County, health plans team up for disease management

Published June 26, 2006

by JOANNE WOJCIK

jwojcik@BusinessInsurance.com

REDWOOD CITY, Calif.--As the benefits manager of San Mateo County, Calif., Paul Hackleman pioneered efforts with each of the county's health plans to devote financial and human resources to collaborative disease management programs that have helped to improve employee health.

A cornerstone of the initiatives is the county's HEAR2T Program, which began in 2001 after completion of a three-year Stanford University study in which the county was the lone public-sector participant.

Two initiatives involving Kaiser Permanente Medical Group Inc. of Redwood City, Calif., were also unique in that the health maintenance organization had previously not conducted research with individual employers.

Both Stanford and Kaiser were particularly interested in using the county for its heart research because the county's demographics were sufficiently diverse to represent a cross-section of its targeted population, said Mr. Hackleman. San Mateo County's workforce is 66% female, and 61% of employees are over age 40.

In 1997, Mr. Hackleman met with the director of Stanford's Center for Research in Disease Prevention to discuss a program that would feature the center's newly developed Cardiovascular Risk Assessment tool, which had success in clinical trials in predicting cardiovascular events, and is still being used by the county's Health Education and Risk Reduction Training (HEAR2T) program today.

Mr. Hackleman also persuaded the county's three health plans to provide more than $180,000 to help fund the county's participation.

First-year results showed significant improvement in smoking cessation, stress reduction, nutrition, physical activity and control of cholesterol and blood pressure.

In the second year, Mr. Hackleman negotiated comparable funding from the health plans and obtained a grant for continuation of the program and its migration from a Stanford-offered program to an internal county program in its third year. Today, Susan Vana serves as the nurse coordinator of the program, which has 50 participants. Sixty-six previous participants have been discharged, having met their cardiovascular health goals.

Although the savings attributable to the Stanford program were not analyzed for the county's specific program, the analysis of the entire clinical trials program reflected a 40% reduction in hospital usage by all participants. An analysis of the program in 2004 showed an additional 4% reduction in total cholesterol, a 19.5% reduction in triglycerides and an average weight loss of eight pounds among participants.

Also as part of its participation in Stanford University's Corporate Health Program, the county engaged in a community clinical trial called the Comprehensive Health Action and Management Program for five years, which resulted in a 44% reduction in health care claims for county employees who participated in the program.

The county's inaugural work with the Stanford Center for Research in Disease Prevention resulted in the county receiving an honorable mention in 1993 for the C. Everett Koop Award, named for the former U.S. surgeon general.

In addition to its collaboration with Stanford, San Mateo County in 2005 entered into a first-of-its-kind partnership with Kaiser Permanente Medical Group Inc. of Redwood City, Calif., to reduce the risk of heart attack and stroke in the county's high-risk plan membership.

Like the HEAR2T Program, Kaiser's Prevent Heart Attacks and Strokes EveryDay Program focused on education of participants to take charge of their cardiovascular risk management by improving medication, diet and exercise management, through both individual counseling and classes. But instead of focusing on individuals who had high cholesterol or hypertension, the PHASE program targeted individuals with co-morbidity factors, including diabetes and heart disease in combination, which put them at increased risk for heart attacks and strokes.

As part of the collaboration, the county provided a registered nurse to assist with teaching the classes, and Kaiser provided two pharmacist care managers, administrative support, educational materials, physical space for classes and individual meetings with members, as well as mailing expenses.

Overall, there was a 20% improvement in LDL cholesterol and a 17% improvement in blood pressure among all participants in the PHASE program. In addition, by the end of the program, 80% of the participants with diabetes had good glycemic control, compared to 71% initially.

Another risk reduction program the county conducted in conjunction with Kaiser focuses on asthma management. The two-year project, which was conducted in 1995 and 1996, resulted in a reduction of sick leave by 17.6%, and utilization of the county's inpatient respiratory care dropped by 31.9%. Kaiser cited the success of this program as the primary reason for a 5% reduction in the county's premiums in the late 1990s.