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Making Worksite Wellness Work!. Denton County Cardiovascular Health Summit. Texas Association of Local Health Officials. August 26, 2010. Texas Association of Local Health Officials (TALHO). State association of county and city health officials

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making worksite wellness work

Making Worksite Wellness Work!

Denton County

Cardiovascular Health Summit

Texas Association of Local Health Officials

August 26, 2010

texas association of local health officials talho
Texas Association of Local Health Officials (TALHO)
  • State association of county and city health officials
  • Members are any Local Health Department in Texas
  • The Local Public Health Official who is the highest decision authority for the LHD is the official member
  • 71 member organizations
  • Members have jurisdictional oversight for over 80% of Texas population
local public health departments
Local Public Health Departments
  • Responsible for providing essential public health services such as:
  • Disease detection
  • Investigation and treatment of infectious diseases
  • Outreach for immunizations
  • Provision and referral for maternal and child health
  • Regulation of environmental health and safety programs
  • Health education and health promotion
  • Lab services
  • Emergency Preparedness
talho offers
TALHO offers
  • Public Health Advocacy – promoting local, state and national policies to improve health
  • Public Health Programs – planning, providing and assisting LHDs in implementing evidence-based, best practice interventions
  • Technology – Provides planning, consulting and implementation of hardware and software solutions for public health and clinical facilities
why should employers care about chronic diseases
Why Should Employers Care About Chronic Diseases?
  • 125 million Americans report having at least one chronic condition
  • 58 million of those are between ages 18-65
  • Chronic conditions are responsible for 7 out of 10 deaths in the US each year
  • Accounts for at least 40 percent of nation’s annual health care expenditures

Partnership for Prevention, “Why Invest? Recommendations for Improving Your Prevention Investment”

affect on employers
Affect on Employers?
  • Workers <age55:
    • with heart disease are 8 times more likely to have reduced productivity
    • with diabetes or arthritis are 6 and 4 times more likely to report work limitations
    • have absenteeism due to health-related causes that could result in at least $65 billion in lost wages each year

Chronic Diseases contribute to employee turnover and the costs of replacement, worker compensation and life insurance benefits.

Partnership for Prevention, “Why Invest? Recommendations for Improving Your Prevention Investment”

Promoting Health and Preventing and Controlling Disease through an Integrated Health and Productivity Enhancement Program

Promote and Support


Healthy Lifestyle

Find and Manage

Risk Factors

to a Healthy Life

Find and Manage


Prevent Disease


  • Health Promotion
  • Health Education
  • Lifestyle Programs
  • Policy Changes
  • Physical Facility Changes
  • Benefits Plan Design
    • Medical
    • Pharmaceutics
    • Wellness
  • Screening
  • Risk Factor Management
  • Awareness of Disease
  • Disease Management
  • Programs
  • Monitoring of complications
  • of Disease
  • Case Management
  • of Disease

Social &



Favorable to Health

Behavioral/Medical Patterns


Promote Health/

Low Population Risk

Few events/

Only Rare Deaths

Low Recurrence

Good Quality of Life

Until Death

Coordinated and Progressive Continuum of Health Programs, Policies and Services

August 26, 2010

Texas Association of Local Health Officials

value based insurance design definition









  • Quality
  • Cost Reduction
  • Direct
  • Indirect
  • Benefits
  • Incentives
  • Behavior Change
Value-Based Insurance Design Definition

Uses data to

Invest in incentives that

Change behaviors to

Reduce financialand health risk (ROI)

Source: Center for Health Value Innovation

A health management process that

vbid sends a message investing in health
VBID Sends a Message: Investing in Health

Integrated Data on PopulationHealth



Rx, Labs


Design Benefits & Incentives to Support Better Health

Create Valuable Incentives for Health Improvement



Healthcare = Cost Focus

Compress Unit Costs

Claims Centric

Health = Person Focus

Investment Philosophy

Person Centric

Source: Center for Health Value Innovation

fundamental change to structuring health benefits
Fundamental Change to Structuring Health Benefits
  • VBID is a strategy that eliminates barriers and encourages the use of high-value services in defined patient populations
    • High-value services are identified through scientific evidence
    • The more clinically beneficial and cost-effective the therapy is for a patient group, the lower the out-of-pocket costs
  • More effective use of high-value services may positively impact the health of the targeted population
    • Preventable adverse health consequences reduced
    • Related high-cost health care services avoided

Chernew ME et al. Health Aff (Millwood). 2008;27:103-112; Fendrick AM et al. Am J Manag Care. 2001;7:861-867; Fendrick AM, Chernew ME. Am J Manag Care. 2006;12 (special issue):SP5-SP10.


When copays were doubled, patients took less medication in important classes. These reductions in medication levels were profound. Reductions in medications supplied were also noted for:

High Cholesterol



  • NSAIDs 45%
  • Antihistamines 44%
  • Antiulcerants 33%
  • Antiasthmatics 32%
  • Antidepressants 26%
  • For patients taking medications for asthma, diabetes, and gastric disorders, there was a 17% increase in annual ER visits and a 10% increase in hospital stays




High Copays Reduce Adherence to Appropriate Medication Use

Changes in Days Supplied for Selected Drug Classes When Copays Were Doubled

Change in Drug Days Supplied (%)

Adapted from Goldman DP, et al. JAMA. 2004;291:2344-2350.


copay reductions for high value drug classes increase adherence







% MPR*


% Reduction in


Copay Reductions for High-Value Drug Classes Increase Adherence

When a large services industry employer reduced copays for certain classes of drugs, nonadherence rates fell by 7-14%

* MPR = Medication Possession Ratio

Copays for generic medications were reduced from $5 to $0; copays for branded drugs were cut in half for 5 classes of drugs. A similar employer with identical disease management offerings and similar but stable copays served as a control group.

Adapted from Chernew ME, et al. Health Affairs. 2008;27(1):103-112.


the community guide
The Community Guide

The Guide to Community Preventive Services is a free resource to help you choose programs and policies to improve health and prevent disease in your community. Systematic reviews are used to answer these questions:

  • Which program and policy interventions have been proven effective?
  • Are there effective interventions that are right for my community?
  • What might effective interventions cost; what is the likely return on investment?

More than 200 interventions have been reviewed.

The Task Force on Community Preventive Services has issued recommendations for their use.




Wellness - In Focus


health promotion efforts
Health Promotion Efforts


  • Mayor Will Wynn
  • Mayor’s Fitness Council
  • PE Department (PIO)
  • HealthPLUS (Human Resources)
  • Health & Human Services (Consultative)
  • Parks & Recreation (PE Swim Facilities)
  • Medical Vendors (United Healthcare & BlueCross)
pe program
PE Program


  • 23 fitness classes being offered fall 2008 - Run, walk, swim and bike
  • Over 10 locations
  • All city departments participating
  • Over 3000 sign ups with 1800 of these being unique participants
  • 60% of participants committed to program by attending 8 out of the 12 classes
  • Volunteer-driven program
  • Nutrition component
  • 50% of participants lost between 2 and 10 lbs.
  • Sick Leave - PE participants usage ↓ by 2 hrs (06/07)
  • Improved indicators of cardiovascular health
  • 62% - ↑ in HDL “good” cholesterol (statistically significant)
  • 97% say the program has had a positive effect on how they view the City as an employer
  • 100% of participants would recommend the program to a co-worker
  • 95% improved their physical health
  • 53% were not exercising regularly before joining PE


HealthPLUS Participation – FY08




Assessment Tools

Blood Screening







Fitness Assessment




Bone Density Screening

Smoking Cessation

Smoking Cessation 101







12 Weeks to Smoke Free *


Wellness Seminars




Weight Watchers




Skin Cancer Screenings




Physical Activity

Pilates-Ballet Austin


3 classes







Flu Shots




Chair Massage





Farm to Work




  • One Texas Center & Town Lake Center
  • 2,150 Orders
  • 713 Unique Participants

Retiree Events




Participation through August 11, 2008

getting most from vendors
Getting Most from Vendors


Coverage for Preventative Health ($0 - $35 Copay)

  • Diabetic Supplies
  • Physicals
  • Blood Pressure
  • Cholesterol
  • Bone Density
  • Blood Glucose
  • Mammogram
  • Fecal occult blood test
  • Colonoscopy (Deductible & 15% coinsurance)
  • Eye Exam
  • Prostate Exams
  • Testicular Exams
  • Eye Exams
  • Oral Evaluation

Employee Tools

  • Wellness Support & Tools
  • Tools for Informed Medical Decisions
  • Quality Doctors
  • Cost Estimators
  • Personal Health Records
  • Prescription Refills for Maintenance Drugs
  • Employee Assistance (Alliance Work Partners)
  • Health/Nutrition Classes
  • Mental Health Counseling
  • Disease Management
  • Notification to Those @ Risk
  • Outreach to High Risk/Cost Claimants
  • Predictive Modeling (Identifying those potentially @ risk)
  • Health Pregnancy Program
  • Reminders to Targeted Members (Diabetes, Mammograms, Pap Smear, Immunizations)
  • Identify High Quality & Efficient Providers
  • Vendor estimates a savings of $4.06 per member per month through their efforts.
city s wellness practices
City’s Wellness Practices

Marquee Programs

PE Program

Farm to Work

Cancer Coverage & Prevention (CEO Gold Standard)

Adult Vaccinations (HPV, Shingles, etc.)

Free Flu Shots

Free Blood Screenings

Free Fitness Assessments

Access to Smoking Cessation Drugs

Diabetic Supplies Bundling

Retiree Wellness

new initiatives
New Initiatives



  • Add Assessments
    • Health Risk Assessment at New Employee Orientation
  • Add Support Groups
    • Weight Management (Phase 1)
  • Consider Incentives in Benefit Design
    • Smoking Cessation Drugs (Free for completion of class)
  • Support Bike Programs
    • Funding for Bike Safety Programs
    • Explore Bike Sharing Programs (Request for Information From Marketplace)
  • Increase Cancer Prevention Awareness
    • LIVESTRONG Survivorship Materials to each Department
    • CEO Gold Standard Award – Cancer Prevention
  • CEO Cancer Gold Standard Award (First City in Nation)
  • Parks & Recreation Department Class Promotion

Future Initiatives


  • Measure & Provide Dashboard for Executives About Employee Health
  • Weight Management Support Initiative
  • Phase 2 – Health Mentoring
  • Health Coach/Mentor
  • Registered Dietician
  • Fitness Specialist
  • Mental Health Help
  • Additional Medical Plan Design Incentives
  • Cancer Screenings (Cover colonoscopies in full)
  • Mental Health (Eliminate Visit Limits)
  • Increased Access to Nutritionists/Registered Dieticians
the community guide assessment of health risks with feedback ahrf to change employee s health
The Community Guide: Assessment of Health Risks with Feedback (AHRF) to Change Employee’s Health

Recommended, based on strong evidence of effectiveness in improving one or more health behaviors or conditions in populations of workers

national instruments
National Instruments
  • Onsite Clinic and Health Risk Assessment

Headquarters in Austin, TX.  

  • 2300 Employees in Austin, 200 outside of Austin in various cities in the U.S., and an additional 2600 international employees in over 40 countries.  
  • For the purposes of all of our benefits/medical discussions we focus solely on the 2500 U.S. based employees.
focus onsite health center
Focus: Onsite Health Center
  • Rising healthcare costs drove the decision to open the health center.
  • In order to combat medical inflation, as well as increased utilization as our population ages, only a few options available:
  • 1.)  pass more costs to our employees  
  • 2.)  reduce the benefit levels (coverage)  or
  • 3.) get healthier.  
  • Opened the health center with the intent of driving our workforce to get healthier
major strategies
Major Strategies
  • Onsite Health Center opened June 2009.
  • Offered acute care and prevention/disease mgmt.
  • HRA and biometric campaign kicked off the opening of the health center with a >99% employee participation.
  • Employees can receive:
    • allergy shots, flu shots, travel shots, physicals, and labwork can be drawn. Spouses on the medical plan will be eligible to use services on 1/1/2011
  • Implemented an intensive weight management and nutrition program
major results
Major Results
  • As of June 2010, almost 50% of the Austin employees had scheduled a unique visit to the health center - excluding flu shots and biometrics.
  • 30 employees graduated from the Weight Management and Nutrition Program this year.
  • Smoking Cessation program just began in 2010.
major results nutrition
Major Results - Nutrition
  • Nutrition program called Healthy Eating Every Day (HEED).
  • Twenty weeks long
  • HEED was developed by the Cooper Institute and facilitators must be certified through Cooper.  Health related data from the most recent class of 14 HEED grads:
  • 131 lbs. lost
  • 68% body fat lost
  • 72.85 inches lost (combined in waist and hip!) -213 total cholesterol points lowered-60 LDL points lowered
  • HDL increased by 128 (good cholesterol)
  • 358 triglycerides points lowered
  • Systolic blood pressure dropped by 97 points
  • Diastolic blood pressure dropped by 192 points
next steps
Next Steps
  • Will conduct a follow up survey of the cohort group to compare the new biometric results.
  • Considering instituting a Tobacco Free Campus by 2012.
  • Chris LaMour│Manager of Compensation and Benefits│National Instruments││Phone: 512.683.8157
the community guide tobacco use
The Community Guide: Tobacco Use

The Task Force on Community Preventive Services recommends:

1) smoke-free policies based on sufficient evidence of effectiveness in reducing tobacco use among workers.

2) worksite-based incentives and competitions when combined with additional interventions to support individual cessation efforts based on sufficient evidence of effectiveness in reducing tobacco use among workers.

austin area company
Austin Area Company
  • Large company with local, state, national and international locations
focus tobacco use
Focus: Tobacco Use
  • Rising healthcare costs
  • Rising facility maintenance costs
  • Provide a supportive healthy environment for workers and customers
cost of tobacco use
Cost of Tobacco Use

Estimated annual EXCESS cost per smoker $3,487 (health and productivity :

  • Smoke breaks $749
    • 10 minutes per day more than non-smokers (Source: Study by Hapren and Rentz) multiplied by the national average hourly wage $17.22 (Source: Bureau of Labor Statistics)
  • Absences $413
    • 2.5 days of additional absences (Source: Study by Hapren and Rentz) multiplied by national average hourly wage of $17.22. (Source: Bureau of Labor Statistics)
  • Health care increase $2,325 (Source: Center for Disease Control, converted from 1998 to 2007 dollars)
  • ACTUAL COMPANY cost difference $500/year in Medical & Rx only. (Source: Analysis of COMPANY data, 2008).

Smoke-free workplaces decrease average daily cigarette consumption among smokers by 3.1 according to 26 studies cited by Johns Hopkins.

Tobacco-free environments help ex-smokers by eliminating cues to smoke and reduces smoking prevalence by 3.8% according to 26 studies cited by Johns Hopkins. According to a report by Phillip Morris, smokers with smoke-free workplaces have an 84% higher quit rate than average.

major strategies38
Major Strategies
  • 2004 – Initiated smoking cessation programs
  • 2008 – Initiated planning activities for Tobacco-free Campus
  • 2009 – Gathered employer/management planning group to develop Tobacco –free campus plan
    • Promotion of policy through website, blogs, company internal news releases
    • No cost smoking cessation classes available
    • Three month supply of generic Wellbutrin
    • Health Rewards Account funds available to purchase quit aids
  • 2010 – January 1 TFC policy in place
major results39
Major Results
  • 2004 – 2008 – workers self-reporting tobacco use around 11-12% (annual HRA)
  • 2010 – workers self-reporting tobacco use around 3% (annual HRA)
the community guide41
The Community Guide

The Task Force on Community Preventive Services recommends worksite programs intended to improve diet and/or physical activity behaviors based on strong evidence of their effectiveness for reducing weight among employees.

the community guide diabetes prevention and control
The Community Guide: Diabetes Prevention and Control

The Task Force on Community Preventive Services recommends that diabetes self-management education (DSME) interventions be implemented in:

Community gathering places on the basis of sufficient evidence of effectiveness in improving glycemic control for adults with Type 2 diabetes

Homes of children and adolescents who have Type 1 diabetes on the basis of sufficient evidence of effectiveness in improving glycemic control among adolescents with Type 1 diabetes

a century of h e b
A Century of H-E-B
  • Innovative retailer known for low prices, fresh food, quality, and convenience







in Texas

& Mexico




  • Largest privately held company in Texas
  • Over $15 Billion in Annual Sales
  • Helping the Community and the Environment
estimated adult obesity attributable medical expenditures 2003 dollars in millions
Estimated Adult Obesity-Attributable Medical Expenditures (2003 dollars in millions)

Finkelstein EA., Fiebelkorn IC, Wang G. State-level estimates of annual medical expenditures attributable to obesity. Obes Res. 2004; 12: 18-24.

data analysis key findings
Data Analysis: Key Findings
  • Diabetic Therapy
    • Rx Cost Driver
    • Medical Cost Driver
  • Total healthcare costs for diabetics
    • Increased 19.43%
    • 2 ½ times the average cost of all other plan members combined



Diabetes is major driver of healthcare costs at H-E-B

partner lifestyle risk factors
Partner Lifestyle Risk Factors

Root cause of obesity is nutrition and lack of exercise!


From 2004 Results:

Physical Activity

was 90%, Fruit/Vegetable Intake was 92%,

Fat Intake was 34%

partner clinical risk factors
Partner Clinical Risk Factors



have 3 out of 5 risk factors =


Our Diabetic “pipeline” continues to grow

We will be left with costs that surpasses income

engagement makes a difference
Engagement Makes a Difference

Even High Risk Partners use 51% LESS Health Care than

Partners Who Do Not Participate in Healthy at H-E-B





Risk Status

Non-Participant In H@H

recommendations evidence based plan design
Recommendations-Evidence Based Plan Design
  • Enroll all Diabetics in H-E-B’s Disease Management Program
  • Initiate personal coaching at H-E-B’s in-store pharmacies to help members with diabetes GET and STAY in control of their disease.
  • Remove financial barriers (Rx co pays) to increase Rx compliance.
recommendations evidence based plan design53
Recommendations-Evidence Based Plan Design
  • Provide “other” financial incentives to Partners to encourage participation (i.e., premium savings, free tools/resources)
  • Communicate with physicians the value of aggressive treatment algorithms
  • Develop a culturally sensitive, company wide education program to help educate the workforce on diabetes
initial financial goals 2008 2009
Initial Financial Goals 2008-2009
  • Reduce PMPY cost for diabetic members to less than $4,000
  • Estimated savings to H-E-B would be approximately $3.5 million



2008 evidence based plan design changes
2008 Evidence Based Plan Design Changes
  • Enroll in Refill Express to encourage Prescription therapy compliance
  • Continue 100% coverage for Preventive benefits
financial results outcomes and savings impact
Financial ResultsOutcomes and Savings Impact



for 2008

contact information
Contact Information

Kathy Durbin

H-E-B Benefits Design

Office: 210-938-8504


  • Leadership and learning are indispensable to each other. John F. Kennedy
  • Management is doing things right; leadership is doing the right things. Peter Drucker
  • Example is leadership. Albert Schweitzer

Jennifer Smith, MSHP

Chief Public Health Officer

2600 McHale Court, Suite 100

Austin, Texas 78758