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If there's one lesson the pandemic should have taught us, it's the value of preventative medicine. Getting vaccinated and wearing a mask aren't foolproof: it hasn't stopped the current Omicron strain from infecting even the vaccinated and wearing masks do not prevent people from getting ill. And isolation brings on other problems like anxiety and depression. There's only so much social distancing you can require of humans, who are social beings.
That's not to say that the vaccinates and masks aren't important, but people also need to eat healthier, take vitamins, go outside and get fresh air and vitamin D from the sun, get good sleep and stop the bad habits. The vast majority of people who wind up in the hospital due to Covid or with Covid have comorbidities driven largely by poor behavior. For kids, Covid deaths are statistically non-existent with those under 17 years old dying of pneumonia at twice the rate as Covid and Covid deaths accounting for 1% of all deaths. Looked another way, 678 kids 17 and under died from Covid in the last two years. And about 650 had comorbidities. But 150,000 kids die from being around cigarette smoke every year, according to the World Health Organization.
According to the CDC, cigarette smoking is responsible for more than 480,000 deaths per year in the United States; that includes more than 41,000 deaths from exposure to secondhand smoke. That average to about 1,300 deaths every day. While corporations are taking measures to protect their workers from dying from COVID, and rightfully so, few of them take smoking cessation seriously.
That was the argument put forth by David Utley, founder and CEO of Pivot, a digital health company that takes a multifaceted approach to getting people to quit smoking, involving mobile technology, behavioral science, and clinical expertise, at a recent breakout session at the Invent Health Virtual Event - Primary Care and the New Medical QB series.
The discussion was around how corporations rethinking wellness and prevention for their employees, and featured moderators Dr. Archana Dubey (CMO Consultant, HP; Chief Clinical Officer, AliveCor) and Bambi Francisco Roizen (Founder and CEO, Vator), along with panelists Utley, Diana Han, MD (Chief Medical Officer, VP Global Health, Unilever), Antonio Tataranni, MD (Chief Medical Officer, PepsiCo), Omar Dawood (President, BetterUp Care)
"COVID, in the United States, caused tobacco sales to go up. There's 50 million people who use tobacco, if you include vape, which is about an 8% increase in the last few years," said Utey.
"Somehow, the HR team has been charged with delivering life saving preventive services that somehow aren't getting to their employees through primary care and specialty care."
Part of the issue, he said, is that executives are overwhelmed with other diseases, including COVID, but also mental health or diabetes, or whatever else is coming up in healthcare claims.
"That's what I hear every day talking to large companies; our largest client is Target, 400,000 lives, a lot of them are family members, and they provide preventative services with our product to like 85,000 tobacco users, which is great. So, they were able to see through COVID and really make it a priority. So, that's the one thing that COVID has done to this current disease state," said Utley.
He also outlined the four preventive services that are rated as a Grade A by the US Preventive Services Task Force: blood pressure screening, colorectal cancer screening, cervical cancer screening, and tobacco cessation.
"All of the others that we talked about: mammography, weight loss, diabetes, they’re very important but I just want to highlight there are some that have been deemed, these are the most cost effective, scalable solutions and it's difficult for an employer, in my humble opinion, to deliver those preventive services," he said.
"My soapbox is that we ought to treat these disease states according to their mortality and morbidity rates and tobacco is the largest killer of all men and women in the United States, so it ought to have attention and it just isn't getting it. And so that's what we're trying to do."
"We somewhat repackaged it and put it on a digital platform to allow it to exist also through the pandemic times and the feedback that I get is that our employees appreciated that pivot," he said.
Utley then brought up the usage rates for tobacco cessation programs and they are quite low; far, far lower than COVID vaccination rates: while those can be 30% in some states, the Mayo Clinic's program's enrollment is less than 1% per year.
"If the compliance rate for colorectal cancer screening is 1% per year, we're going to have not 50,000 cancers every year, we’re going to have 150,000," he said.
"We know that 70% of tobacco users want to quit, 50% try by themselves every year, but only 0.3% join an evidence-based program. Wow. It's like trying to do self vaccination, like with vitamins."
Dubey defended corporations a bit, explaining why it is so difficult for them to focus on something like tobacco; basically, it comes down to the data they can use, which is from claims and electronic health record.
"Let's say the patient came in with heart disease. They may have smoking issues, cholesterol, maybe pre-diabetes and other things, but that doesn't surface that up as the main cause of the claim. So, we are worrying a lot about the bottom of the iceberg underneath that one claim, but the employers and the consultants are reacting to a sliver of information and not the depth of information," she said.
The other problem that she explained is that they can only pick from what brokers sell them, and they are more likely to sell a metabolic solution since there are so many diabetes patients.
"All of the CMOs here are well meaning, but we only have a marketplace and claims data or EHR level data to lean on. I think it does take an innovative chief medical officer, and I got two on the panel, to actually break that box and go back on a solution that is newer or revolutionary that even in a pilot phase or whatever it is, to be able to see and validate it and all these submissions that are right now as part of guidelines, almost, were, at some point, new and were betted on by one of the innovative CMOs," said Dubey.
Francisco asked the next question, which was: how do we then get beyond that claims data to finding what the real problems are?
Utley answered that Pivot doesn't run a practice based on the claims that a group is generating; instead, it runs a practice based on the best evidence-based interventions, because, unlike musculoskeletal or diabetes claims, it's harder to pin down smoking as the root cause of an issue.
"The claims thing is more of a, 'What should I prioritize?' because you guys, self insured employers, are paying all the claims and you're just never going to see a tobacco, and you might not ever see a mental health, claim. I'm not being blanket here but you're not going to see, 'Oh, mental health is costing us this much.' You're going to find it in productivity, user surveys and all that kind of stuff, just like you will tobacco user costs," he said, noting that it costs $9,000 a year, per person, more than a non-tobacco user.
Dawood, who's company focuses on mental health, backed up what Utley said, and encouraged employers to do what they can to understand their population through surveys, and to "actually listen to their employees and talk to their employees."
"Over 55% of employees at companies all around the world of all sizes are what we say are languishing, which means if you see them, if you work with them, if you talk to them, they look normal. They're not sick, they're not ill, but they're not well, either. They may show up to work and suffer from presenteeism. They have underlying challenges that are affecting productivity. They don't show up in claims data," he said.
"That may actually impact how they take care of their own chronic diseases; it may affect drug compliance, it may affect diet and exercise and all these aspects. So, first of all, is understanding what that architecture is of your population is important."
Dawood also said that we have to move in the direction of mental health being thought of in the same way as physical health.
"No one argues about investing in diet and exercise in prevention programs for physical health. We don't do that for mental health. And so, really, really not just talking about it, but investing in prevention and investing in it across the entire population. I’ve had companies that we talk to and their initial thinking and questions around mental health, when we talk about prevention is, 'who do we apply it for? Should it be this group? Should it be the product group? Should it be the engineering group? Should it be this country?' And the question I always ask back is, 'well, when you rolled out health insurance, did you go through the same exercise? Did you decide who's going to get health insurance and try to predict who's going to get sick? You didn’t.' Same thing with mental health is getting in that mindset that it's a must have. Taking care of our employees and prepping them is a must have from that perspective."
You can see the entire discussion below:
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Forte, the provider of best-in-class, on-demand and live streaming technology to hybridize the gym brick-and-mortar experience. Plus clinically proven to help increase motivation to quit while improving quit rates, Pivot is a holistic approach that combines an FDA-cleared carbon monoxide sensor with personalized content, community and live 1:1 coaching via mobile app that can be accessed at any point during a participant's journey to quit.
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Joined Vator onFounder and CEO of Vator, a media and research firm for entrepreneurs and investors; Managing Director of Vator Health Fund; Co-Founder of Invent Health; Author and award-winning journalist.