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

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spending-10345-per-person/
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