north carolina association of county commissioners

Better Healthl hi iFor a Healthier Bottom Line

Sarah LangerNC County Commissioners Meeting

A t August 19, 2011

Session Objectivesj

• Make the business case for better health.

• Demonstrate the county health tool to f th ill t t i i t f further illustrate economic impact of health factors.

• Provide examples of best practices to improve health in the worksiteimprove health in the worksite.

Who We Are and What We Do

• IEI is a public policy organization • IEI is a public policy organization committed to North Carolina’s future.

• Working collaboratively with individuals from all sectors and areas of the state IEI from all sectors and areas of the state, IEI builds an enduring capacity for positive changechange.

emerging issue

4

Healthcare Innovation

Sarah Langersarah langer@ncsu [email protected]

919-513-2800

www.emergingissues.org

6

Better HealthBetter Health –Healthier Bottom Line

Challenges…Opportunities…

Impact…

David Chenoweth, Ph.D., FAWHPDavid Chenoweth, Ph.D., FAWHPFellow, Institute for Emerging IssuesFellow, Institute for Emerging IssuesNorth Carolina State UniversityNorth Carolina State University

North Carolina Association of County Commissionersy

Concord, NC August 19, 2011

National Health Expenditure (NHE) 20.0%*

$4,044

$5,000

15.4% 15.9% 16.0% 16.2% 16.5%

% GDP

$3 000

$4,000

s

%

$Billions

$1 741

$2,016$2,170

$1,878$2,000

$3,000

NHE

in B

illio

ns $Billions

$1,608$1,741

$1,000

$02002 2003 2004 2005 2006 2015*

8Source: Center for Medicare and Medicaid Services.

*Projected

Average UtAverage Utilization

2 5

3

Male

2

2.5FemaleAverage

1

1.5

0.5

1

00-1 1-4 5-19 20-44 45-54 55-64 65+

Age in YAge in YearsAge in Y

Source: CDC, Center for Health Statistics.

Age in Years

The Perfect STORM ??

Medical andPharmaceutical

Direct Medical Costs

I di M di l C

24%

Indirect Medical Costs

Presenteeism

Long-term Disability1%Presenteeism

63%1%

Workers’Compensation<1%

Absenteeism6% Short-term Disability

6%

1%

6%

Source: Hemp, P. Harvard Business Review, October, 2004

On average, asthma accounts for 927 days of lost time g , yper 1,000 working Americans each year.

800-899 Days< 800 Days

National Average: 927 Days/ 1,000 Working Americans

900-999 Days1000+ Days

y

Source: Goetzel, R.Z., et al. (2004). JOEM, 46(4), 398-412 estimates of average days per year absent due to common chronic conditions, CDC Behavioral Risk Factor Surveillance System estimates of disease prevalence by state, and Current Population Survey estimates of employed persons by state.

Diabetes accounts for 112 days of lost time per 1,000 y p ,working Americans each year.

81-105 Days< 80 Days


y106-130 Days131+ Days


Hypertension accounts for 181 days of lost time per yp y p1,000 working Americans each year.

160-179 Days< 160 Days


180-199 Days200+ Days

y


O B E S I T Y

Over - weight

Desired

Under

Source: Chenoweth & Associates, Inc.

Physical inactivity, excess weight, type II diabetes d l f i / i i k N h C li iand low fruit/veggie intake cost North Carolinians

an estimated $32 billion (2010$).

The majority of this tab was paid by business & industry

h h l h l hthrough employer health insurance premiums and

lost productivitylost productivity.

Source. Be Active North Carolina, Inc., 2011.[www.beactivenc.org]

4.6

Billions (2010 dollars)

The News & ObObserver

Aug. 17, 2008, page 8G.

Fitness Management

Ask yourself……Ask yourself……

How can North Carolina competeHow can North Carolina compete in a GLOBAL economy when we spend:

> more $ per capita on illness care than Virginia & Georgia?care than Virginia & Georgia?

> a larger % of our GSP on health care each year?

> more than 10% of our GSP ononly 4 risk factors?

R l ti I fl H H lthR l ti I fl H H lthRelative Influence on Human HealthRelative Influence on Human Health

Source: HHS and CDC.

“Our medical claims were examined to determine what percent were for diagnoses related to lifestyle so we can develop health promotion i t ti th t ill ff ”interventions that will pay off.

– Jared Pankowski, M.A.EdCorporate HealthCarolinas HealthCare

Today’s need for healthy, productive Today’s need for healthy, productive y yemployees – especially in small business…

y yemployees – especially in small business…business…business…

60% employ < 4 employees80% employ < 20 employeesDownsizingDownsizing Doing more with less

The health of North Carolina’s communitiesThe health of North Carolina s communities influences our overall quality of life…

A sampling of county health departmentsmaking positive impacts inmaking positive impacts in

North Carolina

Granville-Vance

Nash CountyWake County

Pitt CountyMecklenburg County

Community and worksiteCommunity and worksite based programs andbased programs andCommunity and worksiteCommunity and worksite--based programs and based programs and incentives…incentives…

Th i tThe impacts…

Healthier citizensBuilding strong social networksMore productive employeesMore loyal employeesLess turnover = greater retentionLess turnover greater retention

Risk Avoidance vs. Risk Reduction…Greater Savings Result from Risks Avoided than Risks ReducedGreater Savings Result from Risks Avoided than Risks Reduced

$500

$300

$400

$500

$100

$200

($200)

($100)

$0

($300)

($200)

3 2 1 0 1 2 3

Overall: Cost per risk reduced: $215; Cost per risk avoided: $304

Source: http://www.umich.edu/~hmrc/slides.pdf Updated from Edington, AJHP 2001; 15(5),341-349.

Promoting Employee Well-being: Wellness Strategies to Improve Health, Performance and the Bottom Line

SHRM Foundation’s EffectivePractice Guidelines Series

By David Chenoweth, Ph.D., FAWHP

www.shrm.org/foundation

The overall prosperity of North Carolina’s people and economy - today and tomorrow…depends heavily on the

health of its communities and businesses

Calculating the Economic Impact of P H lthPoor Health

“COUNTY HEALTHCARE TOOL”Community Health: Raising the Bary g

JobsJobs

ObesityObesity Graduation Graduation FoodFood ObesityObesity raterateDesertsDeserts

SmokingSmoking

Roland Stephens, NCSUMark Holmes, UNC

David Chenoweth, ECU

Co-relationships between healthCo-relationships between health and economics

E l tE l tEmployment and tax baseEmployment and tax base

Graduation rate and

employment

Graduation rate and

employment

Health status (e.g. obesity)Health status (e.g. obesity)

Thank you…y

David Chenoweth, Ph.D., FAWHP

Chenoweth & Associates, Inc.128 St A d Ci l128 St. Andrews Circle

New Bern, NC [email protected]

252-636-3241252-636-3241www.chenoassociates.com

30 Years of Excellence

WELLNESS WORKS

IN NASH COUNTYIN NASH COUNTY

NCACC ConferenceNCACC ConferenceAugust 19, 2011

Better Health, Healthier Bottom Line

Better Health,Healthier Bottom LineNCACC C fNCACC ConferenceAugust 19, 2011

Environmental Challenges In Nash County

o 12.7% Unemployment Rateo32.3% of Adult Population is Considered to Be Obeseo32.3% of Adult Population is Considered to Be ObeseoLocated in the ‘Stroke Belt Buckle’ of the United StatesoLocated in The ‘Sugar Belt Buckle’ of the United States


General Challenges Facing All County Governments

1. Aging Employee Population2. Reduction in Tax Revenue Streams3 Exponential Healthcare Costs’3. Exponential Healthcare Costs

Inflation4. Reduction in Federally-Funded

Community ServicesCommunity Services5. Unprecedented Increased Need of

Public Services6 Hiring Freezes6. Hiring Freezes7. Long-Term Employees Seeking Earlier

Retirement Options


Nash County Implemented an Employee Wellness Program in 2004 For The Following Reasons:

Provide Tools & Resources to Employees in Order to Attain and/or Maintain Healthy LifestylesContain & Eventually Reduce the Employee Healthcare Costs’ BurdenDecrease Employee AbsenteeismIncrease ProductivityyReduce Expensive Employee Turnover


l ll h kl

Participate in Lab Work Clinic or Attain

Employee Wellness Program Participation Checklist:

Lab Work Through Their Own PCP

Attend an Appt w/ Onsite HealthAttend an Appt w/ Onsite Health Coach (Mid‐Level Provider)

Attend At Least One Health/WellnessAttend At Least One Health/Wellness Seminar (Per Calendar Year)

S f ll C l t O li HRASuccessfully Complete Online HRA

Better Health,Healthier Bottom LineNCACC C fNCACC ConferenceAugust 19, 2011Other Wellness Program Components:Other Wellness Program Components:Onsite Fitness Center Available to Employees 24/7 (w/ Fitness Classes)24/7 (w/ Fitness Classes)Smoking Cessation Awards ProgramWalking & Weight‐Loss ChallengesWalking & Weight Loss ChallengesOnsite Life Coach AvailabilityFree Onsite Health Screenings &Free Onsite Health Screenings & ImmunizationsHealth Coach (Mid‐Level Provider)ea t Coac ( d e e o de )Annual Wellness FairsMassage Therapy


Keys To Program Success

Relativity of Educational Programming (i.e. Menopausal, Shift Work Sleep Disorder & Allergy Survival Kit Series))

Flexibility (i.e. Adapt to Accommodate Various Shift Worker Schedules)

Accessibility to Entire EmployeeAccessibility to Entire Employee Population (i.e. Wellness Team Ambassadors, Internet, County‐Wide Email Memo’s, Signage Etc.)

EffectiveMarketing StrategiesEffective Marketing StrategiesElimination of Costs’ Barriers to Employees(i.e. Free Screenings + Employees Are Not Using Leave Reserves to Participate In Wellness Program)


Show Me Some Metrics!Show Me Some Metrics!Time Period 04/01/2009‐03/31/2010 to Time Period 04/01/2010‐03/31/2011

o100% Wellness Program Participation C t i d H lth C t t Id ti l L loContained Healthcare Costs to Identical Levels

11% Decrease of Employees w/ PreHTN

4.5 % Increase in Average HRA Score

12% Decrease of Empl. w/ 5+ Risk Factors

11.3% Reduced Excess Spending on Depression

11 1% Reduced Excess Spending on Hypertension11.1% Reduced Excess Spending on Hypertension

10.8% Reduced Excess Spending on Pre‐Hypertension


OK W G t ItOK…We Get ItNow How Do We Get The Ball Rolling?

1 Create EmployeeWellness Program Implementation Team1. Create Employee Wellness Program Implementation Team(Including County Manager’s Office, HR Director, CFO, Risk Manager & Public

Health Director)

2. Analyze the Numbers (Exponential Healthcare Costs Increases)(In Order To Make Argument To Commissioners and General Public, You Have To

Justify Initial Extra Operational Costs)

3. Visit Counties or Other Municipalities w/ Wellness Programs in Place (Find Out What Works & What Doesn’t Work)

dd ll l i d i4. Add Wellness Program Implementation to Department Head Meeting Agendas (Important To Receive Feedback & Support)

5. Keep Asking the Question..”How Much Longer Can We Afford Not To Do It?”


Worksite Interventions

/Behavioral/Educational:1. Educational Seminars (‘Lunch‐N‐Learns’)2. Tobacco Cessation (ALA‐Trained Coach)3 Utility of EAP (Reinvent Its Utility)

Clinical:1. **Biometric Screening**Including CHOL+ LPD Panel + Blood Glucose2 Clinician Follow Up3. Utility of EAP (Reinvent Its Utility)

4. Healthy Behavior Encouragement Signs5. Worksite Fitness Center (w/classes)6. Walking/Weight‐Loss Challenges

2. Clinician Follow‐Up3. On‐Site Vaccinations/Immunizations4. On‐Site Screenings (kidney, bone

density, mammograms etc.)7. On‐Site Farmers Marker / Healthy

Eating Choices8. Annual Health/Wellness Fair9 Health Risk Appraisal Participation

5. Disease‐Management Enrollment(On‐Site Clinical Program)

6. On‐Site Acute/Episodic Care9. Health Risk Appraisal Participation


How to Sell Wellness to Employees ManagementEmployees, Management

& Citizens?1 Wellness Will Be Necessary in Any SAVE OUR BENEFITS Campaign (for management)1. Wellness Will Be Necessary in Any SAVE OUR BENEFITS Campaign (for management)PLEASE REMEMBER THAT BENEFIT PACKAGES ARE MAIN TOOLS OF RECRUITMENT & RETENTION

2. Enlighten the Employee Population that Employee Wellness is a UNIVERSAL BENEFIT

3. If Self‐Insured, EDUCATE Your Employee Population in How Their Individual Choices & Behaviors Ultimately Affect the County’s Bottom‐Line, and Ultimately Their Pockets

4. Wellness Programs Are Proven to Be Extremely Cost‐Effective in Healthcare Costs’ Burden Containment (reducing operational costs) and increasing employee loyalty(ROI Is Significant + Mechanism to Decrease Risk Of Tax Increase to General Population)


WELLNESS WORKS IN NASH COUNTY

Employee Health Promotions Coordinator

P: (252) 462 2461 F: (252) 462 2446P: (252) 462‐2461 F: (252) 462‐2446Special Thanks to Ms. Sarah Langer, the NCACC & Institute for Emerging Issues for Invitation

Expanding the ImpactExpanding the ImpactExpanding the Impact Expanding the Impact to the Communityto the Communityyy

Policy and Environmental ChangePolicy and Environmental ChangeCan Make A DifferenceCan Make A DifferenceCan Make A DifferenceCan Make A Difference

Jackie SergentGranville-Vance District Health Department

What IsWhat IsP li / E i l Ch ?P li / E i l Ch ?Policy / Environmental Change?Policy / Environmental Change?

Improve PlanningImprove PlanningImprove Planning Improve Planning Increase AccessIncrease AccessE h Ch iE h Ch iEnhance ChoicesEnhance ChoicesPromote Health (within / without)Promote Health (within / without)

Partners can ↑ reach, ↓ costs Partners can ↑ reach, ↓ costs

Small Small cancan make a differencemake a difference

Quality of life improvements attract business / peopleQuality of life improvements attract business / people

Making The Built Environment CaseMaking The Built Environment CaseMaking The Built Environment CaseMaking The Built Environment Case

“Creating or improving access to places for “Creating or improving access to places for g p g pg p g pphysical activity is recommended based on physical activity is recommended based on strong evidencestrong evidence of their effectiveness in of their effectiveness in increasing PA & fitness ”increasing PA & fitness ” CDC C it G idCDC C it G idincreasing PA & …fitness. increasing PA & …fitness. CDC Community Guide CDC Community Guide

According to Robert Wood Johnson FoundationAccording to Robert Wood Johnson Foundation“People who report having access to sidewalks are “People who report having access to sidewalks are 28% more likely to be physically active.”28% more likely to be physically active.”

“People …[with] access to walking/jogging trails are “People …[with] access to walking/jogging trails are 55% more likely to be physically active.” 55% more likely to be physically active.”

“¼ of all trips people make are one mile or less, yet “¼ of all trips people make are one mile or less, yet ¾’s of these short trips are by car.”¾’s of these short trips are by car.”

Greenway Master PlanGreenway Master PlanGreenway Master Plan Greenway Master Plan

County Manager insight andCounty Manager insight andCounty Manager insight and County Manager insight and supportsupportHealth Promotion leadHealth Promotion leadCommunity Workgroup Community Workgroup partnerspartnersppEat Smart Move More NC Eat Smart Move More NC funds ($11,165)funds ($11,165)County planner inputCounty planner inputMPO supportMPO supportpppp

OutcomesOutcomesOutcomes Outcomes GC Master Plan onGC Master Plan on--line for developers et alline for developers et alppMultiMulti--jurisdictional advisory council jurisdictional advisory council County appointed working groupCounty appointed working groupF di f i l iF di f i l iFunding for promotional items Funding for promotional items Ripple effect projectsRipple effect projects

BS Stem Trail / ESMM NC $BS Stem Trail / ESMM NC $BS Stem Trail / ESMM NC $BS Stem Trail / ESMM NC $6 CMAQ projects6 CMAQ projectsNCDOT Enhancement fundsNCDOT Enhancement fundsSRTSSRTSSRTS SRTS Bike/Bike/pedped in CTP, Oxford Vision Planin CTP, Oxford Vision Plan3 Pedestrian Plans3 Pedestrian Plans

$3.79 million$3.79 million

MiniMini--Grant ProgramGrant ProgramMiniMini Grant ProgramGrant Program

$1500 per award (ESMM funded)$1500 per award (ESMM funded)$1500 per award (ESMM funded)$1500 per award (ESMM funded)Open to any entity with 100 Open to any entity with 100 members/clients (10 grants/year)members/clients (10 grants/year)members/clients (10 grants/year)members/clients (10 grants/year)Required policy/environmental changeRequired policy/environmental changeInfo meeting for applicantsInfo meeting for applicantsLunch and learnsLunch and learnsFinal report from granteesFinal report from grantees

Outcomes Outcomes Increased Awareness Increased Awareness PLUSPLUS

Ch hCh h Walking pathsWalking pathsChurchesChurchesSchoolsSchools

Walking pathsWalking pathsOnOn--site PA spacessite PA spaces

HospitalsHospitalsTreatment Facilities Treatment Facilities

SignageSignageStairwell projectsStairwell projects

(day and residential)(day and residential)WorksitesWorksites

p jp jActivity PoliciesActivity PoliciesHealthy Eating PolHealthy Eating Pol

Parks/Parks/RecRec/YMCA/YMCACounty AgenciesCounty Agencies

Healthy Eating Pol.Healthy Eating Pol.Increased access to Increased access to PA t itiPA t itiCounty AgenciesCounty Agencies PA opportunitiesPA opportunities

County ESMM AwardsCounty ESMM AwardsCounty ESMM AwardsCounty ESMM Awards

Annual AwardAnnual AwardAnnual AwardAnnual AwardRecognize organizations that promote Recognize organizations that promote Eating Smart and Moving MoreEating Smart and Moving MoreEating Smart and Moving MoreEating Smart and Moving MoreLook for sustainability, reachLook for sustainability, reachTotal Investment Total Investment

cost of publicity cost of publicity plaquesplaques~$500~$500staff timestaff time

ESMM Weight Loss ChallengeESMM Weight Loss ChallengeESMM Weight Loss Challenge ESMM Weight Loss Challenge

Annual 11 week event (+ maintenance)Annual 11 week event (+ maintenance)Annual 11 week event ( maintenance)Annual 11 week event ( maintenance)Sponsors Sponsors

2 Hospitals, YMCA, Health Dept2 Hospitals, YMCA, Health Dept2 Hospitals, YMCA, Health Dept2 Hospitals, YMCA, Health DeptPhysical Activity PartnersPhysical Activity Partners

Discounts, free classes, prizesDiscounts, free classes, prizes, , p, , pWeekly support messagesWeekly support messages1000+ participants1000+ participants1000 participants 1000 participants >4000 pounds lost each year>4000 pounds lost each year~$4000 cost~$4000 cost$4000 cost$4000 cost

Other Thoughts?Other Thoughts?Other Thoughts?Other Thoughts?

No idea is too smallNo idea is too smallNo idea is too smallNo idea is too smallEveryEvery effort will increase awarenesseffort will increase awarenessSeek opportunities to partnerSeek opportunities to partnerSeek opportunities to partnerSeek opportunities to partner

No one has any moneyNo one has any moneyNo one has any moneyNo one has any money

Need is increasingNeed is increasing

HPC money cut HPC money cut = Health = Health DeptsDepts can’t be only drivercan’t be only driverpp yy

ResourcesResourcesResourcesResources

Community GuideCommunity GuideCommunity GuideCommunity Guidewww.thecommunityguide.org/index.htmlwww.thecommunityguide.org/index.html

Leadership for Healthy Communities (tool kit)Leadership for Healthy Communities (tool kit)Leadership for Healthy Communities (tool kit)Leadership for Healthy Communities (tool kit)www.leadershipforhealthycommunities.org/www.leadershipforhealthycommunities.org/

Eat Smart Move More NCEat Smart Move More NCEat Smart Move More NCEat Smart Move More NCwww.eatsmartmovemorenc.comwww.eatsmartmovemorenc.com

Active Living by DesignActive Living by DesignActive Living by Design Active Living by Design www.activelivingbydesign.orgwww.activelivingbydesign.org

Smart Growth ConceptsSmart Growth ConceptsSmart Growth ConceptsSmart Growth Conceptswww.smartgrowth.orgwww.smartgrowth.org

Questions?Questions?

Jackie Sergent MPH RD LDNJackie Sergent MPH RD LDN

Questions?Questions?

Jackie Sergent, MPH, RD, LDNJackie Sergent, MPH, RD, LDNHealth Promotion CoordinatorHealth Promotion Coordinator

G illG ill V Di t i t H lth D t tV Di t i t H lth D t tGranvilleGranville--Vance District Health DepartmentVance District Health [email protected]@gvdhd.org

Thank You!Thank You!

north carolina association of county commissioners

Health & Medicine

healthier

david chenoweth

physically

improve health

impact

cost

health

make