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.

1. Better Health
For a Healthier Bottom Line
l hi i
Sarah Langer
NC County Commissioners Meeting
August 19, 2011
A t

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. 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. emerging issue
4

5. Healthcare Innovation

6. Sarah Langer
sarah_langer@ncsu.edu
sarah langer@ncsu edu
919-513-2800
www.emergingissues.org
6

7. Better Health –
Healthier Bottom Line
Challenges…
Opportunities…
Impact…
David Chenoweth, Ph.D., FAWHP
Fellow, Institute for Emerging Issues
North Carolina State University
North Carolina Association of County Commissioners
y
Concord, NC August 19, 2011

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*
*Projected
Source: Center for Medicare and Medicaid Services. 8

10. 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 Years
Source: CDC, Center for Health Statistics.

11. The Perfect STORM ??

12. Medical and
Pharmaceutical
24% 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

13. 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.

14. 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+ 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.

15. 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+ 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.

16. O BE SI TY
Over - weight
Desired
Under
Source: Chenoweth & Associates, Inc.

17. Physical inactivity, excess weight, type II diabetes
and 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.[www.beactivenc.org]

18. 4.6
Billions (2010 dollars)

19. The News &
Observer
Ob
Aug. 17, 2008,
page 8G.
Fitness
Management

22. 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?

23. Relative I fl
R l ti Influence on Human Health
H H lth
Source: HHS and CDC.

24. “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.”
i t ti th t ill ff
– Jared Pankowski, M.A.Ed
Corporate Health
Carolinas HealthCare

25. Today’s need for healthy, productive
y y
employees – especially in small
business…
60% employ < 4 employees
80% employ < 20 employees
Downsizing
Doing more with less

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

28. A sampling of county health departments
making positive impacts in
North Carolina
Granville-Vance
Nash County
Wake County
Mecklenburg County Pitt County

29. Community and worksite-based programs and
worksite-
incentives…

30. The i
Th impacts…
t
Healthier citizens
Building strong social networks
More productive employees
More loyal employees
Less turnover = greater retention

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

32. 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

33. The overall prosperity of North Carolina’s people and
economy - today and tomorrow…depends heavily on the
health of its communities and businesses

34. Calculating the Economic Impact of
Poor H lth
P 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

35. Co-relationships between health
and economics
Employment
E l t
and tax base
Graduation
rate and
employment
Health status
(e.g. obesity)

36. 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
hmacheno@coastalnet.com
252-636-3241
www.chenoassociates.com
30 Years of
Excellence

37. WELLNESS WORKS
IN NASH COUNTY
NCACC Conference
August 19, 2011
Better Health, Healthier Bottom Line

38. Better Health,
Healthier Bottom Line
NCACC C f
Conference
August 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

39. Better Health,
Healthier Bottom Line
NCACC C f
Conference
August 19, 2011
General Challenges Facing All
County Governments
1. Aging Employee Population
2. Reduction in Tax Revenue Streams
3.
3 Exponential Healthcare Costs’
Costs
Inflation
4. Reduction in Federally-Funded
Community Services
5. Unprecedented Increased Need of
Public Services
6.
6 Hiring Freezes
7. Long-Term Employees Seeking Earlier
Retirement Options

40. Better Health,
Healthier Bottom Line
NCACC C f
Conference
August 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 Lifestyles
Contain & Eventually Reduce the Employee
Healthcare Costs’ Burden
Decrease Employee Absenteeism
Increase Productivity
y
Reduce Expensive Employee Turnover

41. Better Health,
Healthier Bottom Line
NCACC C f
Conference
August 19, 2011
Employee 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

42. Better Health,
Healthier Bottom Line
NCACC C f
Conference
August 19, 2011
Other 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

43. Better Health,
Healthier Bottom Line
NCACC C f
Conference
August 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)

44. Better Health,
Healthier Bottom Line
NCACC C f
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
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

45. Better Health,
Healthier Bottom Line
NCACC C f
Conference
August 19, 2011
OK…We G t
OK W Get It
Now How Do We Get The Ball Rolling?
1. Create Employee Wellness Program Implementation Team
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
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?”

46. Better Health,
Healthier Bottom Line
NCACC C f
Conference
August 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 Glucose
3.
3 Utility of EAP (Reinvent Its Utility)
Utility of EAP (Reinvent Its Utility) 2. Clinician Follow‐Up
2 Clinician Follow Up
4. Healthy Behavior Encouragement Signs 3. On‐Site Vaccinations/Immunizations
5. 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 Care
9. Health Risk Appraisal Participation
9 Health Risk Appraisal Participation

47. Better Health,
Healthier Bottom Line
NCACC C f
Conference
August 19, 2011
How to Sell Wellness to
Employees,
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 & 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)

48. 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 2446
Special Thanks to Ms. Sarah Langer, the NCACC & Institute for Emerging Issues for Invitation

49. Expanding the Impact
to the Communityy
Policy and Environmental Change
Can Make A Difference
Jackie Sergent
Granville-Vance District Health Department

50. 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, ↓ costs
Small can make a difference
Quality of life improvements attract business / people

51. 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 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.”

52. Greenway Master Plan
County Manager insight and
support
Health Promotion lead
Community Workgroup
p
partners
Eat Smart Move More NC
funds ($11,165)
County planner input
MPO support
pp

53. Outcomes
GC Master Plan on-line for developers et al
on- p
Multi-
Multi-jurisdictional advisory council
County appointed working group
Funding for
F di f promotional i i l items
Ripple 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

54. Mini-
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

55. Outcomes
Increased Awareness PLUS
Churches
Ch h Walking paths
Schools On-
On-site PA spaces
Hospitals Signage
Treatment Facilities Stairwell projects
p j
(day and residential) Activity Policies
Worksites
Healthy Eating Pol
Pol.
Parks/Rec/YMCA
Parks/Rec/YMCA
Increased access to
County Agencies
PA opportunities
t iti

56. 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

57. ESMM Weight Loss Challenge
Annual 11 week event (+ maintenance)
(
Sponsors
2 Hospitals, YMCA, Health Dept
Physical Activity Partners
Discounts, free classes, prizes
, ,p
Weekly support messages
1000
1000+ participants
>4000 pounds lost each year
~$4000 cost
$4000

58. 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
p y

59. 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

60. Questions?
Jackie Sergent MPH RD LDN
Sergent, MPH, RD,
Health Promotion Coordinator
Granville-V
Granville-Vance District H lth D
G ill Di t i t Health Department
t t
jsergent@gvdhd.org
Thank You!