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North Carolina Association of County Commissioners


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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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North Carolina Association of County Commissioners

  1. 1. Better HealthFor a Healthier Bottom Line l hi i Sarah Langer NC County Commissioners Meeting August 19, 2011 A t
  2. 2. Session Objectives j• Make the business case for better health.• Demonstrate the county health tool to further ill t t f th illustrate economic i i impact of t f health factors.• Provide examples of best practices to improve health in the worksite worksite.
  3. 3. 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 state, builds an enduring capacity for positive change. change
  4. 4. emerging issue 4
  5. 5. Healthcare Innovation
  6. 6. Sarah Langersarah_langer@ncsu.edusarah langer@ncsu edu 6
  7. 7. Better Health –Healthier Bottom LineChallenges… Opportunities… Impact…David Chenoweth, Ph.D., FAWHPFellow, Institute for Emerging IssuesNorth Carolina State University North Carolina Association of County Commissioners yConcord, NC August 19, 2011
  8. 8. 20.0%* National Health Expenditure (NHE) $5,000 % GDP 16.2% 16.5% 15.9% 16.0% $4,044 15.4% % $4,000 $3,000 $3 000 $Billions NHE in Billions s $2,170 $1,878 $2,016 $2,000 $1,741 $1 741 $1,608 $1,000 $0 2002 2003 2004 2005 2006 2015* *ProjectedSource: Center for Medicare and Medicaid Services. 8
  9. 9. Average Ut Average Utilization 3 2.5 25 Male Female 2 Average 1.5 1 0.5 0 0-1 1-4 5-19 20-44 45-54 55-64 65+ Age in in Y Age YearsSource: CDC, Center for Health Statistics.
  10. 10. The Perfect STORM ??
  11. 11. Medical andPharmaceutical24% Direct Medical Costs Indirect Medical Costs I di M di l C Long-term Disability Presenteeism 1% 63% Workers’ Compensation <1% 1% Absenteeism 6% Short-term Disability 6% Source: Hemp, P. Harvard Business Review, October, 2004
  12. 12. On average, asthma accounts for 927 days of lost time g , y per 1,000 working Americans each year. National Average: 927 Days/ 1,000 Working Americans < 800 Days 800-899 Days y 900-999 Days 1000+ 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.
  13. 13. Diabetes accounts for 112 days of lost time p 1,000 y per , working Americans each year. National Average: 112 Days/ 1,000 Working Americans < 80 Days 81-105 Days y 106-130 Days 131+ DaysSource: Goetzel, R.Z., et al. (2004). JOEM, 46(4), 398-412 estimates of average days per year absent due to common chronicconditions, CDC Behavioral Risk Factor Surveillance System estimates of disease prevalence by state, and Current PopulationSurvey estimates of employed persons by state.
  14. 14. Hypertension accounts for 181 days of lost time p yp y per 1,000 working Americans each year. National Average: 181 Days/ 1,000 Working Americans < 160 Days 160-179 Days y 180-199 Days 200+ DaysSource: 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.
  15. 15. O BE SI TY Over - weight Desired UnderSource: Chenoweth & Associates, Inc.
  16. 16. Physical inactivity, excess weight, type II diabetesand low fruit/veggie intake cost North Carolinians dl f i/ i i k N h C li i an estimated $32 billion (2010$). The majority of this tab was paid by business & industry through employer health h h l h lh insurance premiums and lost productivity productivity. Source. Be Active North Carolina, Inc., 2011.[]
  17. 17. 4.6Billions (2010 dollars)
  18. 18. The News & Observer Ob Aug. 17, 2008, page 8G. FitnessManagement
  19. 19. 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?
  20. 20. Relative I flR l ti Influence on Human Health H H lth Source: HHS and CDC.
  21. 21. “Our medical claims were examinedto determine what percent were fordiagnoses related to lifestyle so wecan develop health promotioninterventions that will pay off.”i t ti th t ill ff – Jared Pankowski, M.A.Ed Corporate Health Carolinas HealthCare
  22. 22. Today’s need for healthy, productive y yemployees – especially in smallbusiness… 60% employ < 4 employees 80% employ < 20 employees Downsizing Doing more with less
  23. 23. The health of North Carolina s communities Carolina’s influences our overall quality of life…
  24. 24. A sampling of county health departments making positive impacts in North Carolina Granville-Vance Nash County Wake County Mecklenburg County Pitt County
  25. 25. Community and worksite-based programs and worksite- incentives…
  26. 26. The iTh impacts… tHealthier citizensBuilding strong social networksMore productive employeesMore loyal employeesLess turnover = greater retention
  27. 27. Risk Avoidance vs. Risk Reduction…Greater Savings Result from Risks Avoided than Risks Reduced $500 $400 $300 $200 $100 $0 ($100) ($200) ($300) 3 2 1 0 1 2 3 Overall: Cost per risk reduced: $215; Cost per risk avoided: $304 Source: Updated from Edington, AJHP 2001; 15(5),341-349.
  28. 28. Promoting Employee Well-being: WellnessStrategies to Improve Health, Performance and the BottomLine SHRM Foundation’s Effective Practice Guidelines Series By David Chenoweth, Ph.D., FAWHP
  29. 29. The overall prosperity of North Carolina’s people andeconomy - today and tomorrow…depends heavily on the health of its communities and businesses
  30. 30. Calculating the Economic Impact ofPoor H lthP Health “COUNTY HEALTHCARE TOOL”Community Health: Raising the Bar y g Jobs Food Deserts Obesity Graduation rate Smoking Roland Stephens, NCSU Mark Holmes, UNC David Chenoweth, ECU
  31. 31. Co-relationships between healthand economics Employment E l t and tax base Graduation rate and employment Health status (e.g. obesity)
  32. 32. Thank you… y David Chenoweth, Ph.D., FAWHP Chenoweth & Associates, Inc. 128 St Andrews Circle St. A d Ci l New Bern, NC 28562-2907 252-636-3241 30 Years of Excellence
  33. 33. WELLNESS WORKS IN NASH COUNTY NCACC Conference August 19, 2011Better Health, Healthier Bottom Line
  34. 34. Better Health,Healthier Bottom LineNCACC C f ConferenceAugust 19, 2011 Environmental Challenges In Nash County o 12.7% Unemployment Rate o32.3% of Adult Population is Considered to Be Obese o32.3% of Adult Population is Considered to Be Obese oLocated in the ‘Stroke Belt Buckle’ of the United  States oLocated in The ‘Sugar Belt Buckle’ of the United    States
  35. 35. Better Health,Healthier Bottom LineNCACC C f ConferenceAugust 19, 2011 General Challenges Facing All County Governments1. Aging Employee Population2. Reduction in Tax Revenue Streams3.3 Exponential Healthcare Costs’ Costs Inflation4. Reduction in Federally-Funded Community Services5. Unprecedented Increased Need of Public Services6.6 Hiring Freezes7. Long-Term Employees Seeking Earlier Retirement Options
  36. 36. Better Health,Healthier Bottom LineNCACC C f ConferenceAugust 19, 2011Nash 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 y Reduce Expensive Employee Turnover
  37. 37. Better Health,Healthier Bottom LineNCACC C f ConferenceAugust 19, 2011Employee Wellness Program Participation Checklist: l ll h kl Participate in Lab Work Clinic or Attain  Lab Work Through Their Own PCP  Attend an Appt  w/ Onsite Health  Attend an Appt w/ Onsite Health Coach (Mid‐Level Provider) Attend At Least One Health/Wellness  Attend At Least One Health/Wellness Seminar (Per Calendar Year) Successfully Complete Online HRA  S f ll C l t O li HRA
  38. 38. Better Health,Healthier Bottom LineNCACC C f 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 Program Walking & Weight Loss Challenges Walking & Weight‐Loss Challenges Onsite Life Coach Availability Free Onsite Health Screenings &  Free Onsite Health Screenings & Immunizations ea t Coac ( d e e o de ) Health Coach (Mid‐Level Provider) Annual Wellness Fairs Massage Therapy
  39. 39. Better Health,Healthier Bottom LineNCACC C f 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 Employee to Entire Employee  Population (i.e. Wellness Team Ambassadors,  Internet, County‐Wide Email Memo’s, Signage Etc.) Effective Marketing Effective Marketing Strategies Elimination of Costs’ Barriers to Employees (i.e. Free Screenings + Employees Are Not Using Leave  Reserves to  Participate In Wellness Program)
  40. 40. Better Health,Healthier Bottom LineNCACC C f ConferenceAugust 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  C t i d H lth C t t Id ti l L l oContained 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 Hypertension 11 1% Reduced Excess Spending on Hypertension 10.8% Reduced Excess Spending on Pre‐Hypertension
  41. 41. Better Health,Healthier Bottom LineNCACC C f ConferenceAugust 19, 2011 OK…We G t OK W Get It Now How Do We Get The Ball Rolling?1. Create Employee Wellness 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)4. Add Wellness Program Implementation to Department Head Meeting  dd ll l i d i Agendas (Important To Receive Feedback & Support)5. Keep Asking the Question..”How Much Longer Can We Afford Not To Do It?”
  42. 42. Better Health,Healthier Bottom LineNCACC C f ConferenceAugust 19, 2011 Worksite Interventions Behavioral/Educational: / Clinical:1. Educational Seminars (‘Lunch‐N‐Learns’) 1. **Biometric Screening**2. Tobacco Cessation (ALA‐Trained Coach) Including CHOL+ LPD Panel + Blood Glucose3.3 Utility of EAP (Reinvent Its Utility) Utility of EAP (Reinvent Its Utility) 2.   Clinician Follow‐Up 2 Clinician Follow Up4. Healthy Behavior Encouragement Signs 3.   On‐Site Vaccinations/Immunizations5. Worksite Fitness Center (w/classes) 4.   On‐Site Screenings (kidney, bone  6. Walking/Weight‐Loss Challenges density, mammograms etc.)7. On‐Site Farmers Marker / Healthy  5. Disease‐Management Enrollment Eating Choices (On‐Site Clinical Program)8. Annual Health/Wellness Fair 6.   On‐Site Acute/Episodic Care9. Health Risk Appraisal Participation9 Health Risk Appraisal Participation
  43. 43. Better Health, Healthier Bottom Line NCACC C f Conference August 19, 2011 How to Sell Wellness toEmployees,Employees Management & Citizens?1.1 Wellness Will Be Necessary in Any SAVE OUR BENEFITS Campaign (for management) Wellness Will Be Necessary in Any SAVE OUR BENEFITS Campaign (for management) PLEASE REMEMBER THAT BENEFIT PACKAGES ARE MAIN TOOLS OF RECRUITMENT & RETENTION2. 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’ Burden Containment (reducing operational costs) and increasing employee loyalty(ROI Is Significant + Mechanism to Decrease Risk Of Tax Increase to General Population)
  44. 44. Better Health, Healthier Bottom Line NCACC C f Conference August 19, 2011 WELLNESS WORKS IN NASH COUNTY Employee Health Promotions Coordinator P: (252) 462‐2461  F: (252) 462‐2446 P: (252) 462 2461 F: (252) 462 2446Special Thanks to Ms. Sarah Langer, the NCACC & Institute for Emerging Issues for Invitation 
  45. 45. Expanding the Impact to the CommunityyPolicy and Environmental Change Can Make A Difference Jackie Sergent Granville-Vance District Health Department
  46. 46. What Is Policy / E i P li Environmental Ch l Change? ? Improve Planning Increase Access Enhance Ch i E h Choices Promote Health (within / without)Partners can ↑ reach, ↓ costsSmall can make a differenceQuality of life improvements attract business / people
  47. 47. Making The Built Environment Case “Creating or improving access to p g p g places for physical activity is recommended based on strong evidence of their effectiveness in increasing PA & …fitness.” CDC C fitness Community G id it GuideAccording 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.”
  48. 48. Greenway Master PlanCounty Manager insight andsupportHealth Promotion leadCommunity WorkgroupppartnersEat Smart Move More NCfunds ($11,165)County planner inputMPO support pp
  49. 49. OutcomesGC Master Plan on-line for developers et al on- pMulti-Multi-jurisdictional advisory councilCounty appointed working groupFunding forF di f promotional i i l itemsRipple effect projects BS Stem Trail / ESMM NC $ 6 CMAQ projects NCDOT Enhancement funds SRTS Bike/ped Bike/ped in CTP, Oxford Vision Plan 3 Pedestrian Plans $3.79 million
  50. 50. Mini- Mini-Grant Program$1500 per award (ESMM funded)Open to any entity with 100members/clients (10 grants/year)Required policy/environmental changeInfo meeting for applicantsLunch and learnsFinal report from grantees
  51. 51. OutcomesIncreased Awareness PLUSChurchesCh h Walking pathsSchools On- On-site PA spacesHospitals SignageTreatment Facilities Stairwell projects p j (day and residential) Activity PoliciesWorksites Healthy Eating Pol Pol.Parks/Rec/YMCAParks/Rec/YMCA Increased access toCounty Agencies PA opportunities t iti
  52. 52. County ESMM AwardsAnnual AwardRecognize organizations that promoteEating Smart and Moving MoreLook for sustainability, reachTotal Investment cost of publicity plaques ~$500 staff time
  53. 53. ESMM Weight Loss ChallengeAnnual 11 week event (+ maintenance) (Sponsors 2 Hospitals, YMCA, Health DeptPhysical Activity Partners Discounts, free classes, prizes , ,pWeekly support messages10001000+ participants>4000 pounds lost each year~$4000 cost $4000
  54. 54. Other Thoughts?No idea is too smallEvery effort will increase awarenessSeek opportunities to partner No one has any money Need is increasing HPC money cut = Health Depts can’t be only driver p y
  55. 55. ResourcesCommunity Guide for Healthy Communities (tool kit) Smart Move More NC www.eatsmartmovemorenc.comActive Living by Design www.activelivingbydesign.orgSmart Growth Concepts
  56. 56. Questions? Jackie Sergent MPH RD LDN Sergent, MPH, RD, Health Promotion CoordinatorGranville-VGranville-Vance District H lth DG ill Di t i t Health Department t t Thank You!