RE: UA Health in Action Individualized Health Planning-Phase 1 Report

December 10, 2008

UA Joint Healthcare Committee

University of Alaska

RE: UA Health in Action Individualized Health Planning-Phase 1 Report

Dear UA Joint Healthcare Committee:

We are pleased to present you with the phase 1results of the Individualized Health Planning sessions. The attached report shows the cumulative results of the February 1 to October 31, 2008 program. This report was written in fulfillment of our contract with the University of Alaskaand will show our conclusions and recommendations based on the data we tracked on each participant.

Please contact us with any questions or comments you may have.

Yours truly,

Shannon Brady Garman

Summer Neuroth

UA Health in Action

Individualized Health Planning Report

Phase 1

By Wellness Initiatives Network for Alaska, Inc.

UA Health in Action

Individualized Health Planning Report

Phase 1

By Wellness Initiatives Network for Alaska, Inc.

For the Joint Healthcare Committee

of the University of Alaska

December 10, 2008

Table of Contents

List of Figures ……………………………………………………………………………………………………………………………………… 5

Sections

1. Executive Summary ………………………………………………………………………………………………………………. 6
2. Introduction…………………………………………………………………………………………………………………….……. 8
3. Conclusions……………………………………………………………………………………………………………………….…..10
4. Recommendations ………………………………………………………………………………………………………….…… 11
5. Materials...... 13
6. Results Data...... ……………………………………………………………………………………………………..….. 16

6.1 General Data …………………………………………………………………………………………….…………….………16

6.2 Subjective Data ………………………………………………………………………………………………………….…… 19

6.3 Biometric Data ……………………………………………………………………………………….………………….…... 21

6.4 Session Goals ……………………………………………………………………………………………………………….… 28

6.5 IHP Networking Sessions ………………………………………………………………………………………….….… 28

6.6 Participant Comments …………………………………………………………………………….…………………..… 29

List of Figures

Figure 1: Six-month timeline for future IHP phases...... 11

Figure 2: Participant attendance...... 16

Figure 3: Gender of all participants...... 17

Figure 4: Ages of all participants...... 17

Figure 5: Initial interest of all participants...... 18

Figure 6: Initial interest of all participants who started and completed phase 1...... 18

Figure 7: Health of all participants...... 19

Figure 8: Health of all participants who started and completed phase 1...... 19

Figure 9: Behavior change of all participants...... 20

Figure 10: Behavior change of all participants who started and completed phase 1...... 20

Figure 11: Blood pressure of all participants...... 21

Figure 12: Blood pressure of all participants who started and completed phase 1...... 21

Figure 13: Cholesterol of all participants...... 22

Figure 14: Cholesterol of all participants who started and completed phase 1...... 22

Figure 15: BMI of all participants...... 23

Figure 16: BMI of all participants who started and completed phase 1...... 23

Figure 17: Body composition decreased by at least 5%...... 24

Figure 18: Participants who lost more than 10 lbs...... 25

Figure 19: Participants whose blood pressure decreased from a hypertensive level...... 26

Figure 20: Participants who decreased their cholesterol by more than 40 points...... 28

1. Executive Summary

WIN for Alaska’s Individualized Health Planning sessions or IHPs are a unique partnership between a wellness consultant and a participant, and provides the accountability, structure, inspiration, and motivation necessary to enable a participant to improve their overall health, reduce their health risks, and enhance their well-being.

The first phase of Individualized Health Planning sessions were successful in reducing health risks for the participants and for dramatically improving the health of many individuals. For example:

• Of the 207 participants who completed the program, 1,966 goals were set and 1,485 of those goals (76%) were completed.
• Of the 207 participants who completed the program, 38% rated their health in fair condition at session 1. At session 6, only 3% rated their health in fair condition, the rest (35%) had progressed to the good, very good or excellent categories.
• Of the 207 participants who completed the program, 96% are now valued with good, very good or excellent health, as opposed to only 61% at session 1.
• Of the 155 participants who had their heart rate screened at the 1st and 6th sessions, 94 (61%) decreased their heart rate and only one participant was not within the normal range of 60-101 beats per minute by session 6.
• Of the 158 participants who had their blood pressure screened at the 1st and 6th sessions, the total number of participants with a hypertensivereading were reduced from 24% to 9%.
• Of the 143 participants who had their cholesterol screened at the 1st and 6th sessions,19 (13%) reduced their cholesterol to a normal reading and 36 (25%) dropped their cholesterol by 40 points.
• Of the 164 participants who had their body composition screened at the 1st and 6th sessions,139 (87%) decreased their body composition and 14 of those decreased it by 5%.
• Of the 168 participants who had their weight measured at the 1st and 6th sessions, 114 (68%) decreased their weight and 24 lost more than 10 pounds.

All of these physical changes to aparticipant’sbody will help them live a healthy and more productive life.

This partnership is ground breaking and impactful. During Phase I, we guided staff and faculty towards the reduction of their health risks. Based on these reductions, we quantified some of the potential economic expenditures that could have been realized had the participants not participated in the IHPs and decreased their risks.

One example of these decreased risks is an IHP participant who was guided to decrease their diastolic blood pressure by 41% (115 to 68). This took them from the hypertensive category to the normal category. People who have high blood pressure statistically have 12% higher medical care costs than those without. Source: Goetzel RZ, et. al. (1998, October). The relationship between modifiable health risks and health care expenditures: An analysis of the multi-employer HERO health risk and cost database. JOEM, 40(10):843-54.

Some of our recommendations have already been implemented for phase 2. They include:

1. Expanding to Fairbanks.
2. Adding more wellness consultants to our team.
3. Researching and finding some space that will better accommodate confidentiality.
4. Decreasing the time between the sessions.
5. Adding halfway biometrics for high risk participants.
6. Changing the phase start and completion dates to accommodate the university schedule.

Ultimately, we recommend the continuation and expansion of IHPs for UA.

1. Introduction

2.1 THE PROGRAM

IHPs area six-month, one-on-one health-coaching program. The goal of IHPs is to help UA staff and faculty make health improvements, which will enhance morale, increase productivity, and ultimately save the university healthcare costs.

Phase 1 was offered to all UA staff and faculty in Anchorage and Juneau. It ran from February 1 through October 31, 2008. Participants voluntarily registered to meet individually with a trained wellness consultant for six sessions within six consecutive months to set, chart, and make a plan to achievetheir health and behavior modification goals. Each of the six sessions occurred at specific intervals and coveredpreciseobjectives.

Session 1 (Initial Session) was a one-hour meeting, designed to lay the foundation for the following six sessions. We performed a goal-setting exercise to determine where participants were in relation to their goals. We also developed an individualized meal plan and exercise routine, if it was applicable. Participants left their initial session with a vast array of resources and information to help them toward better health and wellness as well as guidelines to reach their initial goals.

Session 2(Two-week Assessment) was a 30-minute meeting that offered biometric screenings (all in house). Screenings included blood pressure, body composition, total cholesterol, HDL, LDL, triglycerides, BMI, and weight. These biometric screenings were recorded in the participants’ IHP folders and compared to screenings done at the six-month strategy session. The participant and the wellness consultant evaluated the short term goals from the initial session and re-evaluated them for session 3.

Session 3 (Four-week Evaluation) was a 30-minute meeting that evaluated the progress of the short-term goals set at session 2. Goals were re-evaluated and modified, as needed, to challenge or motivate the participants to continue making healthful lifestyle changes. Participants received a one-month Healthy Living Certificate incentive that detailed the possible psychological and physiological changes that mayhave occurred for them after one month of making healthful lifestyle changes. The Healthy Living Certificate helped to acknowledge the participant’sefforts and encourage them to keep reaching toward their long-term health goals.

Session 4 (Two-month Checkup) was a 30-minute meeting that occurred one month after session 3. It was designed to update the participants’ meal plans and exercise programs in order to take advantage of the changes (mental and physical) they may have been experiencing. Participants also received a Well Assured Guide to work on in the month between session 4 and session 5. The Well Assured Guide is a work-style booklet that has information and research findings on a specific topic relevant tothe participant’s health needs. It is a good reference and easy to understand.

Session 5 (Three-month Review) was a 30-minute meeting that reviewed the participants’ progress and motivated and encouraged them before they were on their own for 90 days between sessions. During session 5, the wellness consultants reviewed the Well Assured Guide and answered any of the participants’ questions. Diet and exercise journaling was introduced, if applicable, as a way to help participants stay on track until session 6. Participants also received a 30-day gym pass in Anchorage and a Rec Center punch card in Juneau. This allowed staff and faculty to try a membership.

Session 6 (Six-month Strategy Session) was a one-hour meeting that wrapped up the six-month program. Participants received another round of biometric screenings, and their wellness consultant compared the results with their initial biometric screenings to show areas of marked improvement.Wellness consultants also made concluding program adjustments and long term goals, if needed. Participants learned final strategies and received motivation to be successful without the hands-on assistance of a wellness consultant. Finally, participants received a $20 cash card for their hard-earned healthful lifestyle changes.

Group Networking Sessions. In addition to the six IHP sessions, participants were invited to attend an ongoing series of Group Networking Sessions held twice a month at a variety of locations on the UAA campus and once a month on the UAS campus. These sessions were designed to educate participants on a range of topics from portion control and cardiovascular disease to a whole-grain recipe swap. In addition to education, attendees were making social connections with other IHP participants who had like interests and were looking to make healthful lifestyle changes.

2.2 SCOPE OF REPORT

This report includesparticipation in the IHP phase 1 program; change in participants’ health data during the program; realized conclusions; and recommendations based on our assessment of the data. It does not itemize all of WIN’s tasks that facilitated the program. WIN’s facilitating efforts (marketing IHP, coordinating the program’s logistics, email and telephone communications with participants, etc.) are listed in UA’s monthly program reports. This cumulative IHP report focuses on the cumulative outcomes of the phase 1 program.

2.3 ORGANIZATION OF THIS REPORT

Section 3 draws conclusions from phase 1 of the IHPs. Section 4 offersrecommendations on how to adjust the program for future phases. Section 5coversmaterials used to facilitate the program, and Section 6 discusses and shows the results from phase 1.

1. Conclusions

After reviewing the IHP phase 1 data, it is apparent that the program met participants where they were at (the worksite); that participants made life-altering behavior changes which allowed them to decrease their weight, blood pressure, body composition, BMI, and more; that we reached staff and faculty that really needed the program and not necessarily those that were already healthy; and finally that there were things within our WIN IHP model like spacing between sessions and room privacy that needed to be addressed before we started phase 2.

We have found that many participants were uncomfortable with the semi-private meeting rooms. On the Anchorage campus, two full-time WIN employees shared a small 10X10 space. The anonymity and confidentiality of participant information was often compromised. Many participants understood, some made kind remarks about needing more space, while others were visibly upset and even decided to leave the program.

Economic Cost.We also realized that the economic cost of health concerns that we were addressing were important to decreasing potential emergencies of your staff and faculty. For example:

Medical costs attributed to obesity and overweight employees are estimated to be $395 (36%) higher annually than those of normal weight. Finkelstein E, Fiebelkorn C, Wang G. The costs of obesity among full-time employees. Am J Health Promot. 2005 Sep-Oct;20(1):45-51.

Obese employees are about 75% more likely to experience high rates of absenteeism (seven or more absences during a six-month period) than normal weight employees.Tucker LA, Friedman GM. Obesity and absenteeism: an epidemiologic study of 10,825 employed adults. Am J Health Promot. 1998 Jan-Feb;12(3):202-7.

$403 billion was spent on heart disease in 2006 ($258 billion in health care costs; $146 billion in lost productivity).The Centers for Disease Control website.

Theestimated economic cost of cardiovascular disease or CVD for to be approximately $448 billion:

• $296 billion in direct health expenditures
• $38 billion in indirect cost of morbidity
• $114 billion in indirect cost of mortality

National Heart Lung and Blood Institutes (NHLBI) website

A12 to 13 point reduction in systolic blood pressure can reduce heart attacks by 21%, strokes by 37%, and total cardiovascular deaths by 25%. Center for Disease Control website.

1. Recommendations

Adjusted session intervals. WIN has already made positive improvements to the IHP program for phase 2. In phase 1, we discovered that participants were making great strides in their health and fitness goals during their first 3 months when they were meeting regularly with wellness consultants for motivation and accountability. However, in the phase 1 IHP design, there was a 90-day gap between the 5th and 6th sessions, which caused a majority of clients to lose focus on their goals. Of that majority, only a small percentage regressed,most simply maintained what they had accomplished the previous three months. Our problem was that our follow-up biometric screenings were scheduled for session 6. Therefore, we amended the session intervalsfor phase 2 according to figure 1 so that the longest time between any given sessions is now 6-7 weeks (between sessions 5 and 6). This modification gives participants more consistency with their accountability and motivation.

Figure 1. Six-month timeline for future IHP phases. This timeline shows the intervals between each sessionfor phase 1 and the changes we have made for phase 2.

Additional biometric screenings. We added a Halfway Checkup biometric screening to capture participants’ who were focusing on decreasing their biometric readings so that we could revealmarked changes early in the program and could observe high-risk participants at a more frequent interval.

Private consulting locations. A more permanent office/meeting space on campus is greatly needed to allow complete privacy. Currently,there are some consulting locations that participants can hear and be heard by others during their IHP sessions. We have brought in sound machines, dividers, and rented a room in Fairbanks. Ideally a private environment would help decrease the rate of attrition over the course of the series and encourage others to begin IHPs.

Additional communication. Many UA staff and faculty were unsure whether they had the support of their supervisors to attend IHP sessions during work hours. It is important that department heads and supervisors clearly understand that the university supports the wellness program and the IHP sessions. We spoke to Mike Humphrey about this issue and decided for phase 2 that if a supervisor is not allowing their staff to attend, we will send them information from the university showing support of the program. If they are still having problems then Mike will contact them directly. It would also be helpful if UA Human Resources reminded department heads and supervisors of UA’s support of staff and faculty taking advantage of this wellness benefit during work hours each semester. This will encourage even more UA faculty and staff to feel comfortable and register for the IHP program.

1. Materials

Our essential tools in facilitating the IHP sessions included: our wellness consultants, session locations, an online scheduler, laptops/printers and wireless accessibility, participant data storage, our nutrition and fitness programs, handouts, incentives, and biometric testing equipment.

Wellness Consultants. A wellness consultant provides the accountability, structure, and inspiration necessary to enable participants to improve their overall health and reduce their health risks. Our wellness consultants (three in Anchorage and one in Juneau) brought many skills and experiences to the IHP program. These included, but were not limited to:personal training, athletic and recreational coaching, exercise physiology, human performance, public health, diet direction, and physical therapy. Their expertise in educating, directing, and motivating participants was successful in significantly affecting positive behavior changes in phase 1.

Brook Predeger holds a master’s degree in exercise physiology with a minor in public health and abachelor’s degreein exercise science with a minor in athletic coaching. He has many years of experience helping people make lifestyle changes in the private setting. His encouragement has led thousands of people to add health and fitness to their daily lives. Brook has lectured about wellness to 900 underclassmenat Oregon State University and conducted research with Division I and semi-professional athletes. Hisspecialties include multiple human performance assessments.

Judy Ellenburg holds a master’s degree in nutrition from Bastyr University. She worked and studied at the University of Guelph for 13years attending nutrition classes in conventional nutrition as well as alternativeand natural ways to approach nutrition. Judy also worked at Children’s Hospital and RMC inSeattle in the dietary department. She has provided nutritioneducation in Anchorage at The Natural Health Center, LLC, The AlaskaClub, and Comprehensive Medicine, LLC, with a primary focus on whole-food nutrition. Judy’s nutritional services focus on teaching people how to plan, shop, cook and eatwell to achieve long-lasting health.