SummaryChrysler LLC and Health Alliance Plan of Michigan worked with other organizations to create the Driving Diabetes Care Experts program, which screens employees to identify those with diabetes and brings diabetes educators to three Chrysler office and factory worksites for scheduled one-on-one or group counseling sessions with these employees. Sessions help to identify diabetes-related concerns and set goals for diabetes management activities, such as dietary changes, exercise, and medication management. Pre- and post-implementation results from two sites show that the program led to enhanced diabetes knowledge; better blood sugar, cholesterol, and weight control; and less absenteeism. Moderate: The evidence consists of before-and-after comparisons of key outcomes measures, including diabetes knowledge; blood sugar, cholesterol, and weight control; and absenteeism.
Developing OrganizationsChrysler LLC; Health Alliance Plan of Michigan; Henry Ford Medical Group; Medtronic; Novo Nordisk, Inc.; StayWell Health Management
Date First Implemented2005
Problem AddressedDiabetes is a common condition that increases the risk for a variety of health problems, including cardiovascular complications, blindness, and kidney failure. Diabetes and its associated complications are extremely costly for employers, in terms of both direct health care expenditures and indirect costs such as absenteeism and productivity loss. By achieving control of diabetes, these costs can be reduced significantly, but many individuals with diabetes fail to achieve adequate control of the disease.
- Highly prevalent condition: More than 25.8 million US adults and children—8.3 percent of the population—have diabetes; most have type 2 diabetes, in which the body produces insufficient levels of insulin or does not produce it properly.1
- Many complications: Complications from type 2 diabetes include cardiovascular disease, blindness, nerve damage, and kidney damage.2
- High direct and indirect costs: The direct and indirect costs of diabetes are estimated at nearly $174 billion a year; the overall medical costs for people with diabetes are four times those of people without diabetes or other chronic conditions.3 People with diabetes have health a related absenteeism rate that is 0.8% higher than people without diabetes. 3
- Largely unrealized benefits of diabetes control: The American Diabetes Association estimates that people with controlled diabetes cost employers only $24 a month, well below the $115 a month average for those with uncontrolled diabetes.3 Many patients with diabetes cannot achieve and/or maintain adequate control.
Description of the Innovative ActivityThe program screens employees to identify those with diabetes and then brings diabetes educators to select Chrysler office and factory worksites for scheduled one-on-one or group counseling sessions with these employees. Sessions help to identify diabetes-related concerns and set goals for diabetes management activities, such as dietary changes, exercise, and medication management. The program has been run at three Chrysler sites in Michigan: the Auburn Hills headquarters, an assembly plant in Sterling Heights, and a stamping plant in Sterling. Key elements of the program, along with some site-specific differences, are described below:
- Screening to identify potential participants: Employees are screened at each site to identify those with a hemoglobin A1c (HbA1c) level that is above 6 percent; these individuals are invited to participate in the program. The logistics of the screening programs vary by site, as described below:
- Auburn Hills headquarters (10,000 employees): HbA1c screening was added to the annual employee health screening (which also measures height, weight, blood pressure, and cholesterol) conducted by Chrysler’s health promotion department. Of 570 employees who had an annual health screening, 126 were identified as eligible for the program. The health promotion staff contacted these individuals to determine their interest in participating and then scheduled appointments with a certified diabetes educator for those who were interested.
- Sterling Heights assembly plant (2,400 employees): An outreach effort for a special HbA1c screening yielded 70 participants, of whom 22 qualified for the program and were invited to participate.
- Sterling Heights stamping plant (1,800 employees): HbA1c screening was added to the annual employee screening; screenings are encouraged via an incentive program in which the work team with the most screenings wins a luncheon. Of 470 employees screened, 230 qualified for the program and were invited to participate. Of these, 87 agreed to participate and 28 actually signed up.
- Educational sessions: Diabetes education is provided by certified diabetes educators, who may be nurses, dietitians, or pharmacists. During the sessions, diabetes educators ask patients to discuss their diabetes-related concerns, to identify particular challenges in managing/living with the disease, and to articulate what they hope to gain through the program. Diabetes educators then help patients set goals that, if achieved, should lead to improved diabetes management; examples of goals include developing healthier eating habits, losing weight, engaging in more physical activity, and routine blood glucose monitoring. While diabetes educators do not have the authority to make changes in the participants’ medication regimen, they encourage participants to discuss medications with their physicians. The frequency, duration, and logistics of these sessions vary by location, as described below:
- Auburn Hills: Diabetes educators meet with patients one-on-one for 1 hour each month; meetings take place in available office space.
- Sterling Heights assembly plant: Due to the demands of assembly line work, diabetes educator sessions were scheduled for 30 minutes immediately before or after the employee’s shift; sessions took place in the onsite medical facility. Sessions occurred monthly or more often if necessary. (The program was discontinued after 14 months due to staff reductions at the plant.)
- Sterling stamping plant: Certified diabetes educators run 30-minute group sessions (with approximately 10 participants each) once a week for 3 months. One-on-one sessions are offered to employees with an HbA1c greater than 9 percent (these individuals need more intensive education) and to employees who are not comfortable in a group setting. Sessions take place in the safety department’s classroom.
Context of the InnovationChrysler LLC, headquartered in Auburn Hills, MI, has 28 manufacturing plants and 100,000 employees in the United States. Health Alliance Plan is a 545,000-member plan owned by the Henry Ford Health System, an integrated health system with 21,500 employees caring for more than 1 million patients annually across southeast Michigan. The health system comprises Henry Ford Hospital, its flagship hospital, education, and research center in Detroit, and a network of five community hospitals, 25 medical centers, pharmacies, home care, medical equipment companies, nursing homes, and numerous other health care–related services throughout the region. Chrysler, Ford, and General Motors are among Health Alliance Plan’s largest employer customers. The impetus for this program came from quarterly meetings between Health Alliance Plan and automotive leaders. These meetings, which are designed to identify strategies to improve health care quality and reduce costs, led to the development of a variety of initiatives focused on chronic disease management. In one of these programs, medical office–based nurses and nurse practitioners provided intensive coaching to patients. Although this program generated significant clinical improvements among those who participated, many eligible employees elected not to do so, in large part because of the inconvenience of traveling elsewhere for counseling. To encourage participation, the Driving Diabetes Care Experts program was created, bringing diabetes coaching to the workplace.
ResultsPre- and post-implementation results from the Auburn Hills site (measured from August 2005 to February 2006) and the Sterling Heights assembly plant (measured from September 2006 to December 2007) show that the program has led to improved diabetes knowledge; better blood sugar, cholesterol, and weight control; and less absenteeism. Results from the Sterling stamping plant are not yet available.
Moderate: The evidence consists of before-and-after comparisons of key outcomes measures, including diabetes knowledge; blood sugar, cholesterol, and weight control; and absenteeism.
- Enhanced diabetes knowledge: At Auburn Hills, participant knowledge of diabetes improved by 18.6 percent as measured by a pre- and post-intervention Type 2 Diabetes BASICS Knowledge Test (developed by the International Diabetes Center at the Park Nicollet Clinic in Minneapolis).
- Better blood sugar control: At Auburn Hills, the percentage of participants achieving target blood sugar control increased from 68 percent to 77 percent. At the Sterling Heights assembly plant, participants reduced HbA1c levels by 18 percent (to an average of 7.2) and fasting blood sugar (or random blood glucose) levels by 41 percent.
- Lower cholesterol levels: At Auburn Hills, the percentage of participants achieving low-density lipoprotein control increased from 39.5 percent to 42 percent. Sterling Heights assembly plant participants reduced their total cholesterol levels by an average of 16 percent.
- Improved weight control: At Auburn Hills, the percentage of participants achieving their target body mass index increased from 19.5 percent to 20.7 percent.
- Less absenteeism: Participants at the Sterling Heights assembly plant had 50-percent lower rates of absenteeism in 2007 than in the year before program implementation.
Planning and Development ProcessKey elements of the planning and development process included the following:
- Designing the program: Representatives from various organizations (Chrysler LLC, Health Alliance Plan of Michigan, Henry Ford Medical Group, Novo Nordisk, Inc., StayWell Health Management, and Medtronic Diabetes) met every other week for 3 months to design the program. The group set up systems for screening employees (including how and when to do so), inviting eligible employees to participate, and scheduling sessions. This group also delineated the topics to be discussed by the diabetes educator and employee.
- Working with site leadership: Program developers held conversations with management at each of the sites as well as onsite health and wellness staff. During these discussions, developers described the program, discussed how to incorporate HbA1c screenings into the existing screening process, and worked with staff to identify space for the counseling sessions. Union benefit representatives at each site were also notified of the program.
- Hiring and training diabetes educators: Henry Ford Medical Group hired and trained (oriented) the certified diabetes educators and worked in coordination with StayWell (the organization's wellness provider) to develop onsite schedules.
- Meeting with union leaders: Before initiating the program at the Sterling stamping plant, program leaders met with union benefit representatives to obtain feedback on the program. Several of their suggestions, including increasing the frequency of counseling sessions, were adopted.
Resources Used and Skills Needed
- Staffing: Staffing includes three part-time certified diabetes educators, each of whom works 1.5 to 2 days per week and manages approximately 40 employees. Diabetes educators are required to have a licensure or registration as a health care professional or minimum of a master’s degree in various, specified health care fields. In addition, a diabetes educator must have a minimum of 2 years of professional practice experience in diabetes self-management training in a health care setting and at least 1,000 hours of diabetes self-management training experience within the last 5 years.
- Costs: Costs include the salaries of the diabetes educators, the expenses associated with adding HbA1c to employee health screenings, and incentives (where used).
Funding SourcesChrysler LLC; Health Alliance Plan of Michigan; Henry Ford Medical Group; Novo Nordisk, Inc.; Medtronic
Chrysler LLC, Health Alliance Plan of Michigan, Henry Ford Health System, Novo Nordisk, Inc., and Medtronic funded the Auburn Hills program for the first 6 months. After seeing the clinical and other improvements generated by the program, Chrysler LLC leaders decided to have Chrysler assume the cost of the program going forward. Novo Nordisk funded program implementation and operations at the two other plant sites.
Tools and Other ResourcesDiabetesatwork.org
Diabetesatwork.org (sponsored by the U.S. Centers for Disease Control and Prevention, the National Institutes of Health, and the National Diabetes Education Program) enables companies to assess their need for worksite diabetes education. Users can download more than 30 free resources to inform employees about managing diabetes and reducing the risk of complications. Information is available at http://diabetesatwork.org
Type 2 Diabetes BASICS Knowledge Test
The Type 2 Diabetes BASICS Knowledge Test can be ordered from the International Diabetes Center, Park Nicollet Clinic-St. Louis Park by calling 888-825-6315 or online at: http://www.idcpublishing.com/.
Getting Started with This Innovation
- Determine program feasibility for a particular site: Program developers believe that a minimum of 1,000 employees is required to justify onsite diabetes educator visits.
- Incorporate HbA1c screening into general annual screenings: This approach leads to higher screening rates than if employees are invited to participate in separate blood glucose screenings.
- Choose diabetes educators carefully: Diabetes educators should be friendly, engaging, and able to relate well to the population being served (e.g., blue-collar employees, white-collar employees).
- Consider incentives carefully: Incentives to obtain screening and participate in coaching may not have a large impact on behaviors or outcomes. People who are not really ready to adopt a behavior change will likely not be swayed by incentives.
Sustaining This Innovation
- Make employees feel comfortable about taking time off: Managers need to support employees who take time away from work to go to counseling sessions, assuring them they will not be judged because of their condition or participation in the program.
- Tailor implementation to the setting: Program implementation should vary by work setting. For example, employees at Chrysler headquarters found it easy to step away from their duties to attend sessions during the workday. By contrast, assembly line workers could not attend sessions during their shifts and as a result they were scheduled for immediately before and after work. Communication systems also need to vary by location; for example, white-collar workers have ready access to e-mail, thus facilitating communication with the diabetes educators and the health promotion staff. However, other communication vehicles may be need for blue-collar workers.
Original publication: September 16, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: February 12, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.