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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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Ncacc slides

  1. 1. 8/19/2011 Session Objectives Better Health • Make the business case for better health.For a Healthier Bottom Line • Demonstrate the county health tool to further illustrate economic impact of health factors. Sarah Langer NC County Commissioners Meeting • Provide examples of best practices to August 19, 2011 improve health in the worksite. Who We Are and What We Do• IEI is a public policy organization committed to North Carolina’s future. emerging issue• Working collaboratively with individuals from all sectors and areas of the state, IEI builds an enduring capacity for positive change. Healthcare Innovation Sarah Langer sarah_langer@ncsu.edu 919-513-2800 www.emergingissues.org 1
  2. 2. 8/19/2011 20.0%* National Health Expenditure (NHE)Better Health – $5,000 % GDPHealthier Bottom Line 15.9% 16.0% 16.2% 16.5% 15.4% $4,044 $4,000Challenges… $3,000 $Billions NHE in Billions Opportunities… $2,170 Impact… $2,000 $1,741 $1,878 $2,016 $1,608David Chenoweth, Ph.D., FAWHP $1,000Fellow, Institute for Emerging IssuesNorth Carolina State University $0 North Carolina Association of County Commissioners 2002 2003 2004 2005 2006 2015* *ProjectedConcord, NC August 19, 2011 Source: Center for Medicare and Medicaid Services. Average Utilization Average Utilization 3 Male 2.5 Female Average Utilization Index 2 1.5 1 0.5 0 0-1 1-4 5-19 20-44 45-54 55-64 65+ Age inYears Age in Years Source: CDC, Center for Health Statistics.The Perfect STORM ?? Medical and Pharmaceutical 24% Direct Medical Costs Indirect Medical Costs Long-term Disability Presenteeism 1% 63% Workers’ Compensation <1% Absenteeism 6% Short-term Disability 6% Source: Hemp, P. Harvard Business Review, October, 2004 2
  3. 3. 8/19/2011On average, asthma accounts for 927 days of lost time Diabetes accounts for 112 days of lost time per 1,000 per 1,000 working Americans each year. working Americans each year. National Average: 927 Days/ National Average: 112 Days/ 1,000 Working Americans 1,000 Working Americans < 800 Days < 80 Days 800-899 Days 81-105 Days 900-999 Days 106-130 Days 1000+ Days 131+ Days Source: Goetzel, R.Z., et al. (2004). JOEM, 46(4), 398-412 estimates of average days per year absent due to common chronic Source: Goetzel, R.Z., et al. (2004). JOEM, 46(4), 398-412 estimates of average days per year absent due to common conditions, CDC Behavioral Risk Factor Surveillance System estimates of disease prevalence by state, and Current Population chronic conditions, CDC Behavioral Risk Factor Surveillance System estimates of disease prevalence by state, and Current Survey estimates of employed persons by state. Population Survey estimates of employed persons by state. Hypertension accounts for 181 days of lost time per 1,000 working Americans each year. O BE SI TY National Average: 181 Days/ 1,000 Working Americans Over - weight < 160 Days 160-179 Days Desired 180-199 Days 200+ Days UnderSource: Goetzel, R.Z., et al. (2004). JOEM, 46(4), 398-412 estimates of average days per year absent due to commonchronic conditions, CDC Behavioral Risk Factor Surveillance System estimates of disease prevalence by state, and CurrentPopulation Survey estimates of employed persons by state. Source: Chenoweth & Associates, Inc. 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 4.6 insurance premiums and lost productivity. Source. Be Active North Carolina, Inc., Billions (2010 dollars) 2011.[www.beactivenc.org] 3
  4. 4. 8/19/2011 The News & Observer Aug. 17, 2008, page 8G. Fitness Management 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 “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.Ed Corporate Health Carolinas HealthCare Source: HHS and CDC. 4
  5. 5. 8/19/2011Today’s need for healthy, productive The health of North Carolina’s communitiesemployees – especially in small influences our overall quality of life…business… 60% employ < 4 employees 80% employ < 20 employees Downsizing Doing more with less A sampling of county health departments making positive impacts in North Carolina Granville-Vance Nash County Wake County Mecklenburg County Pitt County 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 5
  6. 6. 8/19/2011 Risk Avoidance vs. Risk Reduction…Greater Savings Result from Risks Avoided than Risks Reduced Promoting Employee Well-being: Wellness Strategies to Improve Health, Performance and the Bottom Line $500 $400 $300 $200 SHRM Foundation’s Effective $100 Practice Guidelines Series $0 By David Chenoweth, Ph.D., FAWHP ($100) ($200) ($300) 3 2 1 0 1 2 3 www.shrm.org/foundation 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. Calculating the Economic Impact of The overall prosperity of North Carolina’s people and Poor Healtheconomy - today and tomorrow…depends heavily on the “COUNTY HEALTHCARE TOOL” health of its communities and businesses Community Health: Raising the Bar Jobs Food Graduation Deserts Obesity rate Smoking Roland Stephens, NCSU Mark Holmes, UNC David Chenoweth, ECUCo-relationships between health Thank you…and economics David Chenoweth, Ph.D., FAWHP Chenoweth & Associates, Inc. Employment 128 St. Andrews Circle and tax base New Bern, NC 28562-2907 hmacheno@coastalnet.com 252-636-3241 Graduation www.chenoassociates.com rate and employment Health status (e.g. obesity) 30 Years of Excellence 6
  7. 7. 8/19/2011 Better Health, WELLNESS WORKS Healthier Bottom Line NCACC Conference August 19, 2011 Environmental Challenges In Nash County o 12.7% Unemployment Rate IN NASH COUNTY o32.3% of Adult Population is Considered to Be Obese oLocated in the ‘Stroke Belt Buckle’ of the United NCACC Conference States August 19, 2011 oLocated in The ‘Sugar Belt Buckle’ of the United Better Health, Healthier Bottom Line StatesBetter Health, Better Health,Healthier Bottom Line Healthier Bottom LineNCACC Conference NCACC ConferenceAugust 19, 2011 August 19, 2011 General Challenges Facing All Nash County Implemented an Employee Wellness County Governments Program in 2004 For The Following Reasons:1. Aging Employee Population Provide Tools & Resources to Employees in Order2. Reduction in Tax Revenue Streams3. Exponential Healthcare Costs’ to Attain and/or Maintain Healthy Lifestyles Inflation Contain & Eventually Reduce the Employee4. Reduction in Federally-Funded Community Services Healthcare Costs’ Burden5. Unprecedented Increased Need of Decrease Employee Absenteeism Public Services6. Hiring Freezes Increase Productivity7. Long-Term Employees Seeking Earlier Reduce Expensive Employee Turnover Retirement OptionsBetter Health, Better Health,Healthier Bottom Line Healthier Bottom LineNCACC Conference NCACC ConferenceAugust 19, 2011 August 19, 2011 Other Wellness Program Components:Employee Wellness Program Participation Checklist:  Onsite Fitness Center Available to EmployeesParticipate in Lab Work Clinic or Attain 24/7 (w/ Fitness Classes) Lab Work Through Their Own PCP  Smoking Cessation Awards ProgramAttend an Appt w/ Onsite Health  Walking & Weight-Loss Challenges Coach (Mid-Level Provider)  Onsite Life Coach AvailabilityAttend At Least One Health/Wellness  Free Onsite Health Screenings & Seminar (Per Calendar Year) Immunizations  Health Coach (Mid-Level Provider)Successfully Complete Online HRA  Annual Wellness Fairs  Massage Therapy 7
  8. 8. 8/19/2011 Better Health, Better Health, Healthier Bottom Line Healthier Bottom Line NCACC Conference NCACC Conference August 19, 2011 August 19, 2011 Show Me Some Metrics! Time Period 04/01/2009-03/31/2010 to Time Period 04/01/2010-03/31/2011 Keys To Program Success o100% Wellness Program Participation oContained Healthcare Costs to Identical Levels  Relativity of Educational Programming (i.e. Menopausal, Shift Work Sleep Disorder & Allergy 11% Decrease of Employees w/ PreHTN Survival Kit Series)  Flexibility (i.e. Adapt to Accommodate Various Shift 4.5 % Increase in Average HRA Score Worker Schedules)  Accessibility to Entire Employee 12% Decrease of Empl. w/ 5+ Risk Factors Population (i.e. Wellness Team Ambassadors, 11.3% Reduced Excess Spending on Depression Internet, County-Wide Email Memo’s, Signage Etc.)  Effective Marketing Strategies 11.1% Reduced Excess Spending on Hypertension  Elimination of Costs’ Barriers to Employees (i.e. Free Screenings + Employees Are Not Using Leave 10.8% Reduced Excess Spending on Pre-Hypertension Reserves to Participate In Wellness Program) Better Health, Better Health, Healthier Bottom Line Healthier Bottom Line NCACC Conference NCACC Conference August 19, 2011 August 19, 2011 OK…We Get It Worksite Interventions Now 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 Behavioral/Educational: Clinical: Health Director) 1. Educational Seminars (‘Lunch-N-Learns’) 1. **Biometric Screening** 2. Tobacco Cessation (ALA-Trained Coach) Including CHOL+ LPD Panel + Blood Glucose2. Analyze the Numbers (Exponential Healthcare Costs Increases) 3. Utility of EAP (Reinvent Its Utility) 2. Clinician Follow-Up(In Order To Make Argument To Commissioners and General Public, You Have To 4. Healthy Behavior Encouragement Signs 3. On-Site Vaccinations/Immunizations Justify Initial Extra Operational Costs) 5. Worksite Fitness Center (w/classes) 4. On-Site Screenings (kidney, bone 6. Walking/Weight-Loss Challenges density, mammograms etc.)3. Visit Counties or Other Municipalities w/ Wellness Programs in Place (Find 7. On-Site Farmers Marker / Healthy 5. Disease-Management Enrollment Out What Works & What Doesn’t Work) Eating Choices (On-Site Clinical Program) 8. Annual Health/Wellness Fair 6. On-Site Acute/Episodic Care4. Add Wellness Program Implementation to Department Head Meeting 9. Health Risk Appraisal Participation Agendas (Important To Receive Feedback & Support)5. Keep Asking the Question..”How Much Longer Can We Afford Not To Do It?” Better Health, Better Health, Healthier Bottom Line Healthier Bottom Line NCACC Conference NCACC Conference August 19, 2011 August 19, 2011 How to Sell Wellness to WELLNESS WORKS IN NASH COUNTYEmployees, 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 Employee Health Promotions Coordinator2. Enlighten the Employee Population that Employee Wellness is a UNIVERSAL BENEFIT3. If Self-Insured, EDUCATE Your Employee Population in How Their Individual Choices &Behaviors Ultimately Affect the County’s Bottom-Line, and Ultimately Their Pockets4. Wellness Programs Are Proven to Be Extremely Cost-Effective in Healthcare Costs’ P: (252) 462-2461 F: (252) 462-2446Burden Containment (reducing operational costs) and increasing employee loyalty Special Thanks to Ms. Sarah Langer, the NCACC & Institute for Emerging Issues for Invitation(ROI Is Significant + Mechanism to Decrease Risk Of Tax Increase to General Population) 8
  9. 9. 8/19/2011 What Is Policy / Environmental Change? Expanding the Impact  Improve Planning  Increase Access to the Community  Enhance Choices  Promote Health (within / without) Policy and Environmental Change Can Make A Difference Partners can ↑ reach, ↓ costs Small can make a difference Jackie Sergent Granville-Vance District Health Department Quality of life improvements attract business / peopleMaking The Built Environment Case Greenway Master Plan “Creating or improving access to places for  County Manager insight and physical activity is recommended based on support strong evidence of their effectiveness in  Health Promotion lead increasing PA & …fitness.” CDC Community Guide  Community WorkgroupAccording to Robert Wood Johnson Foundation partners “People who report having access to sidewalks are  Eat Smart Move More NC 28% more likely to be physically active.” funds ($11,165) “People …[with] access to walking/jogging trails are  County planner input 55% more likely to be physically active.”  MPO support “¼ of all trips people make are one mile or less, yet ¾’s of these short trips are by car.” Outcomes Mini-Grant Program GC Master Plan on-line for developers et al  $1500 per award (ESMM funded) Multi-jurisdictional advisory council County appointed working group  Open to any entity with 100 Funding for promotional items members/clients (10 grants/year) Ripple effect projects  Required policy/environmental change  BS Stem Trail / ESMM NC $  6 CMAQ projects  Info meeting for applicants  NCDOT Enhancement funds  Lunch and learns  SRTS  Bike/ped in CTP, Oxford Vision Plan  Final report from grantees  3 Pedestrian Plans $3.79 million 9
  10. 10. 8/19/2011 Outcomes County ESMM Awards Increased Awareness PLUS  Walking paths  Annual Award Churches Schools  On-site PA spaces  Recognize organizations that promote Hospitals  Signage Eating Smart and Moving More Treatment Facilities  Stairwell projects  Look for sustainability, reach  (day and residential)  Activity Policies  Total Investment Worksites  cost of publicity  Healthy Eating Pol. Parks/Rec/YMCA  plaques  Increased access to County Agencies  ~$500 PA opportunities  staff time ESMM Weight Loss Challenge Other Thoughts? Annual 11 week event (+ maintenance)  No idea is too small Sponsors  Every effort will increase awareness  2 Hospitals, YMCA, Health Dept  Seek opportunities to partner Physical Activity Partners  Discounts, free classes, prizes  No one has any money Weekly support messages  Need is increasing 1000+ participants >4000 pounds lost each year  HPC money cut ~$4000 cost = Health Depts can’t be only driver Resources Questions? Community Guide Jackie Sergent, MPH, RD, LDN www.thecommunityguide.org/index.html Health Promotion Coordinator Leadership for Healthy Communities (tool kit) Granville-Vance District Health Department www.leadershipforhealthycommunities.org/ Eat Smart Move More NC jsergent@gvdhd.org www.eatsmartmovemorenc.com Active Living by Design www.activelivingbydesign.org Thank You! Smart Growth Concepts www.smartgrowth.org 10

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