Sibley Heart Center Cardiology - Empl oyee Wellness Program

1. Sibley Heart Center Cardiology - Employee WellnessProgram Modern Initiatives Wellness Team Joye Hurling, Crystal Cohen, April Daniels, Candace Mason, Taleesa Peck, Emmanuel Toe Dr. Michael Dalmat Clayton State University

2. Sibley Heart Center Cardiology • About • Sibley Heart Center Cardiology is a group of more than 40 pediatric cardiologists in 19 locations across Georgia. • Provides comprehensive services for patients from before birth to age 21 with congenital or acquired heart defects. • The Emory/Sibley Adult Congenital Cardiac Program is one of the largest programs in the U.S. - and the only one in Georgia - specializing in the treatment of adults with congenital heart disease (CHD). • Mission • To enhance the lives of children through excellence in patient care, research and education. • Values • Service • Team • Integrity

3. Sibley Heart Center Cardiology Locations • Sibley has a total of 224 employees • There are 95 employees working at the Corporate Office in Atlanta • This number comprises approx 42% of all Sibley employees.

4. Zip Code Spot Map

5. Sibley Heart Center Benefits • Employee Health Benefits • Blue Cross/Blue Shield Health Insurance • Employee Wellness Program in addition to health insurance

6. Current Wellness Activities • Tuesdays 5:15 - 6:15 Cardio Fusion Aerobic Class - At Sibley Corporate Site All Sibley Location Employees are welcome. • Discount Gym Memberships (34 gyms within the Atlanta area) - Globalfit.com • Wellness Challenge - Once a year • Make it a Habit - (Exercise, Eating and Drinking Water Regularly) - Once a year • Maintain Don’t Gain - (Weekly holiday emails on healthy eating) • Host Family Fitness Month • Nutrition Month (March) - Nutritionist sends nutrition questions weekly for entire month of March person with the most correct answers wins a fruit and vegetable box. • Healthy Vending Snacks (Identified by healthy sticker) • Filtered Water

7. Modern Initiatives Wellness Team Objectives • To assist Sibley Heart Center Cardiology in the continued development of their Employee Wellness Program by determining strategies that will: • Provide data regarding the current health and well-being of its employees. • Increase employment participation in Sibley’s Employee Wellness Program. • Be supported and championed by upper management. • Be accepted and used regularly by at least two-thirds of employees. • Be practical, accessible, inexpensive and maintainable. • Show proven improvement in employee health and well-being. • Be replicable at all Sibley sites.

8. Overview of Methods • Determine and obtain necessary information from Sibley representative(s) regarding: • Employee Benefits (i.e., Health Insurance Coverage, wellness initiatives, etc.) • Employee counts • Employee demographics including: • Zip Codes • Race/Ethnicity • Gender • Age • Analysis of employee demographics • Research and analysis of mortality and morbidity rates • National Center for Health Statistics (2010) • Georgia Department of Public Health (OASIS, 2011) • Creation and presentation of Health and Wellness Survey to Sibley employees via Qualtrics • Flier Announcing Wellness Survey • Release of online anonymous survey • 7 day completion deadline • Analysis of survey responses • Recommendations to enhance health and wellness of Sibley employees • Survey responses • Evidence based research practices

9. Demographic cohorts: Age & gender

10. Demographic cohorts: age & race

11. Demographic cohorts: race and gender

12. Sibley Heart Center Cardiology Summary &Target Population • White employees: 48.2% • 64% female • 35% male • Black: 38.8% • 95% are female • Age: 30-39: 33.0% 40-49: 30.4% 50-59: 20.5% 83.9% • Female: 77% • 48%Black • 40% White

13. Top 10 HealthIssues for Women(National Center for Health Statistics, 2010) Heart Disease Accounts for around 27 percent of all female deaths Cancer Second most dangerous threat to a woman’s health, accounts for 22 percent of female deaths Stroke Responsible for almost 8 percent of all female deaths Chronic obstructive pulmonary disease (COPD) Makes up about 5 percent of all female deaths. Alzheimer's Disease Responsible for about 4 percent of all female deaths in the United States each year.

14. Top 10 health issues for women(National Center for Health Statistics, 2010) Unintentional Injuries Accidents — car collisions, falls, and poisonings account for about 3 percent of all female deaths in the United States each year — more than 37,000 women. Diabetes Responsible for around 3 percent of all female deaths in the United States Influenza and Pneumonia Combined account for just under 3 percent of all American female deaths Kidney Disease Accounts for almost 2 percent of all female deaths in the United States. Blood Poisoning (septicemia) Responsible for the deaths of 1.5 percent of all U.S. females.

15. COHORT 1: FEMALE, AGE 30-39 (Georgia Department of Public Health, 2011) AFRICAN AMERICAN/BLACK CAUCASIAN/WHITE • Heart Disease • Cancer • Unintentional Injuries • Homicide • HIV/AIDS • Pregnancy Complications • Diabetes • Stroke • Kidney Disease • Anemia • Heart Disease • Cancers • Unintentional injuries • Suicide • Pregnancy Complication • Homicide • Stroke • Diabetes • Chronic Liver Disease • Chronic Lower Respiratory Disease

16. COHORT 1: FEMALE, AGE 40-49 (Georgia Department of Public Health, 2011) AFRICAN AMERICAN/BLACK CAUCASIAN/WHITE • Cancer • Heart Disease • Unintentional Injuries • Stroke • Diabetes • HIV/AIDS • Kidney Disease • Homicide • Chronic Lower Respiratory Disease • Chronic Liver Disease • Cancer • Heart Disease • Unintentional injuries • Chronic Liver Disease • Chronic Lower Respiratory Disease • Suicide • Stroke • Diabetes • Kidney Disease • Influenza & Pneumonia

17. COHORT 1: FEMALE, AGE 50-59 (Georgia Department of Public Health, 2011) AFRICAN AMERICAN/BLACK CAUCASIAN/WHITE • Heart Disease • Cancer • Diabetes • Stroke • Kidney Disease • Chronic Lower Respiratory Disease • Septicemia • Unintentional Injuries • Hypertension • HIV/AIDS • Heart Disease • Cancers • Chronic Lower Respiratory Disease • Unintentional injuries • Diabetes • Stroke • Chronic Liver Disease • Septicemia • Kidney Disease • Influenza & Pneumonia

18. SurveyResponse Rate • Survey was distributed to 95 employees at the Sibley Heart Center Corporate Office • 33% response rate • 1 dropout/1 incomplete • 45% in the 40-49 age range • 91% of respondents were female • 100% covered by health insurance • 94% covered by Blue Cross/Blue Shield • 6% covered by some other insurance

19. In general, how would you describe your health?

20. Issues of Low to Moderate Concern • 0% smokers • 76% engage in at least 3 days of exercise per week • 44% engage in exercise 5-7 days per week • 73% reported not having any of the top 10 chronic illnesses • Only 1 participant reported receiving a cancer diagnosis within the last 12 months

21. Issues of High Concern • 88% identified stress as a moderate concern • 46% specify identified work related stress as a moderate concern • 56% identified themselves as being overweight • 69% stated that they were trying to lose weight • 18% identified an “Other” health issue: • Hyperlipidemia, GERD • chronic migraines • asthma (2 participants) • ADHD • Nonspecific inflammatory process

22. Identify which of the following wellness activities would you be most willing to commit to doing on a regular basis, and indicate where you would be most likely to participate in this activity on a regular basis at or near your home or at or near your office (Check all that apply)

23. ARE YOU AWARE OF THE EMPLOYEE WELLNESS PROGRAM AT SIBLEY HEART CENTER CARDIOLOGY? 100% of survey respondents indicated that they were aware of the wellness program.

24. 63% of survey respondents ARE willing to pay

25. EMPLOYEES’ RECOMMENDATIONS

26. Focus on Continuity for Success • Keys to maintaining a permanent Wellness Program: • Wellness Committee • Consists of a mix of top management and employees interested in wellness and health. • Individuals from the Human Resources department, health and safety department and employee assistance program may also be considered. • Have consistent programs and rewards to increase and retain employee participation in the wellness program. • Ensure that there is an activity scheduled on a weekly, monthly, quarterly basis

27. Wellness Bulletin Board • Develop wellness bulletin board or digital screen that displays Sibley’s wellness policy. • This board highlights important messages from the policy once a week where suggestions for healthy activities will be posted along with pictures displaying employees post pictures of them engaging in these healthy activities • Quarterly incentive: the family who incorporates the most activities in a photo album will win a small quarterly prize • At the end of the year the family that has completed the most activities wins a grand family prize • Examples include: • Employees bring family recipes to place on wellness bulletin board or email fellow employees • Sibley employee family day at your local, state park or other venues • Wellness Committee and Sibley employees can send out suggestions for physical activities families can do at home.

28. Stress Management 3.Appoint wellness committee advocate to become familiar with a free worksite stress management training program to inform Sibley employees of ways to reduce stress. Once the program has been introduced to Sibley employees can access the link from their home or work computer at their leisure. • Links for worksite stress management: www.cdc.gov/niosh/topics/stress www.webmd.com/a-two-v-guides/video/farrell-stress-reduction www.webmd.com/10-relaxation-techniques-reduce-stress-spot

29. Stress Management 3.Stress Reduction: • Spa’s for Massage • The Atlanta Institute of Massage and Institute of Aesthetics http://www.sensability.com/ 50 min $40 student massages • Gwinnett College http://www.metroatlantacollege.com/index-5.html 60 min $40 student massages • Georgia Massage School http://www.georgiamassageschool.com/student-massage-clinic 50 min $35 student massages • Quiet Meditation Room • Free Yoga at Kaiser Permanente: Crescent Medical Center, Glenlake, and Gwinnett Facilities

30. More Competition, More Rewards 4.Incorporate more competitive challenges with monthly reward incentives and a larger reward for an annual challenge. • Examples: • Gifts cards for healthy eating places • Spa certificates • Workout gear • Water bottles • Allot flex time to allow employees to engage in onsite physical activity • Employees develop walking teams • Wellness Committee build relationships with community partners for group discounts.

31. Chronic Disease Prevention & Self Management 5. Chronic disease prevention and self management through evidence based programs: • Health coaching - Motivational Interview Technique • The Game of Health - Game Based on Social Cognition • Sibley’s Wellness Program should incorporate an education component that offers monthly informational classes or sessions about chronic disease prevention.

32. Health Coaching 5.Motivational Interviewing Based on Health Coaching (Butterworth, Lindeu, & McClay, 2007) • Only technique to have demonstrated causality • Only technique to have shown to be independently associated with positive behavioral outcomes • Components of Effective Health Coaching Interventions: • At risk individuals should be identified • Recruitment efforts must be maximized • Use of various communication modules • E-mail Blasts, E-Letters, Phone Call, Person to Person • Incentives • Valid Coaching Methods should be used: • Motivational Interviewing • Whole Person Interviewing • Shared Decision Making • Evaluation ·

33. Game Of Health 5.Implementation of programs designed to modify behaviors to achieve a healthier lifestyle and improve body composition Game of Health (Courtney, Conrad, Dunn, & Scarborough, 2011) • Study: Effectiveness of 12 wk. lifestyle change program targeted to patients w/ chronic disease Based upon social cognitive theory • Emphasis on enhancing a patient’s behavior capability and self-efficacy • Goal setting • Monitoring • Personalized Feedback • Game of Health also used baseball game metaphor in which the patient “joined the team” to play against the “opponents” of chronic diseases and symptoms. • Game players also introduced to 7 healers – specific behavioral areas in which to improve health • For more information visit the website at www.gameofhealth.com

34. BC/BS Complex Care 6. People who are at risk for chronic diseases or have a chronic disease can sign up for BCBS complex care or condition care programs in order to receive personalized health management. • Complex Care is for individuals who are at risk of developing a chronic disease, while Condition Care is for individuals who have already been diagnosed with a chronic disease. With both programs, individuals get a team of nurses to help manage their health. *For more information regarding care programs http://www.bcbsga.com/wps/portal/chpfooter?content_path=shared/noapplication/healthyliving/nosecondary/notertiary/pw_a087142.htm&label=360%5Edeg%20Health%5Ereg%20Program Sibley may look at Anthem.com for employers to see most recent updates on plan incentives offered by BCBS.

35. Sibley Heart Center Cardiology Logic Model Activities Outputs TEAM FOCUS Short-term Outcomes Medium-term Outcomes Long-term Outcomes Activities What the medium-term outcomes are What the long-term outcomes are What we will propose to put in place What we will do What the short-term outcomes are • -Reduction in medical claims cost • Lower absentees and higher presenteeism • Higher productivity • Fewer workers compensation and disability claims • -28% decrease in sick leaves • 26% reduction in health care costs • 30% reduction in workers compensation & disability claims • -Improve upon current employee wellness plan Family Involvement: -Develop a bulletin board that displays families engaging in healthy activities & highlights important aspects of the wellness policy -Email healthy family recipes and healthy family activities -Have a Sibley Family Day at the park Stress Reduction: -Self stress reduction techniques -Affordable Spa’s -Quiet meditation room -Yoga Increasing Employee Participation: -Offer more incentives and competitive challenges -Allot for flex time to allow time to engage in fitness activities -Employee walking teams Chronic Disease Prevention: -Offer education classes/programs about the prevention of chronic diseases Blue Cross Blue Shield Tools: -Complex-Care Program -Condition-Care Program -Anthem.com for Employer and Employee use - MOU & CA - demographics (zip codes) - Retrieved mortality & morbidity rates based on data in GA - Construct Survey - Implement and Analyze Survey - Formulate Recommendations • Overall weight reduction of employee’s. - Walking Teams • Increased amounts of sleep • Increase in employee energy • Employee Participation -Reduce employee workplace stress -Increase family involvement • Increases in employees who exercise at least 4 times a week • Decrease employees eating out • -Increase employees who eat healthy • Increase use of BCBS tools ROI $5.93 to every $1 MORE PROFITABLE BUSINESS

36. Long Term Outcomes • Reduction in the cost of medical claims • Lower absentees and higher presenteeism • Higher productivity • Fewer worker’s compensation and disability claims - decrease by 30% • 28% decrease in sick leave • 26% reduction in healthcare costs

37. Which Recommendations Would You Like to Adopt?

38. References AHRQ. (2012, October). Cardiovascular disease and other chronic conditions in women: Recent Findings. 12(13), 1-6. Rockdale, Maryland: Agency for Healthcare Research and Quality. Berry, L. L., Mirabito, A. M., & Baun, W. B. (2010). What's the hard return on employee wellness programs. Harvard business review, 88(12), 104-112. Butterworth, S. W., Lindeu, A., & McClay, W. (2007). Health coaching as an intervention in health management programs. Disease Managment and Health Outcomes, 15(6), 299-307. Churchill, S. A., Gillespie, H., & Herbold, N. H. (2014). The Desirability of Wellness Program and Incentive Offerings for Employees.Benefits Quarterly, 30(1), 48-57. Courtney, M., Conrad, S. E., Dunn, P., & Scarborough, K. (2011). The game of health: An innovative lifestyle change program implemented in a family practice. American Academy of Nurse Practitioners, 23, 289-297. Flaxman, P. E., & Bond, F. W. (2010). Worksite stress management training: Moderated effects and clinical significance. Journal of occupational health psychology, 15(4), 347. Fogarty, S. (2007). Evaluating ROI for Wellness Programs. Benefits & Compensation Digest, 22-25.

39. References Gatewood, J. G., Luchfield, R. E., Ryan, S. J., Myers-Gradelmann, J. B., Prudergast, J. F., & Ullom, K. K. (2008). Perceived barriers to community-based health promotion program participation. American Journal of Health Behavior, 32(3), 260-271. Georgia Department of Public Health. (2011). Online Analytical Statistical Information System. Retrieved from OASIS: http://oasis.state.ga.us/oasis/ Gillan, W., Naquin, M., Zannis, M., Bowers, A., Brewer, J., & Russell, S. (2013). Correlations among Stress, Physical Activity and Nutrition: School Employee Health Behavior. ICHPER-SD Journal of Research, 8(1), 55-60. National Center for Health Statistics. (2011). Retrieved from CDC: http://www.cdc.gov/nchs/ Shah, J. (2014). Three Styles of Communication that Will Keep Your Employees Engaged in Your Wellness Program. Employee Benefit Plan Review, 68(7), 25-26. Washoe County Health District. (2014, April 18) . Engaging families in health and wellness:Tips to help get families involved with health and wellness. Retrieved from http://www.GetHealthyWashoe.com

40. References Willingham, R. (2013). Using Incentives within the New Regulatory World of the ACA to Improve Employee Wellness and Productivity. Employee Benefit Plan Review, 68(4), 7-11. Winterdyk, J., Ray, H., Lafave, L., Flessati, S., Huston, M., Danelesko, E., & Murray, C. (2008). The Evaluation of Four Mind/Body Intervention Strategies to Reduce Perceived Stress among College Students. College Quarterly, 11(1).

41. To Sibley Heart Center Cardiology and Ms. Lisa Martin, Senior Manager of Human Resources and Director of the Wellness Committee & To Hearts To Nourish Hope for Hosting