Duke Prospective Health
An employer based initiative that combines health risk assessment with medical care and chronic disease management.

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The Duke Prospective Health program is an innovative approach to early prevention and management of chronic disease for 31,000 Duke University employees and dependents enrolled in the self-funded health plans of the university.

Based on a two year commitment from Duke University for implementation beginning January 1, 2004, the program is a partnership of the university as employer; PrimaHealth IPA representing 1420 Duke University Health System and community physicians in Durham, North Carolina; Physician WebLink (Irvine, California) acting as program administrator; and internal and external service delivery units, for example Health Fitness Corporation (Minneapolis, MN).

The clinical focus of the Duke Prospective Health program emphasizes cardiovascular care, diabetes, tobacco use, obesity in children and adults, and core preventive services. Each participant in the Duke Prospective Health program has the opportunity to complete a Health Risk Assessment (HRA) and simultaneously create a Personalized Health Plan, through which the participant self-selects 1-3 actionable health goals for the next year. The Personalized Health Plan then becomes a "passport" as the participant "travels" from his or her provider to the support services available to enable these goals to be met. Additionally, based on identification and stratification with prior history and claims data (predictive modeling), each participant is placed within a service group (intensive, enhanced, or core), which lead to nurse care management, coaching and educational services (motivation and barrier reduction) appropriate to the needs, value and culture of individuals in each of these service groups. The physician group has defined and supported the clinical outcomes for the program. Duke University provides incentives to plan members and physicians for long term participation and health improvement.

As of December, 2005 over 10,000 Duke employees and dependents actively participate in the program, including over 900 participants within the intensive service group who have engaged with nurse care managers and life-style coaches.

Duke University has committed to funding the program through 2006. Ongoing support and sustainability will be based on the continuing evaluation of 1) operational delivery of program services; 2) improvement of national benchmarked clinical outcomes; and 3) overall impact on cost and use of medical services.