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. 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
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2. 8/19/2011
20.0%*
National Health Expenditure (NHE)
Better Health – $5,000
% GDP
Healthier Bottom Line 15.9% 16.0%
16.2% 16.5%
15.4% $4,044
$4,000
Challenges… $3,000 $Billions
NHE in Billions
Opportunities…
$2,170
Impact… $2,000
$1,741
$1,878 $2,016
$1,608
David Chenoweth, Ph.D., FAWHP
$1,000
Fellow, Institute for Emerging Issues
North Carolina State University
$0
North Carolina Association of County Commissioners 2002 2003 2004 2005 2006 2015*
*Projected
Concord, 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
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3. 8/19/2011
On 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
Under
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.
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]
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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.
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5. 8/19/2011
Today’s need for healthy, productive
The health of North Carolina’s communities
employees – 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
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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 Health
economy - 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, ECU
Co-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
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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 States
Better Health, Better Health,
Healthier Bottom Line Healthier Bottom Line
NCACC Conference NCACC Conference
August 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 Order
2. Reduction in Tax Revenue Streams
3. Exponential Healthcare Costs’ to Attain and/or Maintain Healthy Lifestyles
Inflation Contain & Eventually Reduce the Employee
4. Reduction in Federally-Funded
Community Services
Healthcare Costs’ Burden
5. Unprecedented Increased Need of Decrease Employee Absenteeism
Public Services
6. Hiring Freezes Increase Productivity
7. Long-Term Employees Seeking Earlier Reduce Expensive Employee Turnover
Retirement Options
Better Health, Better Health,
Healthier Bottom Line Healthier Bottom Line
NCACC Conference NCACC Conference
August 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
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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 Glucose
2. 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 Care
4. 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 COUNTY
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 Employee Health Promotions Coordinator
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’
P: (252) 462-2461 F: (252) 462-2446
Burden 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)
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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 / people
Making 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 Workgroup
According 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
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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
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