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The cost of healthcare is weighing down household and county budgets across the state. On Friday, August 19, the Institute for Emerging Issues (IEI) moderated a session, Better Health for a Better Bottom Line, to over 40 county leaders at the North Carolina Association of County Commissioners annual conference in Concord, NC.TRANSCRIPT
8/19/2011
1
Sarah LangerNC County Commissioners Meeting
August 19, 2011
Better HealthFor a Healthier Bottom Line
Session Objectives
• Make the business case for better health.
• Demonstrate the county health tool to further illustrate economic impact of health factors.
• Provide examples of best practices to improve health in the worksite.
Who We Are and What We Do
• 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 builds an enduring capacity for positive change.
emerging issue
Healthcare Innovation
Sarah [email protected]
919-513-2800
www.emergingissues.org
8/19/2011
2
Challenges…
Opportunities…
Impact…
David Chenoweth, Ph.D., FAWHP
Fellow, Institute for Emerging Issues
North Carolina State University
North Carolina Association of County Commissioners
Concord, NC August 19, 2011
Better Health –
Healthier Bottom Line
National Health Expenditure (NHE)
$1,608$1,741
$2,016$2,170
$4,044
$1,878
$0
$1,000
$2,000
$3,000
$4,000
$5,000
2002 2003 2004 2005 2006 2015*
NH
E i
n B
illi
on
s
15.4% 15.9% 16.0%16.2% 16.5%
20.0%*
Source: Center for Medicare and Medicaid Services.
% GDP
$Billions
*Projected
Average Utilization
0
0.5
1
1.5
2
2.5
3
0-1 1-4 5-19 20-44 45-54 55-64 65+
Age in Years
Utilizatio
n In
dex
Male
Female
Average
Source: CDC, Center for Health Statistics.
Average Utilization
Age in Years
The Perfect STORM ??
Direct Medical Costs
Indirect Medical Costs
Medical and
Pharmaceutical
24%
Presenteeism
63%
Absenteeism
6%Short-term Disability
6%
Long-term
Disability
1%
Workers’
Compensation
<1%
Source: Hemp, P. Harvard Business Review, October, 2004
8/19/2011
3
On average, asthma accounts for 927 days of lost time
per 1,000 working Americans each year.
900-999 Days
1000+ Days
800-899 Days
< 800 Days
National Average: 927 Days/
1,000 Working Americans
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
working Americans each year.
81-105 Days
< 80 Days
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.
106-130 Days
National Average: 112 Days/
1,000 Working Americans
131+ Days
Hypertension accounts for 181 days of lost time per
1,000 working Americans each year.
180-199 Days
200+ Days
160-179 Days
< 160 Days
National Average: 181 Days/
1,000 Working Americans
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.
Source: Chenoweth & Associates, Inc.
Over - weight
Under
Desired
O B E S I T Y
Physical inactivity, excess weight, type II diabetes
and low fruit/veggie intake cost North Carolinians
an estimated $32 billion (2010$).
The majority of this tab was
paid by business & industry
through employer health
insurance premiums and
lost productivity.
Source. Be Active North Carolina, Inc.,
2011.[www.beactivenc.org]
Billions (2010 dollars)
4.6
8/19/2011
4
Fitness
Management
The News &
Observer
Aug. 17, 2008,
page 8G.
Ask yourself……
How can North Carolina compete in a GLOBAL economy when we spend:
> more $ per capita on illness
care than Virginia & Georgia?
> a larger % of our GSP on
health care each year?
> more than 10% of our GSP on
only 4 risk factors?
Relative 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
interventions that will pay off.”
– Jared Pankowski, M.A.EdCorporate HealthCarolinas HealthCare
8/19/2011
5
Today’s need for healthy, productive
employees – especially in small
business…
60% employ < 4 employees
80% employ < 20 employees
Downsizing
Doing more with less
The health of North Carolina’s communities
influences our overall quality of life…
A sampling of county health departments
making positive impacts in
North Carolina
Pitt CountyMecklenburg County
Nash County
Wake County
Granville-Vance
Community and worksite-based programs and
incentives…The impacts…
Healthier citizens
Building strong social networks
More productive employees
More loyal employees
Less turnover = greater retention
8/19/2011
6
Risk Avoidance vs. Risk Reduction…
Greater Savings Result from Risks Avoided than Risks Reduced
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.
($300)
($200)
($100)
$0
$100
$200
$300
$400
$500
3 2 1 0 1 2 3
Promoting Employee Well-being: Wellness
Strategies to Improve Health, Performance and the Bottom
Line
SHRM Foundation’s Effective
Practice 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
Poor Health
“COUNTY HEALTHCARE TOOL”
Community Health: Raising the Bar
Roland Stephens, NCSU
Mark Holmes, UNC
David Chenoweth, ECU
Obesity
Jobs
Graduation rate
Smoking
Food
Deserts
Co-relationships between health
and economics
Health status (e.g. obesity)
Graduation rate and
employment
Employment and tax base
Thank you…
David Chenoweth, Ph.D., FAWHP
Chenoweth & Associates, Inc.
128 St. Andrews Circle
New Bern, NC 28562-2907
252-636-3241
www.chenoassociates.com
30 Years of
Excellence
8/19/2011
7
WELLNESS WORKS
IN NASH COUNTY
NCACC Conference
August 19, 2011
Better Health, Healthier Bottom Line
Better Health,
Healthier Bottom Line
NCACC Conference
August 19, 2011
Environmental Challenges
In Nash County
o 12.7% Unemployment Rateo32.3% 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
Better Health,
Healthier Bottom Line
NCACC Conference
August 19, 2011
General Challenges Facing All
County Governments
1. Aging Employee Population
2. Reduction in Tax Revenue Streams
3. Exponential Healthcare Costs’
Inflation
4. Reduction in Federally-Funded
Community Services
5. Unprecedented Increased Need of
Public Services
6. Hiring Freezes
7. 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 Lifestyles
Contain & Eventually Reduce the Employee Healthcare Costs’ Burden
Decrease Employee Absenteeism
Increase Productivity
Reduce Expensive Employee Turnover
Better Health,
Healthier Bottom Line
NCACC Conference
August 19, 2011
Better Health,
Healthier Bottom Line
NCACC Conference
August 19, 2011
Participate in Lab Work Clinic or Attain Lab Work Through Their Own PCP
Attend an Appt w/ Onsite Health Coach (Mid-Level Provider)
Attend At Least One Health/Wellness Seminar (Per Calendar Year)
Successfully Complete Online HRA
Employee Wellness Program Participation Checklist:
Better Health,
Healthier Bottom Line
NCACC Conference
August 19, 2011
Other Wellness Program Components:
Onsite Fitness Center Available to Employees 24/7 (w/ Fitness Classes)
Smoking Cessation Awards Program
Walking & Weight-Loss Challenges
Onsite Life Coach Availability
Free Onsite Health Screenings & Immunizations
Health Coach (Mid-Level Provider)
Annual Wellness Fairs
Massage Therapy
8/19/2011
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Better Health,
Healthier Bottom Line
NCACC Conference
August 19, 2011
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 Employee Population (i.e. Wellness Team Ambassadors, Internet, County-Wide Email Memo’s, Signage Etc.)
Effective Marketing StrategiesElimination of Costs’ Barriers to Employees
(i.e. Free Screenings + Employees Are Not Using Leave Reserves to Participate In Wellness Program)
Keys To Program Success
Better Health,
Healthier Bottom Line
NCACC Conference
August 19, 2011
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
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 Hypertension
10.8% Reduced Excess Spending on Pre-Hypertension
oContained Healthcare Costs to Identical Levels
11% Decrease of Employees w/ PreHTN
Better Health,
Healthier Bottom Line
NCACC Conference
August 19, 2011
OK…We Get ItNow How Do We Get The Ball Rolling?
1. 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)
4. 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?”
Better Health,
Healthier Bottom Line
NCACC Conference
August 19, 2011
Worksite Interventions
Behavioral/Educational:1. Educational Seminars (‘Lunch-N-Learns’)2. Tobacco Cessation (ALA-Trained Coach)3. Utility of EAP (Reinvent Its Utility)4. Healthy Behavior Encouragement Signs5. Worksite Fitness Center (w/classes)6. Walking/Weight-Loss Challenges7. On-Site Farmers Marker / Healthy
Eating Choices8. Annual Health/Wellness Fair9. Health Risk Appraisal Participation
Clinical:1. **Biometric Screening**Including CHOL+ LPD Panel + Blood Glucose2. Clinician Follow-Up3. On-Site Vaccinations/Immunizations4. On-Site Screenings (kidney, bone
density, mammograms etc.)5. Disease-Management Enrollment
(On-Site Clinical Program)6. On-Site Acute/Episodic Care
Better Health,
Healthier Bottom Line
NCACC Conference
August 19, 2011
How to Sell Wellness to
Employees, Management
& Citizens?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)
Better Health,
Healthier Bottom Line
NCACC Conference
August 19, 2011
WELLNESS WORKS IN NASH COUNTY
Employee Health Promotions Coordinator
P: (252) 462-2461 F: (252) 462-2446Special Thanks to Ms. Sarah Langer, the NCACC & Institute for Emerging Issues for Invitation
8/19/2011
9
Expanding the Impact
to the Community
Policy and Environmental Change
Can Make A Difference
Jackie Sergent
Granville-Vance District Health Department
What Is
Policy / Environmental Change?
Improve Planning
Increase Access
Enhance Choices
Promote Health (within / without)
Partners can ↑ reach, ↓ costs
Small can make a difference
Quality of life improvements attract business / people
Making The Built Environment Case
“Creating or improving access to places for physical activity is recommended based on strong evidence of their effectiveness in increasing PA & …fitness.” CDC Community Guide
According to Robert Wood Johnson Foundation
“People who report having access to sidewalks are 28% more likely to be physically active.”
“People …[with] access to walking/jogging trails are 55% more likely to be physically active.”
“¼ of all trips people make are one mile or less, yet ¾’s of these short trips are by car.”
Greenway Master Plan
County Manager insight and
support
Health Promotion lead
Community Workgroup
partners
Eat Smart Move More NC
funds ($11,165)
County planner input
MPO support
Outcomes
GC Master Plan on-line for developers et al
Multi-jurisdictional advisory council
County appointed working group
Funding for promotional items
Ripple effect projects BS Stem Trail / ESMM NC $
6 CMAQ projects
NCDOT Enhancement funds
SRTS
Bike/ped in CTP, Oxford Vision Plan
3 Pedestrian Plans
$3.79 million
Mini-Grant Program
$1500 per award (ESMM funded)
Open to any entity with 100
members/clients (10 grants/year)
Required policy/environmental change
Info meeting for applicants
Lunch and learns
Final report from grantees
8/19/2011
10
Outcomes
Increased Awareness PLUS
Churches
Schools
Hospitals
Treatment Facilities
(day and residential)
Worksites
Parks/Rec/YMCA
County Agencies
Walking paths
On-site PA spaces
Signage
Stairwell projects
Activity Policies
Healthy Eating Pol.
Increased access to
PA opportunities
County ESMM Awards
Annual Award
Recognize organizations that promote
Eating Smart and Moving More
Look for sustainability, reach
Total Investment
cost of publicity
plaques
~$500
staff time
ESMM Weight Loss Challenge
Annual 11 week event (+ maintenance)
Sponsors
2 Hospitals, YMCA, Health Dept
Physical Activity Partners
Discounts, free classes, prizes
Weekly support messages
1000+ participants
>4000 pounds lost each year
~$4000 cost
Other Thoughts?
No idea is too small
Every effort will increase awareness
Seek opportunities to partner
No one has any money
Need is increasing
HPC money cut
= Health Depts can’t be only driver
Resources
Community Guide
www.thecommunityguide.org/index.html
Leadership for Healthy Communities (tool kit)
www.leadershipforhealthycommunities.org/
Eat Smart Move More NC
www.eatsmartmovemorenc.com
Active Living by Design
www.activelivingbydesign.org
Smart Growth Concepts
www.smartgrowth.org
Jackie Sergent, MPH, RD, LDN
Health Promotion Coordinator
Granville-Vance District Health Department
Thank You!
Questions?