Screening on the Road To Health: Fact or Fantasy David Grossman, MD, MPH Senior Investigator Group Health Research Institute Medical Director, Population Health Group Health June 9, 2014 Personal Disclosures • Employee E l and d shareholder, h h ld G Group H Health l h Ph Physicians i i • Former member, US Preventive Services Task Force member Community Preventive Services Task Force • Current member, • Twitter: @grossman_d • Email: E il [email protected] d@ h The Group Health Story on Wellness • Wellness W ll program ffor GH staff ff since 2005 • Incentives started in 2009 • Started with $450 Premium reduction for HRA completion • Evolved E l d tto combination bi ti off HRA plus health promotion points to achieve incentive • Steady engagement rates of 8590% • VBID benefit and Medical home synergistic Group Wellness 2.0 • F Focus on cardiovascular di l h health l h risk i k ffactors • Blood pressure • Body mass index • Tobacco • Biometric screening now required for incentive • Staged with awareness • Then meeting targeted improvement • Incentive I ti dependent d d t on efforts ff t to t achieve hi • Awareness • Effort • Results Role of HRA in Screening • GH developed d l d own HRA • two way data interchange with electronic health record • HRA accessible to primary care MD • Formal part of medical record • HRA emphasized as key part of clinical preventive care • All screening items are validated and linked to evidence based interventions Evidence for HRA’s HRA s • E Evidence id supports HRA use when h lilinked k d to h health l h iimprovement activity (HRA Plus) • Several systematic y evidence reviews • Resulted in Community Guide recommendation • HRA content very heterogenous • HRA’s should use validated screening tools • E.g. PHQ-2 for depression • Some common items not linked to effective interventions Evidence for Biometric Screening • USPSTF supports b basis i ffor some elements l off bi biometric i screening i • Blood Pressure • BMI screening and interventions • Tobacco • Lipid screening • Screening issues • Frequency • Linkage Li k tto primary i care • Engagement Reflections • IIncentives i are a gateway to engagement • Attractant but not sustaining • Building Trust • Evidence • Net benefit • Minimizing harm • Emphasizing health first • Engagement E t starts t t with ith the th participant ti i t • Communication © 2013 Group Health Cooperative and Group Health Options, Inc.