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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.
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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
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
National Average: 112 Days/ 1,000 Working Americans
y106-130 Days131+ 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.
Hypertension accounts for 181 days of lost time per yp y p1,000 working Americans each year.
160-179 Days< 160 Days
National Average: 181 Days/ 1,000 Working Americans
180-199 Days200+ 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.
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
Better Health,Healthier Bottom LineNCACC C fNCACC ConferenceAugust 19, 2011
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
Better Health,Healthier Bottom LineNCACC C fNCACC ConferenceAugust 19, 2011
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
Better Health,Healthier Bottom LineNCACC C fNCACC ConferenceAugust 19, 2011
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
Better Health,Healthier Bottom LineNCACC C fNCACC ConferenceAugust 19, 2011
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)
Better Health,Healthier Bottom LineNCACC C fNCACC ConferenceAugust 19, 2011
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
Better Health,Healthier Bottom LineNCACC C fNCACC ConferenceAugust 19, 2011
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?”
Better Health,Healthier Bottom LineNCACC C fNCACC ConferenceAugust 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)
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
Better Health,Healthier Bottom LineNCACC C fNCACC ConferenceAugust 19, 2011
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)
Better Health,Healthier Bottom LineNCACC C fNCACC ConferenceAugust 19, 2011
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!