Source: JAMA Internal Medicine

What is this about?

This edition of Connections provides a recently published article that gives us a practical and systematic methodology and set of recommendations to reduce low value or “unnecessary” adult primary care use.  The article contains a test of more than 409 specific recommendations representing 178 unique opportunities to make primary care more clinically efficient and to reduce the level of risk associated with medical care utilization. Many of these specific suggestions (also called “deintensification”) originated in the “Less is More” initiative of the Archives of Internal Medicine( now JAMA Internal Medicine), the National Physician’s Alliance’s Promoting Good Stewardship in Clinical Practice project, the American College of Physician’s High Value Care Initiative and the Choosing Wisely campaign of the American Board of Internal Medicine Foundation. Ideal targets for deintensification are ones in which a potential for immediate or long-term harm (eg, from polypharmacy, toxic effects, procedure complications, and unnecessary further workup) exceeds potential benefits. A supplemental publication with all the detail for implementation can be purchased on the JAMA website for $30.

Some of the specific recommendations include:

• Elimination of population-based screening for Vitamin D deficiency
• Avoiding concurrent use of opioids and benzodiazepines
• Avoiding imaging for low back pain
• Over-treatment of diabetes type 2 condition
• Limit screening in patients with less than 10 years of expected life
• Clinicians should not screen for cardiac disease in asymptomatic, low-risk adults with resting or stress ECG, stress echocardiography, or stress myocardial perfusion imaging.

Why is this important?

This document is important for five major reasons.  First, this study report provides employee wellness professionals with a methodology for health plan monitoring and reducing the level of unnecessary primary care use by employees and their family members.  Second, the article and its supplement provide a listing of 37 specific clinical situations that can be used to educate employees and their family members on how to avoid unnecessary primary care use and the associated iatrogenic risk. Third, given the growing COVID-19 use of health and hospital services, these insights can further reduce unrelated use of medical care to help prevent over-use of clinical services.  Fourth, the authoritative and clear nature of these recommendations can be used to help reduce passive attitudes among health care consumers about their role in the health care process. Fifth, this information is a key element of health care literacy and helps to reverse the decades long decline in national health care literacy levels in our population.

What can you do with this document?

• First, download and skim the article to get a sense of the methodology and major findings.
• Next, order the Supplement from JAMA.
• Next, identify the 37 specific clinical recommendations and decide how they will be used with your population.
• Next, determine how your health plan(s) can use this information with your population.
• Then, plan your evaluation of the intervention you are proposing.
• Then, carry out the programming and the evaluation plan and report back to senior management on the findings from your use of the methodology.
• Finally, propose additional consumer education activities for the next program cycle.

In summary, this recent authoritative article and methodology from 4 key physician organizations provide a very useful framework and methodology for reducing unnecessary primary care use in working populations.

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Source: National Institute of Health Care Management (NIHCM)

What is this about?

This edition of Connections provides a very useful summary infographic on the effects of COVID-19 on the mental health of American workers.  It comes from a think tank funded primarily by the Blues. (NIHCM) The data insights provided in this infographic give tangible evidence for addressing more of the mental health and mental well-being needs of our working populations and can be used to make a stronger case for expansion of employer wellness efforts. This infographic also provides a number of practical suggestions on how our employee wellness programming can be modified to better address these growing needs.

Why is this important?

The significantly increasing mental health needs of our working population due to COVID really needs to be addressed by our wellness programming efforts.  This means that mental health and mental well-being related issues, such as:  depression, discouragement, emotional burnout, chronic excess stress, anxiety, feeling overwhelmed, fitful sleep or sleeplessness, fatigue, lowered resilience and presenteeism have been intensifying since early Spring of this year and our wellness efforts now need to more completely address these issues.  We need to adjust our behavioral and psychological targeting of our programming and design more interventions that are effective in minimizing these problems for employees and their family members.

The ability to address more of these mental health and mental well-being issues is important for four distinct reasons.  First, these mental health and mental well-being issues can act to significantly reduce employee productivity if they are not addressed.  Second, these issues can lead to more serious diseases and conditions including accidents that have both severe human and economic consequences for employers.  Some of the ways mental health and mental well-being issues show up include suicide, drug and alcohol abuse, homicide, homelessness, domestic violence, loneliness, sexual addictions, withdrawal from social life, family dysfunction and abuse. The third reason it’s important is that these mental issues, if left unaddressed are likely to seriously undermine our efforts to find an acceptable “new normal” for business and organizational operations that is sustainable in post-COVID work environments.  Finally, the fourth reason I believe this is important is that these types of issues may well act to obviate personal concern for many of the other related wellness issues, such as, nutrition choices, weight gain, sedentarism, sleep disruptions, apathy, use of preventive sevices and receiving social support.  I am afraid if we are not careful in addressing these mental health and mental well-being issues now we may find ourselves facing even higher percentages of unmotivated and apathetic employees about their personal health and well-being.

What can you do with this document?

• First, download and read the infographic document to get a sense of the magnitude of the recent deterioration of mental health and well-being status and the recommended steps employers can take.
• Explore with your health plan(s) wellness staff what services or help they can provide.
• Next, develop a set of possible program targets and interventions to address these needs.
• Next, determine who should receive the infographic along with a set of your recommendations for modifying your employee wellness program in this or the next planning/programming cycle.
• Then, determine which mental health and mental well-being targets the program should address and the companion interventions you are recommending.
• Then, don’t do too much but what you do, do well!
• Then, plan your evaluation for how you are going to measure the mental health and mental well-being effects of these wellness interventions.
• Then, carry out the evaluation plan and report back to senior management on the amount of programming activity conducted, number of participants and any survey or collateral data sources you have planned to use.
• Finally, propose additional activities for the next program cycle.

In summary, this infographic document provides an overview of the emerging mental health and mental well-being needs of U.S. employees associated with COVID-19 along with a variety of useful suggestions for programming. For a number of important reasons, it is probably best that we begin to systematically address these targets and corresponding interventions with our employees and their family members.

(Everyone can now download this document)

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If you have any problem downloading the document go to our website and submit a comment.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know if you found it to be helpful.

What is this about?

The document in this edition of Connections is the latest Solution Set and addresses options and alternatives for how wellness professionals might modify their programs after COVID-19.  A summary of current research on COVID-19 is provided along with an overall assessment of the “big picture.” A concluding excerpt is reproduced below.

“I believe we still need to be careful as individuals who may have significant susceptibilities to the disease, but we certainly don’t have to follow the wholesale and widespread distancing and work disruption that is in place in selected states. We also need to be sensitive to the short term and long term morbidity, pain, suffering, and health care use associated with COVID-19 infection, but I believe that it does not rate the extreme “lockdown” actions caused by a fear of specific disease-caused premature mortality.⁴  I also believe that future historians will essentially say that the weak and those in poor health were the first victims of the virus, but after they died, few were really at-risk for unexpected premature mortality and therefore the virus had largely run its most critical clinical course which should have led quickly to diminished “lockdown” practices.  I believe they may ultimately say that COVID-19 was somewhat of an over-reaction on the part of governmental authorities driven by fear and influenced by a largely national political calculus.”

A series of recommendations for how employee wellness programming should change are provided along with an emerging view of the overall health significance of the pandemic.

Why is this important?

This document represents the most complete summary of the probable overall significance of the pandemic and how it will likely change how workplace wellness programs are conducted in the months and years ahead.  Helpful suggestions are provided about how to navigate the transition from pandemic to post-pandemic to help wellness professionals navigate the challenge of adjustment to the post-COVID-19 “new normal.” Links are also provided to the source documentation.

What can you do with this document?

• First, skim through the document to get a sense of what it is recommending.
• Next, determine if the source documentation can be used in educating employees about the long-term implications of the pandemic.
• Next, determine which of the recommendations you should adopt.
• Next, share with the staff. volunteers and management, the major points and find out how they view the recommendations you have selected to implement.
• Next, as you put your work plan and budget together for the next year of programming consider which recommendations will be addressed and plan accordingly.

In summary, we believe that the intensive acute stage of this current COVID-19 pandemic will be over soon leaving some residual changes and modifications to be made to employee wellness programming efforts.  The challenge moving forward will be to transition smoothly from the current disrupted state of programming to the “new normal” state which will require some thoughtful planning and more flexible programming.

(Everyone can now download this document)

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I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know if you found it to be helpful.

Source: Lancet Public Health

What is this about?

The document highlighted in this edition of the Connections newsletter is a newly published study from the British Journal Lancet Public Health.  The article reports on an extensive modifiable health risk analysis of U.S.health care costs using a cross-comparison technique on two very extensive claims databases.  The objective of this study was to quantify health care spending attributable to modifiable risk factors in the USA for 2016. 

In 2016, US health care spending attributable to modifiable risk factors was $730.4 billion corresponding to 27·0% of total health-care spending.  This “attributable” spending was largely due to five risk factors: high body-mass index, high systolic blood pressure, high fasting plasma glucose, dietary risks, and tobacco smoke.  Spending attributable to risk factor varied by age and sex, with the fraction of attributable spending largest for those aged 65 years and older.  The significance of this is that the cost of governmental health programs like Medicare and Medicaid can be significantly reduced by reducing key health risks among program beneficiaries.  Attributable health care spending was also identified for the top 16 health risk factors.

Why is this important?

The issue in this edition of the Connections newsletter is important for 3 major reasons.  First, reducing the cost burden associated with major modifiable health risks is one of the most important goals of virtually all employee wellness programs.  Second, this study found that fully 27% of all health care costs are considered potentially preventable, which is a huge economic incentive for prevention and wellness among American employers and governmental health programs.  Third, this study provides very valid estimates of the potentially preventable conditions, diseases and costs that can be used by Wellness program managers to make a stronger economic case for funding employee wellness programs.

What can you do with this document?

• First, read the document to get a sense of the methodology and results of the study.
• Next, determine where in your current communications efforts this information can be used.
• Then, determine which of your program interventions should include this information.
• Finally, decide how else to use the information to plan and justify your annual program budget.
• In summary, this document describes a study that found that fully 27% of U.S. health care costs were preventable in 2016.  Employee wellness programs play a major role in reducing these health risks and costs for employers and for governmental health programs like Medicaid and Medicare.

In summary, this document describes a study that found that fully 27% of U.S. health care costs were preventable in 2016.  Employee wellness programs play a major role in reducing these health risks and costs for employers and for governmental health programs like Medicaid and Medicare.

(Everyone can now download this document)

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If you have any problem downloading the document go to our website and submit a comment.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know if you found it to be helpful.

What is this about?

The document in this edition of Connections is a recent article from the British Medical Journal that uses 2 major American long-term epidemiological studies (The Nurses’ Health Study – N= 73,196 and the Health Professions Follow-up Study – N= 33, 366).  These 2 landmark prospective cohort studies are used in this study to document the healthy years gained from a healthy lifestyle.  A healthy lifestyle was defined as five low-risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%). The summary findings are highlighted below:

“The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low-risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low-risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low-risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low-risk lifestyle factors.”

This amounts to 10.7 more years on average for women who live a healthy lifestyle versus those that don’t (45.7% more life-years without chronic conditions) and 12.4 more years on average for men who live a healthy lifestyle versus those that don’t (54.0% more life-years without chronic conditions).  That’s a big difference in chronic conditions and morbidity, especially as we consider the risk of COVID-19 infections!

Why is this important?

This document represents one of the largest population studies on the healthy life years gained from healthy lifestyle choices. The five low-risk lifestyle factors are at the core of virtually all employee wellness programs and are also at the heart of risk factors associated with COVID-19. This study documents the quality of life advantages of a wellness-oriented lifestyle along with the reduced health care use and improvements in life expectancy or likely length of life.  You gain years of life and years of life without major chronic diseases: A pretty good trade-off for the pursuit of wellness.

What can you do with this document?

• First, skim through the research article to get a sense of what findings and evidence it is presenting.
• Next, determine if this information can be used in educating employees about the long-term implications of adopting a wellness-oriented lifestyle.
• Next, determine where the findings should be used in your program.
• Next, share with staff, volunteers and management, the major highlights of the study and how this information can be used with those that may be concerned about COVID-19 infection.
• Next, as you put your work plan and budget together for the next year of programming consider how this information should shape your choice of targets and the corresponding interventions.

In summary, this study provides a quantitative estimate of the healthy years that can be gained from pursuing a wellness-oriented lifestyle.  The article provides recent and significant science-based proof of the value of adopting a healthy lifestyle.

(Everyone can now download this document)

Click here to download this document

If you have any problem downloading the document go to our website and submit a comment.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know if you found it to be helpful.