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A Project Proposal by Vy Doan

CSUSB ISPP Dietetic Intern


Feb 3, 2017
Outline
The Problem
The 3 killers: Heart
Disease, Diabetes,
Obesity
Obesity as the Link
The Solution
Introducing CHIP
CHIP proposal and
analysis
Conclusion and
Recommendations
The Problem
Chronic Diseases are responsible for
7 of 10 deaths each year.
86%
Chronic diseases account for
of our nations health
care costs.

Source: CDC Nov 2016


Team Triple Threat

Heart
Disease

Diabet
es

Obesit
y
Diabetes
9.3
29.1 MILLION
%
PEOPLE OF THE
U.S.
POPULATION
HAVE DIABETES
21 million
diagnose
8.1 d
million people undiagnosed

Source: CDC 2014


Estimated Diabetes Costs in the US (2012)

*2.3 times higher


than people
Direct Costs
$176 without diabetes
after adjusting for
population age and

billion sex differences

Indirect Costs $69


billion
$245
billion
Source: CDC 2014
Heart Disease

Heart disease is the


leading cause of
death for both men
and women. About 1
in 4 deaths each year.
The Cost of Heart Disease
Heart disease and
stroke cost the
nation an
estimated
$316.6
billion in
health
care costs
And lost productivity
In 2011.

source: MillionHearts
Obesity as the Link to Chronic
Disease

rt
Hea s
a
Dise
e

Diabet
es

Obesity
Missing Link, Perhaps?
The health implications of overweight
and obesity include heart disease,
high blood pressure, diabetes,
depression, and certain cancers.
Common modifiable risk factors of
chronic disease are unhealthy diet,
physical inactivity, and tobacco use.

Source: County of San Bernardino, Department of Public Health. Community


Indicators Report, 2014.
Risk Factors of Obesity Linked With
Increased Cardiovascular Events

Source: Bastien, M., Poirier, P., Lemieux, I., & Desprs, J. (2014). Overview of Epidemiology and Contribution
of Obesity to Cardiovascular Disease. Progress in Cardiovascular Diseases, 56(4), 369-381.
doi:10.1016/j.pcad.2013.10.016
Prevalence of Obesity vs. Healthy
People 2020 Goals

Source: Bastien, M., Poirier, P., Lemieux, I., & Desprs, J. (2014). Overview of Epidemiology and Contribution
of Obesity to Cardiovascular Disease. Progress in Cardiovascular Diseases, 56(4), 369-381.
doi:10.1016/j.pcad.2013.10.016
More than one-third
(36.5%) of U.S. adults
O are obese.
B Estimated annual medical cost of
obesity in the U.S. was $147 billion
ES in 2008 U.S. dollars
Medical costs for people who are
IT obese were $1,429 higher than
those of normal weight
Y Medicare and Medicaid spending would be
8.5% and 11.8% lower without
obesity

Health care spending due to obesity


is estimated 21% of total national
health care spending. inpatie
nt
service
s.
Source: Bastien, M., Poirier, P., Lemieux, I., & Desprs, J. (2014). Overview of
Epidemiology and Contribution of Obesity to Cardiovascular Disease.
Without action to address the
causes, deaths from chronic disease
will increase by 17% over the next
ten years, According to the World
Health Organization 2005.
The
Solution
Communit
y Based

risk factors
associated w/ Lifestyle
CVD, T2DM, Modificatio
Depression, n
etc. Reduces risk
factors
associated
with CVD,
T2DM, and
Depression
Program Design
Program ranges from 6-9 weeks
18 group sessions

CHIP in Corporations eighteen 25-minute video


lectures with 25 minute class discussion with
CHIP facilitator

Medical CHIP customized program for specific


disease groups

CHIP in the community eighteen 45-minutes


video lectures with a 45- minute class discussion
Program Design (Cont.)
Participants take part in
blood draws and health risk
assessments
Track progress throughout
classes and encouraged to
share results with
physicians.
Detailed report is prepared
for each participant that
compares risk factor levels
before and after going
through the program.
CHIP Sample Session
https://vimeo.com/58942903
Findings
Improved management and
symptom reversal of type 2
diabetes
Normalizes blood pressure
stroke risk
average cholesterol levels by
10-25% or more
depression
weight
Long-term maintenance of
lifestyle change
WHERE is CHIP?
Offered in 350+
Cities

U.K
.
North
America

Austral New
ia
Theyre also in our neighborhood!

Loma Linda East Campus


Medical/Rehab
LLUMC Transplantation Institute
Community
Loma Linda Community Drayson Center
Community
Loma Linda University School of Nursing
Corporate

Arrowhead Orthopaedics Corporate


The Therapeutic Lifestyle Center-
Medical
Hesperia-Victorville CHIP Community
Show Me the Numbers!
RIV 1,257, 122 IEHP members
SB
*excluding Healthy Kids
(ages 0-5)

618,786 638,
336
57 69
% %
353, 327 441, 090
overweight overweigh
& obese t & obese

794, 417 63
overweight & obese IEHP %
members
Source: Gilbert, Bradley, P. M.D., January 9, 2017. Standard Monthly Report,
Board Report #263. Inland Empire Health Plan.
Show Me the Money!

Assuming $10,345 is being spent per person today/year


Medical costs for people who are obese were $1,429-
$2,741 higher than those of normal weight.

Then an average $11,774-$13,086/year is spent in


medical cost for obese individuals per person.

**Because treatment costs are not going to be incurred


for all 794,417 overweight and obese members, the
inclusive medical costs were excluded.

Source: "$10,345 per person: U.S. health care spending reaches new peak." PBS.
Bastien, M., Poirier, P., Lemieux, I., & Desprs, J. (2014). Overview of Epidemiology and Contribution of Obesity to
Cardiovascular Disease.
Pilot Program for CHIP for 1 year

30 max participants in one class


No eligibility criteria clarified (on
website or at Loma Linda)
Classes offered quarterly (4 x year)
Each quarter 3 months long (90
days)
30 participants x 4 classes/year =
120 member referrals/year
Source: Interview with CHIP
facilitator at Loma Linda (See
Report)
ROI
$800 one-time enrollment fee x
120 members = $96,000 Total Investment
Included in cost are 2 hour
evening classes 2-3x/week, =
food demonstrations, food
sampling, and completion
-$96,000
certificate upon completion of Total Return = +
program.
Assuming half the participants
$85,740-
complete the program and $164,460
maintain 10% reduction weight
loss ROI= $10,260-
$1, 429-2,741 additional
medical cost for obese
$68,460
individual x 60 IEHP potential
CHIP participants = $85,740-
164,460 total medical
costs of potential
Source: Gilbert, savings.
Bradley, P. M.D., January 9, 2017. Standard Monthly Report,
Board Report #263. Inland Empire Health Plan.
Conclusion

?
Limitations
Health Literacy of program not
matched with majority of IEHP
members
Does not take into consideration hard
of hearing (no subtitled videos) or
reading difficulty (of materials)
No bilingual services offered. Classes
and instruction done in all English
Future Considerations
Corporate Setting Utilize new building
Journal of Managed Care from Vanderbilt
University and Medical Center found a return on
investment of over 2 dollars for every 1
dollar spent on conducting the program.
CHIP participants their medical service
utilization costs by 43% and medical usage costs
by 14%.
Use as an example for future projects. Mimic
components and include more lifestyle
intervention programs.
CHIP in Lee Memorial Health
System

https://vimeo.com/185579963
Question
s?
References

1. Shurney, D., S. Hyde, et al. (2012). "CHIP lifestyle program at Vanderbilt University demonstrates an early ROI for a diabetic cohort in a workplace setting: a case
study" Journal of Managed Care Medicine 15(4): 5-15.
2. Aldana, S. G., Greenlaw, R. L., Diehl, H. A., Merrill, R. M., Salberg, A., & Englert, H. (2008). "A video-based lifestyle intervention and changes in coronary risk." Health
Educ Res, 23(1), 115-124.
3. Thieszen, C. L., R. M. Merrill, et al. (2011). "The Coronary Health Improvement Project (CHIP) for lowering weight and improving psychosocial health." Psychol Rep
109(1): 338-352.
4. Kent L, Morton D, Hurlow T, et al. Long-term effectiveness of the community-based Complete Health Improvement Program (CHIP) lifestyle intervention: a cohort
study. BMJ Open 2013;3:e003751. doi: 10.1136/bmjopen-2013-003751
5. S., Heike, Hans A., Roger L., and Steve Al. "The Effects of Lifestyle Modification on Glycemic Levels and Medication Intake: The Rockford CHIP." Primary Care at a
Glance - Hot Topics and New Insights (2012): n. pag. Web.
6. Morton DP, Rankin P, Morey P, et al. The effectiveness of the Complete Health Improvement Program (CHIP) in Australasia for reducing selected chronic disease risk
factors: a feasibility study. N Z Med J. 2013;126(1370):43-54
7. Rankin P, Morton DP, Diehl H, GobbleJ, Morey P, Chang E. Effectiveness of avolunteer-delivered lifestyle modificationprogram for reducing cardiovascular disease risk
factors. Am J Cardiol. 2012;109:82-86.
8. Morton DP, Rankin P, Kent L, et al. The effectiveness of the Complete Health Improvement Program (CHIP) in Canada for reducing selected chronic disease risk factors.
Can J Diet Pract Res. 2014;75(2):72-77.
9. Diehl HA. Coronary risk reduction through intensive community-based lifestyle intervention: the CHIP experience. Am J Cardiol. 1998;82:83T-87T.
10.Heart Disease Fact Sheet. (2016, June 16). Retrieved January 24, 2017, from https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm
11.Chronic Disease Prevention and Health Promotion . (2016, November 14). Retrieved January 25, 2017, from https://www.cdc.gov/chronicdisease/index.htm
12.Complete Health Improvement Program . (n.d.). Retrieved January 25, 2017, from http://www.chiphealth.com/
13.McGinnis, J. M. (1988). "The Surgeon General's report on nutrition and health." R I Med J 71(10): 373.
14.Diehl, H. A. (1998). Coronary risk reduction through intensive community-based lifestyle intervention: the Coronary Health Improvement Project (CHIP) experience. The
American Journal of Cardiology, 82(10), 83-87. doi:10.1016/s0002-9149(98)00746-2
15.Nakayama, K., & Morimoto, K. (2007). P0002 Prevention of Ill-health Effects of Stress and Lifestyle (Part 33) Relationship of lifestyle and quality of sleep. Sleep
Medicine, 8. doi:10.1016/s1389-9457(07)70263-0
16.Bastien, M., Poirier, P., Lemieux, I., & Desprs, J. (2014). Overview of Epidemiology and Contribution of Obesity to Cardiovascular Disease. Progress in Cardiovascular
Diseases, 56(4), 369-381. doi:10.1016/j.pcad.2013.10.016
17.Chronic diseases and health promotion. (n.d.). Retrieved January 26, 2017, from http://www.who.int/chp/en/
18.Finkelstein EA, Fiebelkorn IC, Wang G. State-level estimates of annual medical expenditures attributable to obesity.Obesity Research 2004; 12(1):18-24.
19.Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S.
Department of Health and Human Services; 2014.
20.County of Riverside, Department of Public Health. Community Health Profile, 2013.
21.County of San Bernardino, Department of Public Health. Community Indicators Report, 2014.
22."$10,345 per person: U.S. health care spending reaches new peak." PBS. Accessed January 26, 2017. http://www.pbs.org/newshour/rundown/new-peak-us-health-care-
spending-10345-per-person/
23."Adult Obesity Causes & Consequences." Centers for Disease Control and Prevention. August 15, 2016. Accessed January 26, 2017.
https://www.cdc.gov/obesity/adult/causes.html.
24.Brill, Alex. The Long-Term Returns of Obesity Prevention Policies. April 2013. The Campaign to End Obesity.
25.Gilbert, Bradley, P. M.D., January 9, 2017. Standard Monthly Report, Board Report #263. Inland Empire Health Plan.