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Fixin' Healthcare

Wednesday, March 08, 2006

The Lifestyle Chronicles - NGA Wellness Where We Work - State Initiatives

Previous posts have introduced and outlined the National Governors Association Healthy America initiative that was launched the weekend of February 25-26 at their winter meeting in Washington DC. Healthy America is supported by materials prepared by the Health Division of the National Governors Association Center for Best Practices.

Specific projects by states address each of the action items for governors. The list of projects is derived from materials supplied by the NGA Center for Best Practices. A project is listed only once even though it might apply to more than one action item. It is not a comprehensive list but it is representative. I hope you will be impressed with the momentum that is building at the state and local level to promote healthy lifestyles and prevent disease. The governors deserve our encouragement and support.

Worksite wellness programs have demonstrated the potential to save millions of dollars in direct costs. Johnson Johnson's Healthy People Program estimates it saves $9 to 10 million annually from reduced medical untilization and lower administrative expenses. Citibank's comprehensive health management program saves $4.56 to $4.73 in reduced health care costs for every dollar invested in programming. Union Pacific Railroad's medical self-care program saves $2.78 for every dollar invested by reducing inappeopriate emergency room and outpatient visits.

Indirect costs of poor health can be two to three times the cost of direct medical expenditures. One review found indirect savings through reduced absenteeism and other health care costs resulting from worksite health promotion programs amounted to $3.50 for every dollar invested. Another review concluded that worksite health promotion programs, on average, realized a 28 percent reduction in absenteeism, a 26 percent reduction in health costs, a 30 percent reduction in workers' compensation and disability management claims costs, and a reported savings of $5.93 for every dollar invested.

Another concept of the total cost burden of poor health is "presenteeism", which refers to diminished on-the-job performance due to health-related problem(s). Unmanaged health issues such as allergies, depression, diabetes and asthma can significantly impair productivity when viewed cumulatively across an employee population.

A comprehensive wellness program consisting of health benefits, supportive workplace environment and personal accountability can improve employees' health management. Arkansas. North Carolina, Ohio and Virginia are examples of the few states offering more comprehensive models including data management, health risk assessment, risk reduction interventions, medical consumerism and disease management.

Wellness Where We Work - Actions For Governors
Action 1:
Implement a yearly health risk assessment for all state employees.
  • Arkansas Governor Mile Huckabee implemented a risk assessment program for employees and reduced insurance premiums $10 monthly for those who participated. Additional discounts are offered for adopting healthy lifestyles. Since beginning the program in 2004, 50% of the state's workforce have participated.
  • Delaware Governor Ruth Ann Minner launched in 2003 the Health Rewards pilot study programs for state employees. Those enrolled in group health insurance programs were offered comprehensive health assessments, guidance and fitness prescriptions. Delaware realized more than $62,000 in immediate savings for the first 100 participants in the study.
  • In Nevada, the Washoe County School District developed a wellness program with strong union support. Annually, each employee must submit a health assessment. Staff and retirees who do not submit their annual assessment contribute $40 per month to the wellness program. Employees must contribute an additional $10 monthly for each of their risk factors (e.g., smoking, obesity). Conversely, there are incentives for achieving health goals. Union leadership, employees and senior management have all been enthusiastic partners and participants in this effort. The program has been essentially self-funded by the incentive structure.
Action 2: Improve the "health" of state workplaces.
  • Governor Mike Rounds initiated Healthy South Dakota that includes worksite-based policy changes such as smoke-free buildings and contributions to the health savings accounts of employees who enroll in the wellness program.
  • The Centers for Disease Control and Prevention (CDC) piloted a worksite wellness initiative-called StairWELL to Better Health-that encourages employees to use the stairs rather than the elevators. The stairwells in the pilot building were carpeted and painted, and music was played during business hours. Small signs about the value of exercise were placed next to the elevators to encourage stair use. Most of these improvements were relatively low cost and the stair use greatly increased.
  • Some states have instituted health and safety policies to encourage better health. For example, Arkansas and Wisconsin have banned smoking near or within srate office buildings.
Action 3: Provide access to health caoching and other preventive services for state employees and retirees.
  • North Carolina Governor Mike Easley's HealthSmart program is built on the success of local pilot programs for disease management and wellness that identified employees with particular conditions and provide them with intensive health coaching on lifestyle changes and clinical disease management. From the local pilots state employees annually saved $22.5 million. Based upon those results, Governor Easley expanded the program to all employees in 2005.
  • The City of Asheville, North Carolina initiated a diabetes management program that demonstrated improvement in controlling blood glucose levels; reduced direct medical costs and sick time; and showed $18,000 annual increase in productivity per employee with diabetes.
  • Microsoft has conducted a number of programs to improve wellness among employees, including a coaching program for employees with a high BMI. The company also supports access to preventive services by charging no co-pays or deductibles for their use.
Action 4: Raise employee awareness and employee participation in worksite wellness programs.
  • Under INShape Indiana, a comprehensive campaign to increase Hoosier wellness, Governor Mitch Damiels started an INnovators awards program to identify the "fittest" organization in the state. Governor Daniels will personally present awards to outstanding small, medium and large employers.
  • Arizona Governor Janet Napolitano's Council on Health, Physical Fitness and Sports has raised the visibility of employee wellness throughout the state by awarding public, private and tribal organizations for successful contributions that improved health, fitness or recreation for all Arizona residents.
  • Employees of the state of South Dakota receive $100 wellness incentive if they attain a personal health goal and $50 for participating in a health assessment.
  • Some of the most popular state-sponsored programs encourages walking. Arkansas, Michigan, West Virginia and Virginia encourage physical activity through pedometer programs. Kentucky, New Mexico and Ohio encourage walking through statewide challenges and special events.
  • The Work Well Program in Utah encourages state employees to exercise through a policy allowing workers 30 minutes of exercise, three days per week.
  • South Carolina and Georgia have publically encouraged state health challenges.
  • Michigan and Virginia provide walking trails for state employees around state campuses.
Action 5: Form coalitions and advisory groups across the public and private sectors.
  • Oklahoma Governor Brad Henry uses an employee benefits council to guide benefit decisions for 36,000 active state employees. Representing the concerns and interests of state employees, the council has introduced incentive programs for employees to participate in physical activity and wellness check-ups.
The next posting will address state initiatives for Wellness Where We Learn.

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