Heart and Mind Connections: Integrated Strategies for Greater Health

1. Heart and Mind Connections: Integrated Strategies for Greater Health Workgroup Kick-off Meeting

2. Agenda • Business Risk/Opportunity • Workgroup Mission • Program Goals • Review of Tasks • Next Steps

3. Business Risk/Opportunity Heart Disease • Human cost: No 1. killer of Americans and a leading cause of disability • Financial costs: Key contributor to rising health care and disability expenditures and a prime cause of decreased productivity • Heart disease is often associated with mental health diagnoses. • In these cases of co-morbidity, the mental health conditions may not be properly diagnosed or may be undertreated. • An integrated cardiovascular/behavioral health program must address the strong connection between heart health and mental health.

4. About Heart Disease and Mental Health • Depression, anxiety, hopelessness, pessimism, hostility and anger have all been linked to heart disease.1,2,3 • Depression and anxiety disorders may affect heart rhythms, increase blood pressure, alter blood clotting, and lead to elevated insulin and cholesterol levels. These risk factors often predict, and are a response to, heart disease.4 • People with heart disease are more likely to suffer from depression than otherwise healthy people; conversely, people with depression are at greater risk for developing heart disease.5 • Those who have heart disease and who are depressed have an increased risk of death after a heart attack compared with those who are not depressed.6

5. Fighting Heart Disease: The Role of Behavioral Health Experts • Emotional, psychological and behavioral intervention and support is essential in helping to prevent or manage heart disease. • Behavioral experts can: • identify and manage behavioral health contributors that can impact heart health, such as depression, anxiety and chronic stress • support those who are living with heart disease • promote and sustain a healthy lifestyle

6. Workgroup Mission Senior leadership approved the creation of a multi-functional workgroup to: • recommend an integrated cardiovascular/behavioral health program for our organization • implement and promote the program • continuously monitor the program’s effectiveness and make adjustments as necessary • evaluate and report on program success

7. Program Goals Address the connection between heart health and behavioral health issues by offering programs that: • Educate individuals on the lifestyle habits that put their heart health at risk • Support individuals who are changing their behavior for improved health • For individuals living with heart disease, encourage compliance with their treatment plan and support them in dealing with the stress and emotions surrounding their condition • Help individuals identify the signs of depression, anxiety and chronic stress, and know when to seek help for them

8. Review of Tasks • Assess programs and resources currently available through internal departments and vendors • Assemble supportive programming • Design a communication strategy • Provide recommendations to senior leadership

9. Assess Current Programs, Resources • Internal • Health and safety • Medical • Food service • Fitness center • ? • Vendors/partners • Health plan(s) • ValueOptions • ?

10. Service Options Offered by ValueOptions • Standard: • 24/7 assessment and referral • Employee assistance program (EAP) • Stress-reduction counseling • Depression screening • Intensive case management • Support for family and support systems • Primary care physician (PCP) behavioral health consultation • Educational programs • Enhanced services: • Lifestyle coaching • Tobacco cessation • Nurse line • Integrated care

11. Assemble Supportive Programming • Making lifestyle change • Identify modifiable behaviors to target • Provide information and services to motivate and sustain behavior changes for each • Living with heart disease • Reach out to individuals with information and services to support them in coping with emotions and in complying with an individualized treatment plan • Managing depression, anxiety and chronic stress • Provide screening tools and information on recognizing signs, coping strategies and resources for professional help

12. Design a Communication Strategy • Support program goals • Plan frequent outreach • Use varied mediums • Make a long-term commitment • Consistently promote key messages

13. Provide Recommendations • Program goals • Current programs • Suggested new programs • Resource request (staffing and financial) • Timetable • Measures of success

14. Identify Next Steps

15. Sources 1 Williams R.B. Neurobiology, cellular and molecular biology, and psychosomatic medicine. Psychosom Med, 1994; 56:308-315. 2 Denollet J., Brutsaert D.L. Personality, disease severity, and the risk of long-term cardiac events in patients with a decreased ejection fraction after myocardial infarction. Circulation. 1998; 97:167-173. 3 L.D. Kuzansky, K.W. Davidson, and A. Rozanski. The Clinical Impact of Negative Psychological States: Expanding the Spectrum of Risk for Coronary Artery Disease. Psychosom Med, May 1, 2005; 67(Supplement_1):S10-S14. 4 National Heart, Lung and Blood Institute 5 Nemeroff CB, Musselman DL, Evans DL. Depression and cardiac disease. Depression and Anxiety, 1998; 8(Suppl 1): 71-9. 6 Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation, 1995; 91(4): 999-1005.