Results Show Duke Prospective Health Pays Off
Faydean Cannada is afraid of following in her family's footsteps. Her grandmother died from a stroke, her mother died from colon cancer and her brother died from lung cancer.
Despite her family medical history, Cannada, a phlebotomy technician at Lincoln Community Health Center, could not sustain improvements to her health.
"My doctor told me many times to exercise and lose weight to decrease my risk, but I didn't listen," said Cannada, a borderline diabetic.
As she approached 60 – the age her brother passed away – she felt a nagging anxiety to make long-term changes to avoid her relatives' fate. But she didn't take action until she read an article about Duke Prospective Health.
Since participating in the benefit, Cannada has lost 20 pounds, and she's eating healthier and walking regularly. She finally feels like she's on a promising path. Her story is one of many across Duke that reflects the success of a program launched in 2004 to identify and reduce health risk behaviors.
Bucking the System
In the early 2000s, health care costs across the country began to increase annually by double-digit percentages and most employers began reducing benefits or shifting greater portions of the expense to employees. Duke took a different path, and in 2004, invested $2 million in Duke Prospective Health, which offered an alternative to the traditional approach to health care.
"Historically, health care has focused on treating diseases after they develop, but Prospective Health helps identify and treat risk factors before they develop through an individualized approach to healthier living," said Lois Ann Green, director of Benefits.
Preliminary clinical results appear to reflect the personal successes of participants such as Cannada. During the first two years of Prospective Health, individuals in the high-risk group, people who typically have the highest medical costs, had a 3.5 percent decrease in medical costs. This saved hundreds of thousands dollars in expenses for the health insurance plans paid for by Duke and employee premiums.
Duke has also seen reductions in the number of emergency room visits and the length of hospital stays during the first two years of the program. Such indicators are helping Duke keep its medical costs, and thus its premiums for health insurance, well below national and regional trends. For example, last year, Duke's average health care cost per employee was $5,298, compared to the national average of $7,498, according to Hewitt Associates, a Human Resources consulting firm.
"Financially, we basically broke even with our initial investment in Prospective Health, and we think the program offers even greater potential," Green said. "Still, the greatest success is the difference in the quality of life this program is having for our faculty, staff and their family members."
Prospective Health, which is part of Duke Select/Duke Basic health coverage, offers participants the tools to take an active role in either maintaining or improving their overall health and well-being. Using a health risk questionnaire and past medical claims data, Prospective Health identifies participants at the greatest risk for developing chronic conditions such as cardiovascular disease, hypertension and diabetes.
The program then groups individuals into one of three categories: high risk, moderate risk and low risk. Participants are then directed to health programs, and in some cases, a dedicated health care manager, to reduce risks or better manage their conditions. Participants with higher risk factors receive higher levels of support. For instance, high-risk participants receive regular support from care managers, who, in some cases, work with the individual's primary care physician and clinical team to help participants reach their goals.
One Life at a Time
Cannada and other Prospective Health participants attribute the positive changes in their life to the level of personal attention received through the program.
During her first call to Prospective Health, Cannada was paired with health care manager Alene Timberlake, a registered nurse. Timberlake helped identify Cannada's health risks and goals. Then Timberlake worked with her to synthesize her goals into manageable and measurable pieces.
Timberlake provided Cannada with exercise and nutrition advice and told her about other resources at Duke. Timberlake encouraged Cannada to maintain her medical follow-ups and necessary tests with her primary care physician. The new link between Cannada and her doctor kept everyone on the same page and held everyone accountable.
Cannada said she learned to read food labels and realized how many unhealthy foods she was eating. She reduced the amount of sugar in her diet and began walking regularly and doing strength-building exercises.
"When I called Duke Prospective Health, Alene Timberlake started working with me right away," Cannada said. "She held me accountable in a way that my doctor couldn't because I only saw him once or twice a year. I knew I had to report to Alene at least once a month."
Cannada said that regular phone and e-mail contact forged an important relationship that helped her make life changes.
Armentha Branche, an administrative assistant in Social Work, also found encouragement through Timberlake. Branche, who struggled with high blood pressure and heart disease for 13 years, got winded walking from her car to her office. She became frustrated and reached out for help. With Timberlake's support, Branche broke her goals into manageable steps, taking stairs instead of the elevator and parking farther from buildings.
"She also told me to reward myself, which was great because as a mother, I think of my family, and not always myself," Branche said. "The first reward I gave myself was a nice new pair of New Balance sneakers."
Now, 15 pounds lighter and with stable blood pressure, Branche hopes to get off some medications with undesirable side-effects that have also been a financial burden.
Team Effort
Timberlake's role as a care manager is part of a larger and more coordinated system of support offered through Duke Prospective Health.
Dr. Peter Jacobi, the medical director for the program, said that at the center of the team is the participating staff or faculty member or family member. The participant is surrounded by a support network including physicians, Prospective Health care managers and coaches, including service-providers like LIVE FOR LIFE, Duke's employee health promotion program.
"I believe strongly in the concept that different people need different levels of intervention for success and that giving people access to a team of health care professionals leads to better outcomes," Jacobi said.
For Prospective Health participant Ron Banks, the optimal level of intervention included a combination of facts, care manager encouragement and family.
"As a scientist and a veterinarian, I need a lot of information to help me make decisions," said Banks, director of the Office of Animal Welfare Assurance. "I wouldn't take the time to search for health information myself, but having it sent to me from a trusted source – my care manager – was very helpful."
Banks brings his wife to Prospective Health seminars about topics that affect him such as hypertension. His wife's involvement has been critical in keeping him committed to the program. When he first joined Prospective Health last year, his blood pressure measured about 150 over 95. After losing 22 pounds and increasing exercise, modifying his diet and balancing work with relaxation, his blood pressure dropped to 115 over 70.
At 51, Banks said he was able to change behavior and improve his health due to gradual and sustainable changes. "Dramatic changes usually result in dramatic failures," he said. "Taking regular and small steps toward a clear goal is a more sustainable process. For example, it would be hard to give up fried foods. But it's easier to trim back – that's what they asked me to do."
By Elizabeth Michalka and Paul Grantham
Human Resources Communications
Did You Know?
- Duke Prospective Health is available at no additional cost to more than 30,000 Duke faculty staff and covered dependents enrolled in Duke Basic or Duke Select health care plans.
- After completing a health risk assessment, you are entered in a monthly drawing for a $150 prize package – such as a gift certificate to a day spa.
- Qualifying participants who maintain contact with their care manager a minimum of 8 times for four consecutive months receive a $150 credit toward a prescription drug co-payment.
- The most important things you can do to prevent disease and be healthy are be tobacco free, physically active and eat a healthy diet.
Want to Get Started?
Visit
www.dukeprospectivehealth.org and complete an online Health Risk Assessment, or call 1-888-279-9445.
