1. IMPACTING COMMUNITIES FROM OUR DOORSTEP
Stacey Lane, RN, BSN, MA, HN-BC
Carmela Valentino, MPH, CHES, CPHQ
10/26/2016

2. YNHHS Culture of Health Progression
2010
2011
2012
2013
2007
2008
2009
YNHHS goes tobacco free
Tobacco use surcharge on annual medical plan premium
--Preventive services: 100%
coverage under YNHHS plans
--On-line HRA (completion = $50 gift card)
--Active Health telephone coaching 42 conditions + prenatal care
-- livingwell CARES pilot launched - focus on diabetes
Get Active, YNHHS! team fitness challenge with special website
--livingwell program launched
--Disease management (6 conditions) coaching by medical plan
Tobacco cessation program
livingwell vision:
Taking Care. Giving Care.
Taking excellent care of our employees.
Giving excellent care to our patients. --
Screenings + on-line HRA = $500 credit on 2014 medical plan premium
--livingwell
CARES
program
expansion – priority/high risk and preventiont

3. YNHHS Multifaceted Approach to Nurture Health and Wellbeing
Employees and Families
Patients and Families
Communities and Neighborhoods
Corporate Clients and Municipalities

4. Culture of Health Promotion Patient and Families
Communities and Neighborhoods
Corporate Clients and Municipalities
Smoke Free Campus
Employee and Family Resources
On-site Fitness Center
Know Your Numbers-HRA and Biometrics
Revamped all the cafeterias
Free Nutritional Counseling
Legal and Financial Support
Mindfulness-Stress Management
livingwellCARES
Asthma Action Plan
Shared medical Appointments
Disease management Registries
Clinical Practice Guidelines
Emmi
MDLive
My Chart
Safe neighborhoods
Fitscripts
Agency on Aging
Malta House of Care
Project Access
Tuesday/Friday in person and phone Meditations
Labyrinth walks
Get Healthy CT
Grocery Tours
Biometric Screenings
Flu vaccinations
Health Coaching/
Disease Management
Nutrition Counseling
Workplace Challenges
On-site Walk-in Clinics

5. Leverage Technology for millenniums Work life balance
Intervention Design
Leverage Technology for millenniums
Work life balance
Bringing programs and resources into their environment

6. So How are We Doing?

7. LWC-Fitscript Video

8. Patient Pilot Summary Fitscript
Measure
Pre Fitscript
Post Fitscript
Mean Annual Rx Spend
$16, $
Annual Cost Savings for Rx Spend
Mean Weight Loss per Patient
9.7 lbs
Mean A1c
9.8
7.6
Average A1c Improvement
2.2

9. Diabetes Campaign Annual Diabetes Office Visit/Gaps in Care
Utilized the Epic Diabetes Registry
NEMG PCP (16 pilot providers) only
271 patients called
36% engagement rate with patients
32 patients transferred to the office and 40 patients were given the scheduling information
day report indicated that 123 patients in this campaign had completed the appointment to date

10. livingwellCARES Objectives
Healthier Employees (individuals, groups, and communities)
Establish trusting relationships
Improve engagement
Improve productivity
Identify risk factors/address barriers to care
Decrease unnecessary health care utilization and cost

11. LWC INTERVENTION DESIGN
Meeting individuals where they are
Support in self-motivation
Goal setting
Track Outcomes
Build accountability
Monitor Progress
Waived/Reduced co-pays

12. Measured Outcome Indicators
Financial and Efficiency Metrics
Utilization Metrics
Clinical/Biometric Tests/KYN+
Lifestyle Indicators/Goal Progression
Participant Satisfaction/Engagement
Compliance with;
Annual Exams/Tests/Immunizations

13. livingwellCARES Outcomes 1/2013-7/2015
Managed
Pre
Post
Declined
PMPM
1,040
1,722
2,912
7,182
ED Visits
334
305
534
680
Admissions
150
124
364
1,138
Hospital Days
639
561
2,276
5,529
Progression to and or goals met NA
78%
55%
Source Conifer

14. livingwellCARES
"My  coordinator is very sincere in showing the personal interest in making progress to help take better care of my health. I always leave the office with updates and encouragement.“
"My personal time with my coordinator is encouraging and sincere. It blows my mind how she follows up with whatever she has me working on. She always has goals for me. She has a caring heart. I love her. She is real. She tells me what I need, not always what I want to hear“

15. Lessons Learned

16. Tour de Cure 2016
livingwellCARES staff “stuck by me until I was in a better place,” Jordan said. “It sounds dramatic to say this, but I credit them and this program with saving my life.”