ul><li>Constant tiredness </li></ul><ul><li>Depression </li></ul><ul><li>Sexual dysfunction </li></ul><ul><li>Hormonal imbalances </li></ul><ul><li>Gallbladder disease </li></ul><ul><li>Hysterectomy </li></ul><ul><li>High health care utilization (more than 5 GP visits annually) </li></ul>Journal American Medical Association 2003:289(19)2573-2575 International Journal of Obesity 1998;22:520-528
  • 6. 1998 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2006 (*BMI  30, or about 30 lbs. overweight for 5’4” person) 2006 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  • 7. Overweight/Obesity Epidemic <ul><li>Estimates show that overweight and obese employees cost American companies $12.7 billion a year, including higher medical bills, higher health insurance costs, lower productivity and 39 million lost workdays! </li></ul><ul><li>The Centers for Disease Control and Prevention recently reported that the overweight epidemic affects 2/3 of U.S. adults and is not just a health issue. </li></ul>
  • 8. <ul><li>HIGH CHOLESTEROL </li></ul><ul><li>37 million Americans </li></ul><ul><li>Lipitor 2003 U.S. Sales: $5.8 billion </li></ul><ul><li>Annual cost per patient: $1,100 </li></ul><ul><li>Potential side effects: </li></ul><ul><ul><li>Muscle weakness </li></ul></ul><ul><ul><li>Rare cases of severe muscle breakdown </li></ul></ul><ul><ul><li>Liver/Kidney damage </li></ul></ul><ul><li>Drug Alternatives </li></ul><ul><ul><li>Diet: oats and soy protein/super low fat </li></ul></ul><ul><ul><li>Exercise </li></ul></ul>
  • 9. <ul><li>HYPERTENSION </li></ul><ul><li>50 million Americans </li></ul><ul><li>Norvasc 2003 U.S. Sales: $1.9 billion </li></ul><ul><li>Annual cost per patient: $500 </li></ul><ul><li>Potential side effects: </li></ul><ul><ul><li>Edema </li></ul></ul><ul><ul><li>Dizziness </li></ul></ul><ul><ul><li>Flushing </li></ul></ul><ul><ul><li>Palpitations </li></ul></ul><ul><li>Drug Alternatives </li></ul><ul><ul><li>Diet: low-salt </li></ul></ul><ul><ul><li>Weight loss </li></ul></ul><ul><ul><li>Exercise </li></ul></ul>
  • 10. “ The Metabolic syndrome but not BMI (obesity) predicts future cardiovascular risk in women.” Circulation 2004;109:706-713
  • 11. Metabolic Syndrome: A major, under-recognized risk factor <ul><li>High risk for heart disease, stroke, diabetes and even mortality, among many others </li></ul><ul><li>A patient has metabolic syndrome if they have any 3 of the following: </li></ul><ul><ul><li> Waist size </li></ul></ul><ul><ul><li> Blood pressure </li></ul></ul><ul><ul><li> Triglycerides (blood fats) </li></ul></ul><ul><ul><li> Fasting blood sugar; </li></ul></ul><ul><ul><li> HDL (good cholesterol) </li></ul></ul><ul><li>Stronger predictor than classic risk factors like high cholesterol or blood pressure alone </li></ul>Circulation 2004;110:1239-1244
  • 12. The Cost of Metabolic Syndrome <ul><li>Afflicts nearly 50 million Americans – almost ¼ of U.S. adults </li></ul><ul><li>For those > age 40, >60% increase in the past decade </li></ul><ul><li>Associated with a twofold increased risk of developing artherosclerotic cardiovascular disease </li></ul><ul><li>MBS presents a fivefold increased risk of developing diabetes </li></ul><ul><li>Most cardiovascular cost & risk born by employers is concentrated in 1/3 of the working-age population with MBS </li></ul>
  • 13. Prescription Drug Costs <ul><li>Prescription drugs are the fastest growing category of health care spending </li></ul><ul><li>Exceeded spending on nursing homes and home health care combined, for the first time in 2001 </li></ul><ul><li>No end in sight </li></ul>
  • 14. High Cost of Medication <ul><li>$4 of every $10 spent on prescription drugs for adults is spent on treating Metabolic Syndrome </li></ul><ul><li>Ave. annual cost per patient: $4,116 </li></ul><ul><li>4.2 times the average spent on the same age group </li></ul><ul><li>36% increase from 2002 to 2004 </li></ul><ul><ul><li>Data compiled by Medco Health Solutions, a large prescription benefits manager (5/2004) </li></ul></ul>
  • 15. November 29, 2004 “ Millions of us are popping prescription pills for innocuous ills, when simple lifestyle changes of diet and exercise – harped on by physicians for decades – are more effective and a lot cheaper.” “ 2 million cases each year of drug complications that result in 180,000 deaths or life-threatening illnesses in the elderly”
  • 16. “ Heart Patient Wes Miller radically altered his lifestyle and went from 16 drugs a day to 2.”
  • 17. American Journal of Cardiology 2004;94:1558-1561 “ the findings clearly show that many patients who have conventional risk factors for coronary heart disease can achieve goal levels without medications within 12 weeks of initiating therapeutic lifestyle changes.”
  • 18. Laurence S. Sperling, MD, (Co-author of the study) <ul><li>“ With the current concern over rising health care costs, it is also important to note that TLC can generally be implemented less expensively than most medications and, unlike single drug therapy, favorably impacts multiple cardiovascular disease risk factors.” </li></ul>American Journal of Cardiology 2004;94:1558-1561
  • 19. “ The lifestyle intervention, compared with the metformin intervention, provided greater health benefits at lower costs and, from the prospective of a fiscally prudent policymaker, represents the intervention of choice. ” Annals of Internal Medicine 2005;142:323-332
  • 20. TLC is more effective and less expensive than Medication Annals of Internal Medicine 2005;142:323-332 Lifestyle Metformin Delay in development of diabetes 11 years 3 years Reduced incidence of disease 20% 8% Cost (per QALY) $1,100 $31,000
  • 21. There is a Solution <ul><li>FirstLine Therapy® Corporate Wellness </li></ul><ul><ul><li>because </li></ul></ul><ul><li>You want a program to address the key health issues that increase your health coverage costs the most </li></ul><ul><li>You want a program that reduces employee risk factors to improve health and productivity long-term </li></ul>
  • 22. FirstLine Therapy Corporate Wellness Program <ul><li>A Therapeutic Lifestyle Program (TLC) </li></ul><ul><li>Produces greater risk reduction compared to published data from other diet and lifestyle programs </li></ul><ul><li>Proven to be more effective than AHA Step I diet in controlled clinical trial </li></ul><ul><li>An effective treatment for Metabolic Syndrome and other lifestyle-related health problems </li></ul><ul><ul><li>Many patients can achieve risk reduction goals in as little as 12 weeks without medication </li></ul></ul>
  • 23. What Makes FLT Different? <ul><li>More than just a weight loss program </li></ul><ul><ul><li>It’s a “therapeutic lifestyle program” </li></ul></ul><ul><ul><ul><li>Effective for lifestyle related chronic illness </li></ul></ul></ul><ul><ul><ul><li>Weight loss is a beneficial secondary goal </li></ul></ul></ul><ul><li>The FLT diet is different </li></ul><ul><ul><li>Low Glycemic diet (to manage blood sugar) </li></ul></ul><ul><ul><ul><li>Consistent with current research </li></ul></ul></ul><ul><ul><ul><li>Better risk reduction </li></ul></ul></ul><ul><ul><ul><li>Better weight loss </li></ul></ul></ul><ul><ul><ul><li>Less hunger </li></ul></ul></ul><ul><ul><ul><li>Better compliance </li></ul></ul></ul>Arch Intern Med 2004;164:2141-2146 JAMA 2004:292:2482-2490 Diabetes Care 2003;26(8):2261-2267 JAMA 2002;287:2414-2423 Am J Clin Nutr, 2002;76:281S-285S Diabetes Care 1997;20:545-550
  • 24. What Makes FLT Different? <ul><li>FLT Employs Medical Foods and appropriate dietary supplements </li></ul><ul><ul><li>Improves clinical outcomes </li></ul></ul><ul><ul><li>Improves patient compliance </li></ul></ul><ul><ul><li>Shortens time required to achieve risk reduction goals </li></ul></ul><ul><li>Demonstrated to be effective in controlled clinical trials </li></ul><ul><li>Brings licensed healthcare practitioners directly to your employees for health screening and counseling. </li></ul>
  • 25. Results of 12-Week Trial of FirstLine Therapy Program with a Soy and Phytosterol Based Medical Food Nutrition 2006;22:104-113 Before After Change % Change Triglycerides 212 mg/dl 117 mg/dl -95 mg/dl -45% Total Cholesterol 275 mg/dl 231 mg/dl -44 mg/dl -16% LDL-C 185 mg/dl 158 mg/dl -27 mg/dl -15% HDL-C 48 mg/dl 51 mg/dl +3 mg/dl +6% tChol/HDL-C 5.7 4.5 1.2 -21% TG/HDL-C 4.4 2.3 -2.1 -48% hs-CRP 5.0 mg/l 3.3 mg/l -1.7 mg/l -34 % Fasting insulin 8.3 mcIU/ml 6.2 mcIU/ml -2.1 mcIU/ml -25% Blood Pressure 130/84 mmHG 124/77 mmHG -6/-7 mmHG -5%/-8% Weight 186 lbs 171 lbs -15 lbs -8% % lean body mass 61.1% 62.7% +2.1% +3%
  • 26. Reduced Key Metabolic Syndrome Marker by 48% in 12 Weeks <ul><li>Triglyceride/HDL ratio </li></ul><ul><ul><li>High triglycerides and low HDL are features of Metabolic Syndrome </li></ul></ul><ul><ul><li>TG/HDL ratio of 3 or higher suggests individual has Metabolic Syndrome </li></ul></ul>Before After Change % Change 4.4 2.3 -2.1 -48%
  • 27. Comparing Trials FLT program with UltraMeal Plus (Nutrition 2006;22:104-113) vs. Low - GIycemic Diet ( Arch Intern Med. 2004;164:2141-46) 12 week trial of FLT diet with UltraMeal Plus in overweight, postmenopausal women with elevated LDL cholesterol vs. 12 week trial of low glycemic diet alone in a similar patient population. FLT with UltraMeal® Plus Low-GI Diet alone Triglycerides -95 mg/dl -42 mg/dl Total Cholesterol -43 mg/dl -11.9 mg/dl LDL-C (bad chol) -27 mg/dl -3.9 mg/dl HDL-C (good chol) +3 mg/dl - 1.3 mg/dl Weight - 15 lbs 13.6 lbs
  • 28. Potential Cost Savings Issue Associated Costs How does it apply to you? Healthcare cost per employee $8,046 on average for 2006, employers absorb 2/3 $6034.5 x # of employees covered Short-term disability claims (26% result of chronic condition-Cigna study ‘04) $13,094 per claim on average $13,094 x # of short-term disability claims per year Absenteeism $660 per employee/year (2004 Hewitt study) $660 x # of absent employees Metabolic Syndrome (MBS) Annual cost of treatment for adults > $4000 – more than 4x annual average spent on drugs for all other patients $626 (vs. $367 for others) - $259 incremental cost! $259 x # of employees with MBS Investment in Corporate Wellness $1 investment results in $2.05 - $4.64 in median cost savings* How many employees could benefit in your organization?
  • 29. FirstLineTherapy ® Corporate Wellness Basic Program Components <ul><li>Health profile screening </li></ul><ul><ul><li>Online questionnaire </li></ul></ul><ul><ul><li>On-site screening: BIA, waist circ., WHR, BP, BMI </li></ul></ul><ul><ul><li>Lipid testing for cholesterol and blood sugar </li></ul></ul><ul><li>Employee Education </li></ul><ul><ul><li>Group classes delivered on-site by experienced local practitioners </li></ul></ul><ul><ul><li>Email & web access to health/lifestyle information </li></ul></ul><ul><ul><li>Online narrated presentations on health topics </li></ul></ul><ul><li>Medical foods / dietary supplements </li></ul><ul><ul><li>Available to employees at discount online </li></ul></ul><ul><ul><li>May be reimbursable - Flexible Spending Accounts </li></ul></ul>
  • 30. FirstLineTherapy ® Corporate Wellness Basic Program Components <ul><li>Tracking Tools </li></ul><ul><ul><li>Web-based software to track cumulative results to help you see the outcome of the program test </li></ul></ul><ul><ul><li>Multiple access levels: software administrator, doctor and your company </li></ul></ul><ul><li>Incentive Program </li></ul><ul><ul><li>Helps motive employees to participate and stay with the program </li></ul></ul>
  • 31. Benefits of Health Profile Screening <ul><li>Identify High Risk Employees </li></ul><ul><li>On-site screening, only 10 minutes </li></ul><ul><ul><li>Health Profile Questionnaire </li></ul></ul><ul><ul><li>BIA / Body composition testing (simple, non-invasive) </li></ul></ul><ul><ul><li>Waist Circumference </li></ul></ul><ul><ul><li>Waist-to-Hip Ratio </li></ul></ul><ul><ul><li>BMI </li></ul></ul><ul><ul><li>Blood Pressure </li></ul></ul><ul><li>Optional lipid testing (finger-stick test) </li></ul><ul><li>Educate, Motivate, and Inspire Employees </li></ul>
  • 32. Bioimpedance Analysis (BIA) <ul><li>FDA approved clinical device </li></ul><ul><li>Accurate, reproducible </li></ul><ul><li>Non-invasive, simple procedure </li></ul><ul><li>Allows tracking of weight as muscle vs. fat vs. water </li></ul><ul><ul><li>(measures quality of weight loss) </li></ul></ul><ul><li>Relates to insulin resistance/ chronic illness/ metabolism/ aging/ organ reserve </li></ul><ul><li>Great patient education/motivation tool </li></ul>J Amer Diet Assoc 2002;102(7):944-955 Amer J Clin Nutr 2003;78:228-35 Am J Clin Nutrition 1996; 64:472S-477S J Amer Diet Assoc 2001;101(10):1209-1212
  • 34. Understanding BIA <ul><li>Body Fat </li></ul><ul><li>Muscle Mass </li></ul><ul><li>BMI (overweight / obesity) </li></ul><ul><li>Basal Metabolic Rate (metabolism) </li></ul><ul><li>Hydration </li></ul><ul><li>Cellular Health </li></ul>
  • 35. Patient Guidebook <ul><li>Program concepts & instructions </li></ul><ul><li>Diet </li></ul><ul><li>Exercise </li></ul><ul><li>Supplements </li></ul><ul><li>Stress management </li></ul><ul><li>Tracking forms </li></ul>
  • 36. Diet & Exercise Summary <ul><li>Low glycemic index foods </li></ul><ul><li>Small, frequent meals </li></ul><ul><li>Medical food for body composition (UltraMeal) </li></ul><ul><ul><li>To increase intake of quality nutrients </li></ul></ul><ul><ul><li>To improve insulin sensitivity </li></ul></ul><ul><ul><li>To achieve meal frequency and portion size goals </li></ul></ul><ul><li>Quality EFAs, esp. omega 3 (EPA, DHA) </li></ul><ul><li>Exercise – progressively increase intensity </li></ul><ul><ul><li>Aerobic, strength, flexibility </li></ul></ul><ul><li>Additional supplementation as needed </li></ul>
  • 37. Flexible Spending Plans <ul><li>Medical Food or dietary supplements are reimbursable </li></ul><ul><ul><li>When prescribed by a practitioner for medical conditions </li></ul></ul><
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